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Published on: January 18, 2018
Efficacy of endovascular therapy for direct occlusion of intracranial aneurysms
K Tamrakar1, B Karki, C Z Duan
1Department of Neurosurgery, Zhujiang Hospital, China.
Insights
Endovascular therapy effectively obliterates intracranial aneurysms, significantly reducing mortality and morbidity. This treatment offers a high rate of total occlusion, improving patient outcomes.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Intracranial aneurysms pose significant risks, including subarachnoid hemorrhage.
- Endovascular therapy has emerged as a key treatment modality.
Purpose of the Study:
- To evaluate the effectiveness of endovascular therapy using detachable coils and balloons for direct intracranial aneurysm occlusion.
Main Methods:
- Retrospective review of 563 patients undergoing digital subtraction angiography (DSA) from January 2007 to July 2009.
- Analysis of 323 embolized intracranial aneurysms in 250 patients.
Main Results:
- Total occlusion was achieved in 93% of aneurysms treated endovascularly.
- High rates of favorable Glasgow Outcome Scale (GOS) scores were observed post-treatment.
- Aneurysm recurrence rate was low (1.2%), with successful re-embolization.
Conclusions:
- Endovascular treatment is an effective method for obliterating intracranial aneurysms.
- This approach leads to decreased mortality and morbidity, particularly in patients with aneurysmal subarachnoid hemorrhage (SAH).
- Clinical grading (Hunt and Hess) and GOS are significant indicators of treatment outcomes.
Introduction:
Our purpose was to evaluate the effectiveness of endovascular therapy using detachable coils and balloons for the direct occlusion of intracranial aneurysms.
Methods:
We retrospectively reviewed 563 patients undergoing digital subtraction angiography from January 2007 to July 2009. Two hundred and fifty patients with 323 embolized intracranial aneurysms were studied.
Results:
Among 250 patients, 66 % were female and 34 % male, the age ranging from 19 - 83 years (mean 50.66 ± 12.92). One hundred and seventy-seven had a single aneurysm while 73 showed multiple aneurysms. Seventeen (9.6 %) had giant aneurysms. Three hundred and eleven aneurysms were treated using detachable coils, and 12 giant aneurysms were embolized by detachable balloons for the parent vessel occlusion. Of 323 aneurysms treated via the endovascular approach, total occlusion was seen in 93 % of the aneurysms, near total occlusion in 5.2 % and incomplete embolization in 1.5 %. Among patients presenting with sub-arachnoid hemorrhage, 62 improved to the Glasgow outcome score (GOS) of 5, 93 improved to GOS 4, 14 improved to GOS 3, 10 improved to GOS 2 at the time of discharge and 5 patients died. Angiographic follow-up was scheduled between 6 - 12 months post-embolization. The aneurysm recurred in 1.2 % and were re-embolized using additional coils. Statistically, Hunt and Hess Grade and GOS indicated clinical significance (P < 0.05). The patients, gender, clinical presentation and aneurysmal location did not show statistical significance (P > 0.05).
Conclusions:
Hunt and Hess VI and V are considered as poor clinical gradings in aneurysmal SAH. However, endovascular treatment has been established as an effective method to obliterate intracranial aneurysms allowing subsequent decrease in mortality and morbidity.
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