Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment

To determine the types of aneurysm that may be treated endovascularly with platinum detachable coils.

Two hundred eight patients with 236 intracranial berry aneurysms underwent endovascular coil embolization; 150 patients had subarachnoid hemorrhage at the time of presentation.

Treatment was performed in 182 patients with 203 (86%) aneurysms (86%). Follow-up angiograms were obtained at 3 months in 160 cases of aneurysm. A second procedure was performed in 18 (11%) of these cases, and a third was performed in one case. Final follow-up results in 152 aneurysms demonstrated total occlusion in 123 (81%) cases, subtotal occlusion in 26 (17%) cases, and incomplete occlusion in three (2%) cases. All patients with subtotally occluded aneurysm were scheduled for later angiographic follow-up and any indicated repeat treatment. Technique-related morbidity rate was 4% (seven patients with permanent neurologic deficits due to clotting). Technique-related mortality rate was 2% (perioperative rupture in two, hematoma due to urokinase perfusion in one, rebleeding of the initial hematoma after excessive uncontrolled anticoagulation in one). Rebleeding occurred in one patient after incomplete occlusion.

Endovascular coil embolization seems to be a reliable technique, with good anatomic and clinical results, that provides protection against rebleeding of ruptured aneurysms.