Embolization of Cerebral Aneurysms Using Guglielmi Detachable Coils —Problems and Treatment Plans in the Acute Stage after Subarachnoid Hemorrhage and Long-term Efficiency—

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

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Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199970030s224 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 118-120

Author(s):

H. Manabe ◽

S. Fujita ◽

K. Akasaka ◽

S. Suzuki

Keyword(s):

Cerebral Aneurysms ◽

Critical Factor ◽

Dissecting Aneurysm ◽

Acute Stage ◽

Saccular Aneurysm ◽

Long Term Results ◽

Complete Occlusion ◽

Detachable Coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.

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Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199030090s105 ◽

2003 ◽

Vol 9 (1_suppl) ◽

pp. 47-50 ◽

Cited By ~ 1

Author(s):

Y. Nakai ◽

M. Sonobe ◽

K. Sugita ◽

Y. Matsumaru

Keyword(s):

Morphological Changes ◽

Cerebral Aneurysms ◽

Guglielmi Detachable Coils ◽

Complete Occlusion ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Detachable Coils ◽

Aneurysm Occlusion

The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms. Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms. At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged. There were significant differences of the long-term angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.

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The Embolization of Ruptured Aneurysms in Acute Stage with Guglielmi Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199990050s135 ◽

1999 ◽

Vol 5 (1_suppl) ◽

pp. 191-193 ◽

Cited By ~ 3

Author(s):

Y. Matsumaru ◽

M. Sonobe ◽

R. Masuda ◽

M. Yasuda ◽

E. Hori ◽

...

Keyword(s):

Acute Stage ◽

Long Term Results ◽

Morbidity Rate ◽

Guglielmi Detachable Coils ◽

Ruptured Aneurysms ◽

Symptomatic Vasospasm ◽

Detachable Coils ◽

Promising Treatment ◽

Permanent Morbidity

We have treated 43 ruptured aneurysms in 42 patients with Guglielmi Detachable Coils (GDC) in acute period. Thirty-one patients (74%) were independent on discharge. Among the patients of Hunt and Hess Grade I, II and III, 27 patients (84%) were independent. Acute rerupture occurred in two elderly patients with insufficient embolization and another patient experienced rerupture 45 days after the embolization. Symptomatic vasospasm was reported in 16% of patients and its permanent morbidity rate resulted in 3.1%. Although the long term results remain to be determined, embolization with GDC is a safe and promising treatment for acutely ruptured aneurysms.

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Embolization of Ruptured Cerebral Aneurysms with GDC in Acute Stage

Interventional Neuroradiology ◽

10.1177/15910199980040s119 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 93-95

Author(s):

K. Onizuka ◽

M. Sonobe ◽

K. Sugita ◽

Y. Matsumaru ◽

S. Takahashi

Keyword(s):

Cerebral Aneurysms ◽

Acute Stage ◽

Guglielmi Detachable Coils ◽

Detachable Coils ◽

Occlusion Rate ◽

Primary Hemorrhage

21 cases of 22 ruptured cerebral aneurysms were treated in acute stage with Guglielmi detachable coils and the outcome was assesed. GDCs were placed intra-aneurysm for intra-aneurysmal occlusion. Cases: age 42–80 (mean; 59) y. o., 7 male and 14 female; 4, 6, 8 and 3 patients were categorized (Hunt and Hess) as grades 1, 2, 3 and 4 respectively. GDC embolization was performed within 24 hours of primary hemorrhage in 11 patients, within 2 to 3 days in 4 patients and 5 to 19 days in 6 patients. The occlusion rate was 100% in 7 ANs, more than 75% in 9 ANs and less than 75% in 6 ANs. There were 7 cases of complications, two coil deposits, one embolism and 4 reruptures.

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Early Clinical Outcome of Patients with Ruptured Cerebral Aneurysms Treated by Endovascular (GDC) or Microsurgical Techniques

Interventional Neuroradiology ◽

10.1177/159101999500100105 ◽

1995 ◽

Vol 1 (1) ◽

pp. 19-27 ◽

Cited By ~ 43

Author(s):

B. Richling ◽

G. Bavinzski ◽

C. Gross ◽

A. Gruber ◽

M. Killer

Keyword(s):

Clinical Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Guglielmi Detachable Coils ◽

Early Results ◽

Detachable Coils ◽

Vienna Medical School ◽

Microsurgical Techniques ◽

Short Time

Over the past 3.5 years 220 patients with aneurysmal subarachnoid hemorrhage were treated in the Department of Neurosurgery University of Vienna Medical School using either endovascular techniques (Guglielmi Detachable Coils) or open craniotomy with aneurysm clipping. A retrospective analysis was undertaken to assess whether any difference in outcome could be correlated with the treatment choice. The patients were stratified as to 1) Hunt and Hess grade at time of treatment, 2) method of treatment, and 3) clinical outcome at 2–4 weeks following treatment. The outcomes in this population of patients were consistent with recent published series regardless of whether the aneurysms were treated with microvascular surgery or endovascular surgery. There was a trend toward better outcome in a relatively small sub-group of patients presenting as Hunt and Hess grade III who were treated by the endovascular method. Guglielmi detachable coils have been available for a relatively short time, and although early results are promising, the ultimate long-term efficacy of the coils will have to be assessed.

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Intracranial aneurysms treated with Guglielmi detachable coils: long-term imaging follow-up with contrast-enhanced magnetic resonance angiography

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(08)79046-5 ◽

2008 ◽

Vol 2008 ◽

pp. 273-274

Author(s):

A.G. Osborn

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Intracranial Aneurysms ◽

Guglielmi Detachable Coils ◽

Contrast Enhanced ◽

Detachable Coils

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Clearance of Subarachnoid Clots after GDC Embolization for Acutely Ruptured Cerebral Aneurysm

Interventional Neuroradiology ◽

10.1177/15910199010070s108 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 57-60 ◽

Cited By ~ 2

Author(s):

S. Kobayashi ◽

A. Satoh ◽

Y. Koguchi ◽

M. Wada ◽

H. Tokunaga ◽

...

Keyword(s):

Cerebral Aneurysm ◽

Intrathecal Administration ◽

Acute Stage ◽

Guglielmi Detachable Coils ◽

Mortality And Morbidity ◽

Symptomatic Vasospasm ◽

Group 12 ◽

Cisternal Irrigation ◽

Detachable Coils ◽

Causes Of Mortality

It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery. Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage. The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly. GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.

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