(Stroke. 2000;31:100.)
© 2000 American Heart Association, Inc.
Original Contributions |
Endovascular Treatment of Ruptured Posterior Circulation Cerebral Aneurysms
Clinical and Angiographic Outcomes
From the Departments of Radiology, Division of Interventional Neurovascular Radiology (T.E.L., A.M.M., V.V.H., C.C.P., P.M.M., C.F.D., R.T.H.) and Neurosurgery (V.V.H., C.F.D., R.T.H.), University of California at San Francisco.
Correspondence to Adel M. Malek, MD, PhD, Division of Interventional Neurovascular Radiology, UCSF Medical Center, Room L-352, 505 Parnassus Ave, San Francisco, CA 94143. E-mail ammalek{at}bics.bwh.harvard.edu
Background and Purpose—We sought to describe the clinical outcome and angiographic results obtained in the endovascular therapy of ruptured posterior circulation cerebral aneurysms using Guglielmi detachable coils (GDC) over a 7-year period.
Methods—A retrospective analysis was performed of 112 patients evaluated at the University of California at San Francisco Medical Center between June 1991 and August 1998. The Hunt-Hess grade at presentation of treated patients was I in 26 patients (24%), II in 24 (22%), III in 27 (25%), IV in 24 (22%), and V in 8 (7%). Clinical follow-up for the total population was achieved in 104 of 109 patients (96%), with a mean duration of 13.1 months. Angiographic follow-up for the subset excluding parent vessel occlusion cases was obtained in 93% of cases, with a mean duration of 7.2 months.
Results—Technical success, defined as the ability to catheterize
and embolize the aneurysm with GDC, was achieved in 109
of 112 of cases (97%). The mean angiographic occlusion rate, or
projected area of the aneurysm occluded by the coils, for
all 110 successfully treated aneurysms was 94.6%. At latest
clinical follow-up, 81 of 109 patients (74%) achieved good recovery
with Glasgow Outcome Scale (GOS) score of I, 10 of 109 (9%) were
moderately (GOS II) and 5 of 109 (5%) were severely (GOS III)
disabled, 1 of 109 (1%) remained in a vegetative state (GOS IV), and
12 of 109 (11%) were dead. Of the subset of 77 patients with Hunt-Hess
grades I to III, 68 (88%) achieved a good clinical outcome (GOS I). A
statistically significant correlation was demonstrated between
Hunt-Hess grade at presentation and final GOS outcome score
(
2=41.4, P<0.0005). Procedure-related
permanent morbidity was 2.8% (3/109 patients). Repeated
hemorrhage was observed in a single patient (0.9%) with a
partially treated aneurysm.
Conclusions—The observed favorable outcome and low morbidity in this group of high-risk patients point to GDC embolization as an effective method for the endovascular management of patients with ruptured posterior circulation aneurysms.
Key Words: cerebral aneurysm • embolization, therapeutic • occlusion • outcome • subarachnoid hemorrhage
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