doi: 10.1161/01.STR.0000031928.71695.A9
(Stroke. 2002;33:2509.)
© 2002 American Heart Association, Inc.
Progress Review |
Guglielmi Detachable Coil Embolization of Posterior Circulation Aneurysms
A Systematic Review of the Literature
From the Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, NY.
Correspondence to Alan P. Lozier, MD, Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, 710 W 168th St, New York, NY 10032. E-mail al466{at}columbia.edu
Background— Early multicenter trials of Guglielmi detachable coil embolization of posterior circulations aneurysms have been followed by the publication of numerous single-center experiences.
Summary of Review— We performed a MEDLINE literature search and extracted data from single-center reports containing at least 10 posterior circulation aneurysms. Twelve reports (495 aneurysms) were specific to the posterior circulation. Eighty-two percent of aneurysms arose near the basilar apex. Eighty-one percent of patients harbored unruptured aneurysms or presented in good clinical condition. Sixty-three percent of lesions were small, and 41% exhibited a narrow neck. Coil deposition was achieved in 97.6% of cases. Procedural complication and morbidity rates were 12.5% and 5.1%, respectively. Procedural and 30-day mortality rates were 1.4% and 6.7%, respectively. Complete aneurysm occlusion was achieved in 47.6%, near-complete occlusion (90% to 99%) in 43.4%, and incomplete occlusion in 9.0% of cases. There were a total of 52 recurrences (22.2%) in a subset of 234 evaluable patients. Ninety-two percent of these aneurysms exhibited wide necks. The annual risk of subarachnoid hemorrhage after embolization was 0.8%. Eighty-five percent of patients achieved functional independence, while only 5.3% lived dependent lifestyles. The overall mortality rate was 9.8%.
Conclusions— The published literature approximates a large series of basilar apex aneurysms. Embolization is moderately effective in completely excluding an aneurysm from the posterior circulation. The incidence of recurrence in wide-neck aneurysms and incompletely coiled aneurysms is substantial. Coil embolization is effective in preventing early rebleeding. Its role in the treatment of unruptured aneurysms remains unclear.
Key Words: aneurysm • basilar artery • embolization, therapeutic • subarachnoid hemorrhage
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