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01-04-2007 | Original Article

Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center

Authors: G. B. Bradac, M. Bergui, G. Stura, M. Fontanella, D. Daniele, L. Gozzoli, M. Berardino, A. Ducati

Published in: Neurosurgical Review | Issue 2/2007

Abstract

Despite increasing experience and improved material, endovascular treatment of cerebral aneurysms still has risks linked to the technique itself and to the specificity of the pathology treated. The purpose of this report is to examine procedural technical and clinical negative events, even minimal ones, occurring in this type of treatment. We considered 557 procedures carried out from January 1994 to December 2005 in 533 patients harboring 550 aneurysms. Of the patients, 448 presented with SAH and 85 with unruptured aneurysms. All procedures were performed under general anesthesia. The GDC-10 system was routinely used. Additional devices like the balloon remodeling technique, Trispan and stents were also occasionally used. Every procedural complication occurring during or soon after treatment was registered. Endovascular treatment was completed in 539 out of 557 procedures. There were 18 failures (3.3%). Occlusion of the aneurysm was judged complete in 343 (64%), near complete in 184 (34%) and incomplete in 12 (2%). Procedural complications occurred in 72 (13%) of the cases. The most frequent negative events were thromboembolisms (6.6%) and ruptures (3.9%). Other types (coil migration, transient occlusions of the parent vessel, dissections and early rebleeding) were rarer (2.5%). In the majority of cases there were no clinical consequences. Procedural morbidity and mortality were 1.1 and 1.8%, respectively. Considering the 449 procedures performed in ruptured and the 90 in the unruptured aneurysms separately, morbidity and mortality were 1.1 and 2.2% in the former group and 1.1 and 0% in the latter. Many factors influence the risk of complications. Being progressively aware of this and with increasing experience, the frequency can be limited. Negative events linked to the procedure have more significant serious clinical consequences in patients admitted in a critical clinical condition after SAH, because of the already present changes involving the brain parenchyma and cerebral circulation.

Batista LL, Mahadevan J, Sachet M et al (2002) Five year angiographic and clinical follow-up of coil-embolized intradural saccular aneurysms. A single centre experience. Interv Neurorad 8:349–366

Bendszus M, Koltzemburg M, Burger R (1999) Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospecytive study. Lancet 354:1594–1597PubMedCrossRef

Biondi A, Oppenheim C, Casasco A et al (200) Cerebral aneurysms treated by Guglielmi detachable coils: evaluation with diffusion weighted MR imaging. AJNR Am J Neuroradiol 21:957–963PubMed

Bradac GB, Bergui M, Fontanella M (2005) Endovascular treatment of cerebral aneurysms in elderly patients. Neuroradiology 47:938–941PubMedCrossRef

Byrne JV, Sohn MJ, Molineux AJ et al (1999) Five year experience in using coil embolization in ruptured intracranial aneurysms; outcome and incidence of late rebleeding. J Neurosurg 90:656–663PubMed

Cronquist M, Pierot L, Boulin A et al (1998) Local intracranial fibrinolysis of thromboemboli occurring during the endovascular treatment of intracranial aneurysms: comparison of anatomical results and clinical outcome. AJNR Am J Neuroradiol 19:157–165

Cronquist M, Wirestam R, Ramgren B et al (2005) Diffusion and perfusion MR in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome. Neuroradiology 47:855–873CrossRef

Derdeyn CP, De Witte T, Cross III, Moran Ch J et al (2002) Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 96:837–843PubMed

Eskridge JM, Song JK et al (1998) Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils. Results of the Food and Drug Administration multicentre clinical trial. J Neurosurg 89:81–86PubMed

10.

Friedman JA, Nichols DA, Meyer FB et al (2003) Guglielmi detachable coil treatment of ruptured saccular aneurysm: retrospective review of a 10 years single center experience. AJNR Am J Neuroradiol 24:526–533PubMed

11.

Gallas S, Pasco A, Cottier J Ph et al (2005) A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 26:1723–1731PubMed

12.

Groden C, Eckert B, Ries T et al (2003) Angiographic follow-up of vertebrobasilar artery aneurysms treated with detachable coils. Neuroradiology 45:435–440PubMedCrossRef

13.

Guglielmi G, Vinuela F, Dion J et al (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75:8–14PubMed

14.

Hadeishi H, Suzuki A, Yasui N et al (2002) Diffusion weighted magnetic resonance imaging in patients with subarachnoid haemorrhage. Neurosurgery 50:741–748PubMedCrossRef

15.

Henkes H, Fisher S, Weber W et al (2004) Endovascular coil occlusion of 1,811 intracranial aneurysms: early angiographical and clinical results. Neurosurgery 54:268–285PubMedCrossRef

16.

Henkes H, Fisher S, Mariushi W et al (2005) Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms. J Neurosurg 103:990–999PubMed

17.

Katz JM, Tsiouris AT, Biondi A et al (2005) Advances in endovascular aneurysms treatment: are we making a difference? Neuroradiology 47:695–701PubMedCrossRef

18.

Kole MK, Pelz DM, Kalapos P et al (2005) Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion. J Neurosurg 102:607–615PubMed

19.

Kuether TA, Nesbit GM, Barwell St L (1998) Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single center experience. Neurosurgery 43:1016–1023PubMedCrossRef

20.

Lempert TE, Malek AM, Van Halbach V et al (2000) Endovascular treatment of ruptured posterior circulation cerebral aneurysms: clinical and angiographic outcomes. Stroke 31:100–110PubMed

21.

Lozier AP, Connolly ES, Lavine SD et al (2002) Guglielmi detachable coils embolisation of posterior circulation aneurysms: a systemic rewiew of the literature. Stroke 33:2509–2518PubMedCrossRef

22.

Molineux A, Kerr R, Stratton I et al (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1167–1274

23.

Mont’alverne F, Mivacchio M, Tolentino V et al (2005) Endovascular management for intracranial ruptured aneurysms in elderly patients: outcome and technical aspects. Neuroradiology 47:446–457PubMedCrossRef

24.

Mordasini P, Schroth G, Guzman R et al (2005) Endovascular treatment of posterior circulation cerebral aneurysms by using Guglielmi detachable coils: a single center experience with special regard to technical development. AJNR Am J Neuroradiol 26:1732–1738PubMed

25.

Moret JJ, Cognard C, Weill A et al (1997) The ‘remodelling technique’ in the treatment of wide neck intracranial aneurysms. Interv Neuroradiol 3:21–35

26.

Murayama Y, Nien Yl, Duckwiller G et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966PubMedCrossRef

27.

Norback O, Gal G, Johansson M et al (2005) The establishment of endovascular aneurysm coiling at an endovascular unit: report of experience during early years. Neuroradiology 47:144–152PubMedCrossRef

28.

Park HK, Horowitz M, Jungreis C et al (2005) Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:506–514PubMed

29.

Raymond J, Roy D (1997) Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41:1235–1246PubMedCrossRef

30.

Pelz DM, Lownie SP, Fox AJ (1998) Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 19:1541–1547PubMed

31.

Ricolfi F, Le Guerinel C, Blustajn J et al (1998) Rupture during treatment of recently ruptured aneurysms with Guglielmi electro detachable coils. AJNR Am J Neuroradiol 19:1653–1658PubMed

32.

Rordorf G, Bellon RJ, Budzik RF et al (2001) Silent thromboeembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion weighted imaging. AJNR Am J Neuroradiol 22:5–10PubMed

33.

Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004PubMed

34.

Sluzewski M, Van Roij W, Rinkel GJE et al (2003) Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long term clinical and angiographic results. Radiology 227:720–724PubMed

35.

Soeda A, Sakai N, Sakai H et al (2003) Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion weighted MR imaging. AJNR Am J Neuroradiol 24:127–132PubMed

36.

Soeda A, Sakai N, Murao K et al (2003) Thromboembolic events associated with Guglielmi detachable coil embolization with use of diffusion weighted MR imaging. Part II: detection of microemboli proximal to cerebral aneurysms. AJNR Am J Neuroradiol 24:2035–2038PubMed

37.

Song JK, Niimi Y, Fernandez PM et al (2004) Thrombus formation during intracranial aneurysms coil placement: treatment with intra-arterial abcximab. AJNR Am J Neuroradiol 25:1147–1153PubMed

38.

Thornton J, Debrun GM, Aletich VA et al (2002) Follow up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:239–250PubMedCrossRef

39.

Tummala RP, Chu RM, Madison MT et al (2001) Outcomes after aneurysmal rupture during endovascular coil embolization. Neurosurgery 49:1059–1066PubMedCrossRef

40.

Valavanis A, Machado E, Chen JJ (1996) Aneurysm rupture during GDC treatment: Incidence, management and outcome. Neuroradiology 38(Suppl 2):45

41.

Vanninen R, Koivisto T, Vapalathi M (1999) Ruptured intracranial aneurysms. Acute endovascular treatment with electrolitically detachable coils—a prospective randomized study. Radiology 211:325–336PubMed

42.

Vinuela F, Duckwiler G, Mawad M et al (1997) Guglielmi detachable coil embolization of acute intracranial aneurysms: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482PubMedCrossRef

Title: Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center
Authors: G. B. Bradac
M. Bergui
G. Stura
M. Fontanella
D. Daniele
L. Gozzoli
M. Berardino
A. Ducati
Publication date: 01-04-2007
Publisher: Springer-Verlag
Published in: Neurosurgical Review / Issue 2/2007
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-006-0059-z

At a glance: The STEP trials

Springer Medicine

Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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