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Endovascular Occlusion of Basilar Bifurcation Aneurysms With Electrolytically Detachable Coils

Published online by Cambridge University Press:  02 December 2014

Gary Redekop
Affiliation:
Departments of Medical Imaging and Surgery, The Toronto Hospital, Toronto, Canada.
Robert Willinsky
Affiliation:
Departments of Medical Imaging and Surgery, The Toronto Hospital, Toronto, Canada.
Walter Montanera
Affiliation:
Departments of Medical Imaging and Surgery, The Toronto Hospital, Toronto, Canada.
Karel TerBrugge
Affiliation:
Departments of Medical Imaging and Surgery, The Toronto Hospital, Toronto, Canada.
Michael Tymianski
Affiliation:
Departments of Medical Imaging and Surgery, The Toronto Hospital, Toronto, Canada.
M. Christopher Wallace
Affiliation:
Departments of Medical Imaging and Surgery, The Toronto Hospital, Toronto, Canada.
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Abstract

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Object:

To describe the clinical and angiographic results of endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils, and to identify factors which should be considered in deciding upon surgical or endovascular treatment.

Methods:

We report our experience with 40 patients in whom occlusion of basilar bifurcation aneurysms with electrolytically detachable coils was attempted. All patients underwent superselective angiography and attempted embolization with Guglielmi detachable coils (GDCs). Angiographic and clinical results were prospectively recorded. Twenty-eight aneurysms presented with subarachnoid hemorrhage (SAH), 2 were symptomatic and 10 were incidental.

Results:

Coils were not placed in 10 patients (25%) because of unfavorable anatomy. Complete aneurysm occlusion was achieved at the time of the initial procedure in 13 (32.5%), small neck remnants were present in 13 (32.5%), and in 4 (10.0%) there was obvious residual contrast filling of the aneurysm body. Of 23 patients successfully coiled after SAH, 20 were Grade 1 to 3 and 3 were grade 4 or 5 at the time of treatment. Eighteen (78%) made a good recovery. Procedural mortality was 2.5% and permanent morbidity was 7.5%. There were no permanent complications in patients with unruptured aneurysms. Complete aneurysm occlusion was possible in 10 (56%) of 18 aneurysms with small necks and 3 (14%) of 22 with large necks. Follow-up angiography in 25 of 28 surviving patients (mean, 12 months) demonstrated stability of all completely occluded aneurysms. Incompletely coiled aneurysms had variable results on follow-up angiograms: 15.4% improved, 69.2% worsened, and 15.4% were stable. No aneurysm bled after treatment during clinical follow-up averaging 22 months.

Conclusion:

Endovascular treatment of basilar bifurcation aneurysms appears to prevent early aneurysm rebleeding with acceptable rates of morbidity and mortality, but long-term follow-up is required.

Résumé

RÉSUMÉ <span class='bold'> <span class='italic'>Sujet:</span> </span>

Nous décrivons les résultats cliniques et angiographiques de l’occlusion endovasculaire d’anévrismes de la bifurcation basilaire au moyen de spires électrolytiquement détachables et nous identifions les facteurs dont on devrait tenir compte dans le choix d’un traitement chirurgical ou endovasculaire.

<span class='italic'> <span class='bold'>Méthodes:</span> </span>

Nous rapportons notre expérience chez 40 patients chez qui une tentative d’occlusion d’anévrismes de la bifurcation basilaire au moyen de spires électrolytiquement détachables a été tentée. Tous les patients ont subi une angiographie supersélective et une tentative d’embolisation au moyen de spires détachables de Guglielmi. Les résultats angiographiques et cliniques ont été recueil- lis de façon prospective. Le mode de présentation chez 22 patients était celui d’une hémorragie sous-arachnoïdienne (HSA), 2 patients étaient sympto- matiques et il s’agissait d’une trouvaille fortuite chez 10 autres patients.

<span class='italic'> <span class='bold'>Résultats:</span> </span>

Une spire n’a pas été utilisée chez 10 patients (25%) parce que l’anatomie ne le permettait pas. Une occlusion complète de l’anévrisme a été obtenue au moment de la procédure initiale chez 13 patients (32.5%), un petit col résiduel était présent chez 13 (32.5%) et il existait un remplissage résiduel évident du corps anévrismal chez 4 (10.0%). Parmi les 23 patients chez qui l’intervention a été un succès, 20 étaient de grade 1 à 3 et 3 étaient de grade 4 ou 5 au moment du traitement. Dix-huit (78%) ont bien récupéré. La mortalité attribuable à l’intervention a été de 2.5% et la morbidité permanente a été de 7.5%. Il n’y a pas eu de complication permanente chez les patients ayant un anévrisme non rupturé. Une occlusion complète de l’anévrisme a été possible chez 10 des 18 patients (56%) dont l’anévrisme avait un col étroit et chez 3 des 22 patients (14%) dont l’anévrisme avait un col large. Une angiographie de contrôle chez 25 des 28 patients survivants, faite en moyenne à 12 mois de suivi, a démontré la stabilité de tous les anévrismes complètement occlus. Quand l’occlusion était incomplète, les résultats étaient variables à l’angiographie de contrôle: 15.4% étaient améliorés, 69.2% avaient empiré et 15.4% étaient stables. Aucun anévrisme n’a saigné après le traitement au cours d’un suivi clinique moyen de 22 mois.

<span class='italic'> <span class='bold'>Conclusions:</span> </span>

Le traitement endovasculaire des anévrismes de la bifurcation basilaire sem- ble prévenir une récidive précoce du saignement avec des taux de morbidité et de mortalité acceptables. Un suivi à long terme déterminera l’efficacité de l’occlusion partielle et complète par une spire quant à la stabilité anatomique et à la prévention d’hémorragies tardives.

Type
Research Article
Copyright
Copyright © The Canadian Journal of Neurological 1999

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