Endovascular treatment of ruptured intracranial aneurysms

Abstract The Guglielmi detachable coil (GDC) is an important tool for the treatment of ruptured intracranial aneuryms by an endovascular approach. This new device may be introduced under fluoroscopy into the aneurysmal sac through a microcatheter. When the coil is judged well positioned, it can be detached with accuracy by electrolytic breakdown. The procedure is completed when a dense coil packing is obtained. When vasospasm is present, papaverin infusion or angioplasty may be used by the endovascular approach as well. Best results are achieved in cases of small aneurysm with small neck. The morbidity and mortality rates in the first 200 patients treated by GDC for a ruptured intracranial aneurysm were 4% and 1.5%, respectively. Complications are generally related to rupture of the malformation by the endovascular device or to thromboembolic events. Despite these promising results, further studies using larger numbers of patients are required to determine the exact role of these procedures in patient care.

[1]  B Richling,et al.  Early Clinical Outcome of Patients with Ruptured Cerebral Aneurysms Treated by Endovascular (GDC) or Microsurgical Techniques , 1995, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[2]  V. Zelman,et al.  Management of intraoperative rupture of aneurysm without hypotension. , 1991, Neurosurgery.

[3]  A. Molyneux,et al.  Endosaccular treatment of inoperable intracranial aneurysms with platinum coils. , 1995, British journal of neurosurgery.

[4]  H. Winn,et al.  Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. , 1989, Journal of neurosurgery.

[5]  H. Adams,et al.  The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. , 1990, Journal of neurosurgery.

[6]  F Viñuela,et al.  Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. , 1992, Journal of neurosurgery.

[7]  J. Dion,et al.  Technical considerations on intra-arterial papaverine hydrochloride for cerebral vasospasm , 1997, Neuroradiology.

[8]  G. Guglielmi.  The GDC System in the Treatment of Intracranial Aneurysms , 1996 .

[9]  Carotid-cavernous fistula caused by a ruptured intracavernous aneurysm: endovascular treatment by electrothrombosis with detachable coils. , 1992 .

[10]  H. Winn,et al.  The natural history of aneurysms and arteriovenous malformations. , 1985, Journal of neurosurgery.

[11]  D. Roy,et al.  Role of angioplasty in the treatment of symptomatic vascular spasm occurring in the post-operative course of intracranial ruptured aneurysms. , 1990, Journal of neuroradiology. Journal de neuroradiologie.

[12]  G. Duckwiler,et al.  Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. , 1991, Journal of neurosurgery.

[13]  S. Peerless,et al.  Giant unclippable aneurysms: treatment with detachable balloons. , 1981, AJNR. American journal of neuroradiology.

[14]  F Viñuela,et al.  Intracranial aneurysms. Guglielmi electrothrombotic coils. , 1994, Neurosurgery clinics of North America.

[15]  N. Kassell,et al.  Treatment of cerebral vasospasm with intra-arterial papaverine. , 1992, Journal of neurosurgery.

[16]  R. Holgate,et al.  Intracranial angioplasty for treatment of vasospasm after subarachnoid hemorrhage: technique and modifications to improve branch access. , 1990, AJNR. American journal of neuroradiology.

[17]  David S. Smith,et al.  Superselective intra‐arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. , 1993 .

[18]  R. Higashida,et al.  Intracranial aneurysms: interventional neurovascular treatment with detachable balloons--results in 215 cases. , 1991, Radiology.

[19]  G. Duckwiler,et al.  Carotid-cavernous fistula caused by a ruptured intracavernous aneurysm: endovascular treatment by electrothrombosis with detachable coils. , 1992, Neurosurgery.

[20]  H. Adams,et al.  The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. , 1990, Journal of neurosurgery.

[21]  J. Hodes,et al.  Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. , 1993, Journal of neurosurgery.

[22]  L. Pierot,et al.  Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. , 1996, Neurosurgery.

[23]  V. Macellari,et al.  Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. , 1991, Journal of neurosurgery.

[24]  R. Higashida,et al.  Transluminal angioplasty for treatment of intracranial arterial vasospasm. , 1989, Journal of neurosurgery.