title: Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes.
abstract: OBJECTIVE
  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 (chi(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.
authors.affiliation: Department of Radiology, Division of Interventional Neurovascular Radiology, University of California at San Francisco, 94143, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Lempert
authors.forename: A M
authors.initials: AM
authors.lastname: Malek
authors.forename: V V
authors.initials: VV
authors.lastname: Halbach
authors.forename: C C
authors.initials: CC
authors.lastname: Phatouros
authors.forename: P M
authors.initials: PM
authors.lastname: Meyers
authors.forename: C F
authors.initials: CF
authors.lastname: Dowd
authors.forename: R T
authors.initials: RT
authors.lastname: Higashida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D008670:Metals