title: Impact of Guglielmi detachable coils on outcomes of patients with intracranial aneurysms treated by a multidisciplinary team at a single institution.
abstract: OBJECTIVE
  The goal of this study was to investigate the impact of the introduction of the Guglielmi detachable coil (GDC) therapeutic option on the overall management outcome of intracranial aneurysms. The authors accomplished this by assessing patient morbidity and mortality, inflation-adjusted hospital charges, lengths of stay in the hospital and the intensive care unit (ICU), and treatment efficacy.
  
  
  METHODS
  The authors conducted a retrospective analysis of consecutive cases of intracranial intradural aneurysms managed by a single multidisciplinary neurovascular team at a tertiary care, academic referral center during the 24 months preceding the introduction of the GDC procedure (Group I or pre-GDC era, 77 patients) and during the first 24 months after its introduction (Group II or GDC era, 99 patients). Treatment with GDCs was considered for cases of higher clinical grade or poor surgical risk, or in response to patient preference (27 [27%] of 99 patients in Group II). Host and lesion parameters in our cohort were validated against outcome parameters by using univariate and multivariate analyses. The pre-GDC and GDC subgroups of patients were comparable for major disease severity parameters (patient age, lesion location, clinical grade, and hemorrhage severity). There was no significant difference in clinical outcome at 6 months, infarcts on computerized tomography scanning, or aneurysm obliteration rates before and after introduction of GDC treatment. Decreasing trends in duration of hospital and ICU stay and in inflation-adjusted hospital charges occurred well before and thus were unrelated to the introduction of the GDC therapeutic option.
  
  
  CONCLUSIONS
  The results of this study do not demonstrate any significant impact of integration of the GDC modality on clinical outcome, mortality, morbidity, or effectiveness of treatment. Ongoing improvements in hospital charges and length of hospital stay appeared unrelated to the introduction of the GDC option.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Sturaitis
authors.forename: J
authors.initials: J
authors.lastname: Rinne
authors.forename: J C
authors.initials: JC
authors.lastname: Chaloupka
authors.forename: M
authors.initials: M
authors.lastname: Kaynar
authors.forename: Z
authors.initials: Z
authors.lastname: Lin
authors.forename: I A
authors.initials: IA
authors.lastname: Awad
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000191:economics / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007362:Intensive Care Units; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome