title: Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience.
abstract: OBJECTIVE
  We retrospectively analyzed our results with Guglielmi detachable coils (GDCs) for the endovascular occlusion of acutely ruptured saccular cerebral aneurysms over 10 years.
  
  
  METHODS
  Between 1991-2000, 83 patients (mean age, 56.1 years) with aneurysmal subarachnoid hemorrhage were treated with endovascular GDCs. Patients with aneurysms due to trauma or dissection and those with mycotic or fusiform aneurysms were excluded. Mean follow-up in survivors was 19.1 months, and the mean Hunt-Hess grade at admission was 2.2. Angiographic follow-up was performed in 93% of surviving patients (mean interval, 11.6 months). The basilar caput (34 patients) and anterior communicating artery complex (19 patients) were most commonly treated.
  
  
  RESULTS
  Sixty-four patients (77%) had a Glasgow Outcome Scale score (GOS) of 4 or 5, nine (11%) had a score of 2 or 3, and 10 (12%) died. At follow-up, 24 patients (35%) had complete aneurysm occlusion, 18 (26%) had a dog-ear remnant, 24 (35%) had a residual neck, and two (3%) had residual aneurysm filling. No treated aneurysm rebled. Three patients required surgical repair after incomplete endovascular treatment. Two or more GDC occlusion procedures were required in 28 patients (34%). Major procedural complications occurred in two patients (2%), resulting in serious neurologic disability or death.
  
  
  CONCLUSIONS
  Endovascular treatment of ruptured cerebral aneurysms with GDCs has low morbidity, and it facilitates good overall outcomes in patients after subarachnoid hemorrhage. The short-term effectiveness of GDC occlusion in preventing aneurysmal rebleeding was excellent. Durability of the treatment in preventing long-term rebleeding as compared with direct surgical clipping warrants further study. Advances in device technology and technique may improve future outcomes.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Friedman
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Nichols
authors.forename: Fredric B
authors.initials: FB
authors.lastname: Meyer
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pichelmann
authors.forename: Jon I
authors.initials: JI
authors.lastname: McIver
authors.forename: L Gerard
authors.initials: LG
authors.lastname: Toussaint
authors.forename: Patsy L
authors.initials: PL
authors.lastname: Axley
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging / Q000401:mortality; D002423:Cause of Death; D002533:Cerebral Angiography; D004185:Disability Evaluation; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015996:Survival Rate