Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms.
OBJECTIVE
To report morbidity, mortality, and angiographic results of elective coiling of unruptured intracranial aneurysms.


METHODS
In a 10-year period, 176 unruptured aneurysms in 149 patients were electively treated with detachable coils. Seventy-nine aneurysms were additional to another ruptured aneurysm but were coiled more than 3 months after subarachnoid hemorrhage, 59 aneurysms were incidentally discovered, and 38 aneurysms presented with symptoms of mass effect. Mean size of the 176 unruptured aneurysms was 10.6 mm (median, 8 mm; range, 2-55 mm). One hundred thirteen aneurysms (64%) were small (<10 mm), 44 aneurysms (25%) were large (10-25 mm), and 19 aneurysms (11%) were giant (25-55 mm). Thirty wide-necked aneurysms (17%) were coiled with the aid of a supporting device.


RESULTS
Procedural mortality of coiling was 1.3% (2 of 149; 95% confidence interval [CI], 0.7-5.1%), and morbidity was 2.6% (4 of 149, 95% CI, 0.8-7.0%). The 4 patients with permanent morbidity were independent (GOS 4). Initial aneurysm occlusion was complete (100%) in 132 aneurysms, nearly complete (90%-98%) in 36 aneurysms, and incomplete (60%-85%) in 8 aneurysms. Six-month follow-up angiography was available in 132 patients with 154 coiled aneurysms (87.5%); partial reopening occurred in 25, mainly large and giant aneurysms (16.2%). Additional coiling was performed in 22 aneurysms and additional parent vessel occlusion in 1 aneurysm. There were no complications of additional treatments.


CONCLUSIONS
Elective coiling of unruptured intracranial aneurysms has low procedural mortality and morbidity. For the management of unruptured aneurysms, endovascular treatment should be considered.
van Rooij
W J
WJ
Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands. radiol@knmg.nl
Sluzewski
M
M
D000293:Adolescent; D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D001925:Brain Damage, Chronic / Q000401:mortality; D002533:Cerebral Angiography; D017558:Elective Surgical Procedures; D004621:Embolization, Therapeutic / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D033162:Incidental Findings; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome