Endovascular treatment of unruptured intracranial aneurysms with Guglielmi detachable coils: short- and long-term results of a single-centre series.
OBJECTIVE
Purpose of the present study is to evaluate the clinical outcome of endovascular treatment of unruptured intracranial aneurysms and to address the question of long-term stability and protection against future subarachnoid hemorrhage.


METHODS
Retrospective analysis of all patients treated in a 12-year period (173 patients: age 26 to 76 yr, mean 52.2+/-10.8/202 aneurysms: size 3 to 50 mm, mean 10.0+/-8.3).


RESULTS
The mortality was 0.5%; the overall morbidity was 3.5%. The most frequent complications were thromboembolic events (10.9%). Of these, 3.0% of patients suffered a stroke, leading to severe disability in 1 patient (0.5%). In 1 patient, the aneurysm ruptured during treatment, resulting in relevant neurological disability. Another patient suffered a fatal aneurysm rupture hours after treatment. The occlusion rate depended on aneurysm and neck size. Follow-up angiography revealed a decrease of the occlusion rate over time. This trend was obvious in all size categories and was most pronounced in giant aneurysms. In 3 patients (1.5%) with partially thrombosed giant aneurysms of the posterior circulation, embolization could not prevent later aneurysm rupture. There were no ruptures of any other aneurysms in the follow-up period (3.7+/-3.4 yr).


CONCLUSIONS
Endovascular treatment is a highly safe procedure with low intervention-related morbidity and mortality. Long-term data for nongiant aneurysms showed good protection against rupture in the observation period. In contrast, the risk of rupture for giant aneurysms of the posterior circulation was as high as expected in observational studies.
Standhardt
Harald
H
Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. harald.standhardt@meduniwien.ac.at
Boecher-Schwarz
Hans
H
Gruber
Andreas
A
Benesch
Thomas
T
Knosp
Engelbert
E
Bavinzski
Gerhard
G
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000209:etiology / Q000401:mortality; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome