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AJNR - American Journal of Neuroradiology

Publication Preview: Published October 9, 2007

American Journal of Neuroradiology 2008;29:63.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0757

INTERVENTIONAL

Feasibility, Procedural Morbidity and Mortality, and Long-Term Follow-Up of Endovascular Treatment of 321 Unruptured Aneurysms

S. Gallas, J. Drouineau, J. Gabrillargues, A. Pasco, C. Cognard, L. Pierot and D. Herbreteau

From the Department of Neuroradiology (S.G., L.P.) Hospitalier Universitaire Maison Blanche, Reims, France; Department of Radiology A (J.D.), Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Department of Radiology (J.G.), Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France; Department of Radiology (A.P.), Centre Hospitalier Universitaire d'Angers, Angers, France; Departments of Neuroradiology (C.C.), Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France; and Department of Neuroradiology (D.H.), Centre Hospitalier de Tours, Tours, France.

Please address correspondence to Sophie Gallas, MD, Department of Neuroradiology, Centre Hospitalier Universitaire Maison Blanche, 45 rue Cognacq-Jay, 51100 Reims cedex France; e-mail: sgallas{at}chu-reims.fr

BACKGROUND AND PURPOSE: The purpose of our study was to evaluate the technical feasibility, morbidity and mortality, and durability of occlusion of unruptured aneurysms treated with Guglielmi detachable coils (GDCs) with a long-term follow-up.

MATERIALS AND METHODS: Between January 1998 and January 2005, we treated 321 unruptured aneurysms with GDCs in 5 neuroradiologic institutions. During this period, 63% of unruptured aneurysms were treated by endovascular technique. Procedural feasibility, technical complications, morbidity and mortality, and acute and long-term angiographic occlusion were assessed.

RESULTS: Overall technical feasibility of coiling treatment was 94%; 302 aneurysms were treated by endovascular technique. At the end of the initial procedure, acute occlusion was classified as complete in 207 cases (70%), subtotal in 84 cases (26.1%), and incomplete in 11 cases (3.9%). Ischemic complications were observed in 28 patients (9%); 8 patients (2.6%) had perforation of their aneurysms. Treatment-related morbidity was 14.4%, and morbidity with clinical complications was evaluated at 7.7% (n = 23 patients). Five patients (1.7%) died as a result of aneurysm perforation. Final follow-up angiograms, after 9 secondary treatments, demonstrated complete occlusion in 193 patients (69.5%), subtotal in 80 aneurysms (28.5%), and incomplete occlusion in 5 (1.8%). Nineteen patients were lost to follow-up (6.3%).

CONCLUSION: Endovascular coiling with detachable coils is an attractive option for treatment of unruptured aneurysms. This method of treatment is safe with a low rate of complications. Prospective studies with longer follow-up periods are needed to assess the long-term durability of occlusion in unruptured aneurysms.