Detachable coil embolisation of ruptured intracranial aneurysms: A single center study, a decade experience

• Published in: Clinical neurology and neurosurgery Vol. 111; no. 2; pp. 179 - 188
• Main Authors: Renowden, S.A, Beneš, V, Bradley, M, Molyneux, A.J
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.02.2009; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm treatment; Aneurysm, Ruptured - therapy; Aneurysms; Biological and medical sciences; Blood clots; Blood Vessel Prosthesis - statistics & numerical data; Cerebral Angiography; Clinical outcome; Coiling; Disabled Persons - statistics & numerical data; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Embolization, Therapeutic - mortality; Endovascular therapy; Feasibility Studies; Female; Humans; Intracranial Aneurysm - therapy; Male; Medical imaging; Medical sciences; Middle Aged; Neurology; Neurosurgery; Procedural complication; Rebleeding; Retreatment - methods; Retreatment - statistics & numerical data; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Treatment Outcome; United Kingdom; Veins & arteries; Young Adult; Clinical outcome; Procedural complication; Rebleeding; Endovascular therapy; Aneurysm treatment; Coiling; Nervous system diseases; Prognosis; Cardiovascular disease; Endovascular route; Cerebral disorder; Coil; Vascular disease; Treatment; intracranial aneurysm; Surgery; Central nervous system disease; Complication; Cerebrovascular disease
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2008.09.026

Abstract Objective The introduction of detachable coils revolutionised the management of patients with intracranial aneurysms and is now considered a first-line treatment in our institution. The purpose of this study was to review 10 years of experience with this method. Methods A retrospective review of prospectively collected data on 711 patients undergoing endovascular treatment of ruptured intracranial aneurysm between 1996 and 2005 with regard to technical feasibility, procedural complications, rebleeding, anatomical outcome, need for retreatment and overall clinical outcome. Results Endovascular treatment failed in 25 aneurysms from a total of 717 (4%). Aneurysm rupture complicated 37 procedures (4.7%) leaving 10 patients permanently disabled or dead (1.3%). Thromboembolic events complicated 35 procedures (4.5%) leaving 8 patients permanently disabled or dead (1%). One other patient died because of fatal parent vessel rupture. Further 6 procedures were complicated by arterial dissection and 18 by coil loop protrusion, however all of these patients achieved independent recovery. Overall morbidity–mortality was 2.9%. Further subarachnoid heamorrhage occurred in 16 patients (2.3%), 12 of which died. Altogether, 121 aneurysms from 511 (24%) were recanalized on follow up angiography, 52 required retreatment (7.1%). At 6 months follow up, 580 patients (82%) were independent, while 130 patients (18%) were disabled or dead. Conclusion Detachable coil embolisation of intracranial aneurysms is a very feasible treatment method associated with a small risk of permanent morbidity–mortality. Risk of further bleeding is small, but related with devastating outcome. Approximately 25% of aneurysms will recanalize and 7% will require retreatment. Despite these shortcomings, vast majority of patients will achieve independent recovery.