Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils

Abstract

In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm. One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia. A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion. Overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III). It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.

Anesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery

“…[1][2][3][4][5] Initially, aneurysms that were surgically difficult to access, such as those situated in the posterior fossa, were treated by interventional neuroradiology (INR). 6 As well, patients with high-risk medical conditions may benefit from INR as they need not be subjected to the more invasive technique of surgery. 7 The most common endovascular treatment is by the insertion of Guglielmi detachable coils (GDC).…”

21 Endovascular Treatment of Posterior Circulation Aneurysms

“…The clinical outcome seems not to be associated with aneurysm size and location, as has been previously noted (Ogilvy and Carter 1998), in contrast to significant associations between aneurysm size and angiographic outcome (Guglielmi et al 1992;Fernandez Zubillaga et al 1994). In the multivariate model described above this association only held for the largest fundus dimension and a derived neck-tofundus ratio, which compares well with previously known results (Guglielmi et al 1992;Fernandez Zubillaga et al 1994).…”

Aneurysms of the Posterior Cerebral Artery: Retrospective Review of Surgical Treatment

“…Aneurysms of the posterior cerebral artery (PCA) are rare, accounting for about 0.7% to 2.3% of all intracranial aneurysms, 3,4,[6][7][8][9][10]19,21,25,27,31,36,38) mainly in the fourth decade. 30) PCA aneurysms mainly arise from the anterior portion of PCA, 36,38) and tend to form larger 5,30) and dissecting type of aneurysms.…”

“…23) PCA aneurysms can be treated by the direct approach which utilizes clipping of the aneurysm or the more recent indirect approach which utilizes coil embolization. 4,9,34) Here we review our experience with PCA aneurysms treated by direct surgery.…”