Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series

Mejdoubi, Mehdi; Gigaud, M.; Trémoulet, M; Albucher, Jean‐François; Cognard, Christophe

doi:10.1007/s00234-006-0144-6

Cited by 12 publications

(4 citation statements)

References 23 publications

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“…A good clinical result (mRS0-1) was assessed in 77.3% of the interviewed patients (130/168), a disabling neurological deficit (mRS2-3) was observed in 11.3% (19/168) and a prolonged hospitalisation (mRS4-5) in 7.7% (13/168). These data are in agreement with those in literature: mRS0-2 is reported in 75-88% (79% in our experience) and mRS3-6 in 16-25% (21% in our experience) 16,[21][22][23][24] . despite the retrospective nature of our study, long-term clinical follow-up was possible in 88,8% of discharged patients (168/189).…”

Section: Safety and Efficacy Of The Proceduressupporting

confidence: 93%

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

et al. 2012

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Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0–1), 8.9% died and the remainder showed moderate-severe disability (mRS2–3). The long-term stability of the anatomical result is a critical issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient.

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Section: Safety and Efficacy Of The Proceduressupporting

confidence: 93%

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

et al. 2012

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“…16,27,28 With the clinical questionnaire or telephone interviews, we found an mRS score of 0 to 2 in 87.9% and an mRS score of 3 to 6 in 12.1% of patients. In other series, the Glasgow Outcome Scale (GOS) was used, and a GOS score of 4 to 5 (good recovery or moderately disabled) was found in 73.3% to 84.0% of patients (Table 4).…”

Section: Long-term Clinical Outcomementioning

confidence: 85%

Intradural Saccular Aneurysms Treated by Guglielmi Detachable Bare Coils at a Single Institution Between 1993 and 2005

Holmin

Krings

Ozanne

et al. 2008

Stroke

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Background and Purpose-The aim of this study was to analyze the clinical results of Guglielmi detachable bare coil (GDC) embolization of intradural saccular aneurysms (AAs) at a single center and to relate the morphological results at various time points to the clinical situation. Methods-All intradural saccular AAs treated with GDCs between 1993 and April 2005 were prospectively entered into a database completed by retrospective analysis of charts and images and a long-term clinical outcome questionnaire. In 413 consecutive patients, there were 466 treated AAs, of which 68.7% were ruptured and 31.1% were unruptured. Results-The periprocedural thromboembolic event rate, retreatment procedures included, was 5.4%, causing permanent neurologic deficits in 2.2% of patients. One patient (0.2%) bled during a meanϮSD clinical follow-up of 64.3Ϯ39.9 months (93 AAs were followed up for Ͼ8 years and 45 AAs were followed up for Ͼ10 years) for a total of 1810 patient-years. The modified Rankin Scale score was 0 in 54.7%, 1 in 21.0%, 2 in 12.1%, 3 in 7.1%, 4 in 2.1%, 5 in 0.3%, and 6 (death from unrelated causes) in 2.7% of patients. If an aneurysm, with or without a remnant, was unchanged for 12 months, then the risk for future morphological loss was 4.8%, whereas if an aneurysm showed a morphological loss during the earlier 12-month interval, the risk for additional late loss was 38.3% (PϽ0.001, odds ratioϭ12.4). Conclusions-Embolization of saccular AAs entails a prolonged management period. A stable angiographic result during a 12-month interval predicts a low risk for morphological deterioration. This regimen, aiming for a stable angiographic result rather than complete aneurysm occlusion, gives a low rebleed rate and excellent clinical long-term results. (Stroke.

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“…In all the treated aneurysms, there was complete occlusion achieved in 77.9% aneurysms and neck remnant in 18.5% aneurysms and aneurysm remnant in 3.6% aneurysms in our series. The ISAT revealed a complete occlusion rate of 66% (584 of 988) in the coiled patients, whereas other case series of ruptured coiled aneurysms revealed complete occlusion rates ranging from 33% to 81% [10,[32][33][34][35][36][37][38] [Table 9]. Therefore, our Gallas et al [32] 650/705 496 (72.6) 171 ( 25) 16 (2.4) Henkes et al [33] 1579/1811 1192 (65.8) 375 (20.7) 192 (10.7) Willinsky et al [34] 377/391 170 (43) 142 (36) 79 (20) Cerecyte trial [10] 63/67 33 (49) 14 ( 21) 20 (30) occlusion rates are comparable, if not better, then the previous results in spite of a large proportion of aneurysms treated preferentially by endovascular means in the ruptured state.…”

Section: Discussionmentioning

confidence: 99%

“…The ISAT revealed a complete occlusion rate of 66% (584 of 988) in the coiled patients, whereas other case series of ruptured coiled aneurysms revealed complete occlusion rates ranging from 33% to 81% [10,[32][33][34][35][36][37][38] [Table 9]. Therefore, our Gallas et al [32] 650/705 496 (72.6) 171 ( 25) 16 (2.4) Henkes et al [33] 1579/1811 1192 (65.8) 375 (20.7) 192 (10.7) Willinsky et al [34] 377/391 170 (43) 142 (36) 79 (20) Cerecyte trial [10] 63/67 33 (49) 14 ( 21) 20 (30) occlusion rates are comparable, if not better, then the previous results in spite of a large proportion of aneurysms treated preferentially by endovascular means in the ruptured state. This can be attributed to the vast technological advances as said before.…”

Section: Discussionmentioning

confidence: 99%

A decade after International Subarachnoid Aneurysm Trial: Coiling as a first choice treatment in the management of intracranial aneurysms - Technical feasibility and early management outcomes

Goel¹,

Gupta²,

Chinchure³

et al. 2014

Asian J Neurosurg

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Purpose:The technique of coiling has evolved in the last decade with evolution in both equipment and material. The preferable treatment of intracranial aneurysms at our center is endovascular coiling. We discuss the technical and management outcomes of consecutive patients treated with this approach and compare our results with a decade old International Subarachnoid Aneurysm Trial.Materials and Methods:Between January 2006 and November 2011, a total of 324 aneurysms in 304 consecutive patients were treated. Endovascular treatment was done in 308 aneurysms (95.0%) in 288 patients while 16 patients (5%) underwent surgical clipping. Of the 308 aneurysms treated endovascularly, 269 (87.3%) were ruptured, and 39 (12.7%) were unruptured aneurysms.Results:The endovascular coiling was feasible in all (99.6%) but 1 case. The immediate postoperative occlusion status was complete occlusion in 240 aneurysms (77.9%), neck remnant in 57 aneurysms (18.5%), and aneurysm remnant in 11 aneurysms (3.6%). Technical issues – with or without clinical effect–were encountered in 20 patients (6.9%). They included 18 thromboembolic events (6.2%) and intraprocedural aneurysmal rupture in 2 cases (0.7%). In “good grade” patients, H and H grade 1-3, a good outcome (modified Rankin score [mRS] 0-2) was in 87.6% patients while the bad outcome (mRS 3-5) was in 10.2% patients and mortality of 2.2%. In “bad grade” patients, H and H grade 3-5, a good outcome was in 29.2%, and bad outcome was in 41.7% patients with mortality was 29.1%. In the unruptured aneurysm group, the good outcome was seen in 97.7% and bad outcome in 2.3% with no mortality.Conclusions:In the current era, the favorable results of coiling demonstrated in previous studies may be applicable to the larger proportion of patients. In our series of consecutively treated patients using latest advances, such as three-dimensional imaging and the interventional material, endovascular management as first choice was feasible in 95% of patients with good technical and management outcomes.

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Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series

Abstract: This consecutive prospective series shows that EVT can be performed routinely as first-intention treatment in most aneurysmal SAH. Using this therapeutic strategy, EVT was performed in 82% of patients with long-term clinical results similar to those of the ISAT study.

Cited by 12 publications

References 23 publications

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

Intradural Saccular Aneurysms Treated by Guglielmi Detachable Bare Coils at a Single Institution Between 1993 and 2005

A decade after International Subarachnoid Aneurysm Trial: Coiling as a first choice treatment in the management of intracranial aneurysms - Technical feasibility and early management outcomes

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