Saccular intracranial aneurysms: endovascular treatment with mechanical detachable spiral coils.

Abstract

In this relatively small group, endovascular treatment with mechanical detachable spiral coils had a success rate of 90%, and it appears to be a rapid, reliable, and relatively safe technique in the treatment of life-threatening subarachnoid hemorrhage.

Evidence-Based Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage English Edition

“…Incidence and risk factors 1-1. Incidence The age-adjusted annual incidence of SAH varied 10-fold between different countries, 13) from 1.04 cases per 100,000 population/year in the Middle East 27) to approximately 20 per 100,000/year in Finland 13) and Japan. 12,18,25,28) The sex difference varied between studies; some studies reported no sex difference, 13) while others have reported a higher incidence among women.…”

“…Although the detection rate for small (under 2 mm in diameter) aneurysms may be low, 27,67) it is a highly useful modality for assessing the 3D orientation of vessels around the aneurysm 1,2,9,20,27,33,42,63,64,71) (Grade B). Recently, it has been reported that 3D-CTA is comparable to DSA in the detection of cerebral aneurysm, and that it is even better in providing information for developing surgical strategies.…”

“…6,11) The tolerability of the procedure is checked by a test occlusion prior to ligation. If the occlusion test is positive, an arterial bypass should be performed before ligation of the parent artery 12,25,27) (Grade B). Combined treatment such as combination of endovascular treatment (parent artery occlusion with a coil) and bypass surgery has also been reported to be useful 20) (Grade C1).…”

“…The overall outcome of acute endovascular treatment (within 15 days after the initial bleeding) is favorable. Even during the high risk period of vasospasm, it has been reported that embolization is possible if percutaneous angioplasty or vascular dilation is performed 3,20,27) (Grade C1). Therefore, early treatment with endovascular embolization after the initial bleeding is desirable (Grade B).…”

“…However, this method is slightly invasive and not yet routinely available. 20,22,27) The mean blood flow velocity (at the M1 segment of the middle cerebral artery), measured by transcranial Doppler ultrasonography on consecutive days soon after the initial bleeding, of more than 120-150 cm/sec or an increment of at least 50 cm/sec per day indicates the onset of cerebral vasospasm. Definitive diagnosis by imaging studies such as angiography, followed by endovascular treatment, should be performed in these patients.…”