| Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. | |
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MedLine Citation:
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PMID: 9402574 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To study the safety and efficacy of endovascular treatment of acutely ruptured aneurysms with Guglielmi detachable coils. METHODS: From August 1992 until December 1995, 75 patients were referred for endovascular treatment of acutely ruptured aneurysms. There were 49 women and 26 men, with a mean age of 55 years. Patients were classified according to the Hunt and Hess grading system. There were 18 Grade I patients (24%), 13 Grade II patients (17%), 30 Grade III patients (40%), 11 Grade IV patients (15%), and 3 Grade V patients (4%). Fifty patients (66%) were treated within 48 hours, and 64 (85%) were treated within 1 week of hemorrhage. The most frequently treated aneurysms were located at the basilar bifurcation (32%), anterior communicating artery (16%), posterior communicating artery (15%), and ophthalmic segment of the carotid artery (11%). Most of the aneurysms were smaller than 15 mm (77%). Fifty-six percent of the aneurysms had small (4 mm) necks, and 44% had wide (> 4 mm) necks. Clinical follow-up was performed at 6 months, and results were classified according to the Glasgow Outcome Scale (GOS). Control angiograms were performed immediately, at 6 months, and yearly thereafter. RESULTS: Immediate angiographic results were considered to be satisfactory in 58 patients (77%) (complete obliteration, 40%; residual neck and dog ear, 37%). Technical failures occurred in 5 patients (7%), and 12 patients experienced some residual opacification of their aneurysms (16%). The procedure-related mortality and morbidity rate was 8%. At 6 months, the outcomes were as follows: GOS score of 1, 50 patients (66.7%); GOS score of 2, 4 patients (5.3%); GOS score of 3, 4 patients (5.3%); and GOS score of 5, 17 patients (22.7%). The main causes of death and disability at 6 months were the direct effect of the initial hemorrhage (9%), delayed ischemia (6.7%), subsequent bleeding (4%), intraprocedural rupture (4%), open surgical complications (3%), and unrelated deaths (4%). Six-month angiographic follow-up data were available for 50 patients (67%). The morphological results were considered to be satisfactory in 44 of these 50 patients (88%) (complete occlusion, 46%; residual neck or dog ear, 42%). CONCLUSION: Endovascular treatment of acutely ruptured aneurysms was attempted without clinically significant complication in 92% of the patients. The morphological results were unsatisfactory in 23% of the patients. Complete obliteration of the sac, with or without residual neck, is essential to prevent subsequent bleeding, which occurred in 5% of the patients. The overall outcome at 6 months was similar to that of surgical series, despite a selected group of patients with negative prognostic factors. |
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Authors:
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J Raymond; D Roy |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 41 ISSN: 0148-396X ISO Abbreviation: Neurosurgery Publication Date: 1997 Dec |
Date Detail:
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Created Date: 1998-01-22 Completed Date: 1998-01-22 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1235-45; discussion 1245-6 Citation Subset: IM |
Affiliation:
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Centre Hospitalier, l'Université de Montréal, Quebec, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aneurysm, Ruptured / physiopathology, radiography, therapy* Cerebral Angiography Cerebral Hemorrhage / etiology Embolization, Therapeutic* Female Glasgow Coma Scale Humans Intracranial Aneurysm / physiopathology, radiography, therapy* Male Middle Aged Postoperative Complications Prospective Studies Recurrence Safety Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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