Embolization therapy with Guglielmi Detachable Coils in intracranial aneurysms

Abjective To evaluate the efficacy of endovascular embolization in intracranial aneurysms with GDC. Materials and Methods Eighty one patients with 84 intracranial aneurysms (63 with aneurysmal subarachnoid hemorrhage, 18 cases without ruptured aneurysm) had been treated by GDC embolization with both silkworm silk like technique and silkworm mulberry piece meal technique. The follow up cerebral angiography was performed 3 or 6 months after the procedure in 45 cases. Results Seventy four cases with 77 aneurysms were successfully embolized by the endovascular procedure with a complete occlusion in 42 aneurysms, a subtotal occlusion in 22 and a partial occlusion in 13. 7 cases failed in this apprach. The degree of occlusion was relative to both the size of aneurysm and it's dome/neck ratio. A complete occlusion was not achieved in giant aneurysm and broad neck aneurysm (dome/neck ratio2). Follow up cerebral angiography demonstrated an enlargement of the remnant cavity in 7 aneurysms with initial subtotal and partial occlusions. 7 cases suffered from complications relative to the procedure, including 4 aneurysm rupture and 3 thrombosis during the procedure. In 4 cases with aneurysm rupture, 3 of them were cured with continuous GDC embolization and one died one week afterwards. In 3 cases with thrombosis, two completely recovered with local intraarterial thrombolysis and one had permanent monoplegia. Conclusion GDC embolization is a safe modality for treatment of intracranial aneurysm in selected patients, follow up cerebral angiography is essential for evaluation of its efficacy and the complication rate can be minimized by an expertised operator. (Shanghai Med J, 2000,23∶535 539)