Combined endovascular and extravascular neurointerventional technique for treatment of acutely ruptured cerebral aneurysms.

Objective To assess the initial clinical effect of combined endovascular and extravascular neurointerventional technique for treatment of acutely ruptured cerebral aneurysms.Methods Forty patients with acutely ruptured aneurysms were embolized with Guglielmi detachable coil (GDC) or Dendron electrically detachable coil (EDC) firstly. Immediately after the embolization, all patients were received lumbar puncture and over-the-wire microcatheters were catheterized into cisterna magna via the spinal subarachnoid space. Urokinase(100,000 IU in 2mL normal saline) was injected into cisterna magna via the microcatheter to dissolve clot 2 hours later. Urokinase injection was repeated according to the CT results. Results All the procedures of aneurysm embolization and catheterization of cisterna magna were successful, no technical complications were found. In all patients, CT scans of the day 3th to day 7th revealed complete disappearance of clot in basal cistern. One patient experienced transient sympotomatic cerebral vasospasm without permanent neurologic deficit. The other 39 patients didn't manifest symptomatic cerebral vasospasm. No aneurysmal rebleeding was detected. Conclusions Combined endovascular and extravascular neurointerventional technique can obliterate acutely ruptured cerebral aneurysms and remove the clot of basal cistern. It can prevent aneurysm rebleeding and cerebral vasospasm. Therefore it is a minimally invasive, safe and reasonable method for treatment of acutely ruptured cerebral aneurysms.