Abstract
The introduction of detachable platinum coils (Guglielmi detachable coils [GDC]) for endosaccular treatment of cerebra aneurysms has changed the strategy of brain aneurysm treatment worldwide considerably. The aim of this study is to evaluate retrospectively clinical outcomes and angiographic follow-ups of patients being treated for ruptured brain aneurysms using microsurgical clipping or GDC. Of a series of 716 patients harboring 888 aneurysms, 470 patients were included in this study. Excluded were patients with multiple or unruptured aneurysms and patients in whom other endovascular techniques, such as parent vessel occlusion, were applied. Clinical outcome (mean, 43.5±14.3 months; range 3 to 79 months) and angiographic follow-up (mean, 15.3±12.6 months; range, 1 to 66 months) were evaluated according to different aneurysm locations (4 in the anterior, 4 in the posterior circulation). The results showed that in the anterior circulation locations GDC has been the primary choice only in the group of paraophthalmic aneurysms, whereas anterior communicating artery and middle cerebral artery aneurysms were usually treated by surgical clippings. In these locations, clinical outcomes were not significantly different between the 2 treatment groups; angiographic follow-ups of the GDC-treated aneurysms showed the best results in the paraophthalmic group, however. In the posterior circulation, a general preference for GDC treatment was found in this retrospective analysis. Clinically, there was no outcome difference between the surgical and the embolized group; angiographic follow-up in the endovascular group gave the highest occlusion rates in basillary tip aneurysms. The elegance of the minimally invasive endovascular approach to aneurysms is disturbed by the limited angiographic appearance in follow-up examinations. Further long-term experience and the evaluation of different endovascular tools are needed to offer a minimally invasive, effective, and long-lasting therapy to patients with ruptured aneurysms.
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