Article Figures & Data
Figures
- Fig 1.
Graph depicting patients with ruptured cerebral aneurysms treated with endovascular GDC occlusion by year.
- Fig 2.
A 56-year-old man with Hunt-Hess grade 1 subarachnoid hemorrhage.
A, Towne-view right vertebral DSA demonstrates an 8-mm basilar caput aneurysm. The aneurysm was treated with seven GDCs measuring a total length of 51 cm.
B, Immediate post-treatment Towne-view right vertebral DSA demonstrates total occlusion of the aneurysm. Follow-up angiography obtained 6 months after treatment demonstrated persistent total occlusion of the aneurysm (not shown).
- Fig 3.
A 39-year-old man with Hunt-Hess grade 1 subarachnoid hemorrhage.
A, Towne-view left vertebral DSA demonstrates a 16-mm basilar caput aneurysm. The aneurysm was treated with seven GDCs measuring a total length of 180 cm. Immediate post-treatment DSA demonstrated a small “dog ear” neck remnant (not shown).
B, Towne-view left vertebral DSA obtained 6 weeks post treatment demonstrates slight enlargement of the “dog ear” neck remnant (arrow) at the right base of the aneurysm.
C, Towne-view left vertebral DSA obtained immediately after detachment of one GDC measuring 8 cm in the dog ear neck remnant demonstrates occlusion of the neck remnant and total occlusion of the aneurysm.
- Fig 4.
A 88-year-old man with Hunt-Hess grade 2 subarachnoid hemorrhage.
A, Lateral view right internal carotid DSA demonstrates a 3 × 6-mm anterior choroidal artery aneurysm. Oblique views (not shown) demonstrated direct origin of the anterior choroidal artery from the neck of the aneurysm. Significant atherosclerotic disease involving the cavernous right internal carotid artery and the right middle cerebral artery is also demonstrated.
B, Lateral view right internal carotid DSA immediately after detachment of four GDCs measuring a total length of 20 cm demonstrate occlusion of the fundus and dome of the aneurysm. A residual neck remnant (arrow) was intentionally left to preserve the origin of the anterior choroidal artery.
- Fig 5.
A 66-year-old woman with Hunt-Hess grade 3 subarachnoid hemorrhage.
A, Lateral view left internal carotid DSA demonstrates a 15-mm superior hypophyseal aneurysm. Seven GDCs measuring a total length of 140 cm were detached in the aneurysm. Immediate post-treatment DSA demonstrated persistent opacification of the aneurysm.
B, Six-month follow-up lateral view left internal carotid DSA demonstrates a residual aneurysm. The aneurysm was subsequently surgically clipped without complications.
- Fig 6.
Graph depicting degree of occlusion at follow-up angiography with respect to initial angiographic result.
- Fig 7.
Graph depicting angiographic outcome at longest angiographic follow-up with respect to initial aneurysm size.
Tables
Characteristic Value Sex Male 33 Female 50 Age, y Mean 56.1 Range 27–88 Hunt-Hess grade at admission I 33 II 14 III 20 IV 12 V 3 Mean 2.2 Clinical follow-up, mo Mean 16.8 Range 0.25–112 Mean in survivors 19.1 Range in survivors 0.5–112 Patients with angiographic follow-up 68 Angiographic follow-up, mo Mean 11.6 Range 0.2–70 Location Number Anterior circulation 37 Ophthalmic artery 2 Paraclinoid internal carotid artery 3 Posterior communicating artery 7 Anterior choroidal artery 2 Internal carotid bifurcation 1 Anterior communicating artery 19 Middle cerebral bifurcation 3 Posterior circulation 46 Basilar caput 34 Posterior cerebral artery 1 Superior cerebellar artery 2 Basilar trunk 2 Vertebrobasilar junction 4 Posterior inferior cerebellar artery 3 GOS Score Number* 5 56 (67) 4 8 (10) 3 8 (10) 2 1 (1) 1 10 (12) Mean 4.2 * Data in parentheses are percentages.
Outcome Immediately after Treatment (n = 83) At Longest Angiographic Follow-Up (n = 68) Complete occlusion 27 (33) 24 (35) Dog-ear remnant 20 (24) 18 (26) Residual neck 32 (39) 24 (35) Residual aneurysm 4 (5) 2 (3) Note.—At follow-up, angiographic results improved in 20 patients (29%), were worse in 10 patients (15%), and were unchanged in 38 patients (56%). Data in parentheses are percentages.
Complication No. of Patients n = 16* Intervention Neurologic Deficit Death n = 1 None n = 10 Temporary n = 4 Permanent n = 1 Major, thromboembolic 2 (2) Reopro perfusion in 1 patient 0 0 1 1 Minor 14 (17) Aneurysm perforation 1 Continued coiling 0 1 0 0 Coil migration 2 None 1 1 0 0 Thromboembolic 4 None 2 2 0 0 Vertebral dissection 3 None 3 0 0 0 Groin hematoma 2 Conservative 2 0 0 0 Retroperitoneal hematoma 1 Blood transfusion, reversal of anticoagulation 1 0 0 0 Contrast-agent related 1 Steroids, Benadryl 1 0 0 0 * This represented 19% of patients. Data in parentheses are percentages.
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