뇌동맥류의 혈관내 Guglielmi Detachable Coil 치료

Abstract

The purpose of the study was to evaluate short-term clinical results in 44 patients who had cerebral aneurysms and underwent endovascular treatment with Guglielmi detachable coil(GDC), and to establish selection criteria of the patients for this treatment. From March 1996 to November 1997, we treated 258 patients either by surgery or endovascular treatment, or by combination of both. Forty-four patients of them were assigned to endovascular GDC embolization as an initial treatment rather than surgery because of an anticipated technical difficulty for surgery due to anatomy of the aneurysm on cerebral angiography(25 patients), patient’s poor physical or neurological condition( 18 patients), or referring neurosurgeon’s preference(one patient). Twenty patients were presented with ruptured aneurysm, 13 with unruptured aneurysm, 6 with mass effect, and 5 with initial incomplete clipping. Twenty-six patients had anterior circulation aneurysm and 18 had posterior circulation aneurysm. Among total of 44 patients, we were able to achieve 70 to 100% obliteration of the aneurysm in 32 patients (72.7%) but failed in 12(27.3%). Causes of failure were 5 wide neck, 4 vessel tortuosity, 2 difficult geometry, and a perforation of the distal basilar aneurysm. Seven of the failed patients were treated by subsequent clipping. Complications caused by the intra-aneurysmal endovascular treatment were a fatal perforation of the aneurysm with guide wire and an occlusion of the parent artery from over-packing of the coil, and distal migration of the coil in 2 patients, all of which could be retrieved. At an average 6-month follow-up, only one of six death was caused by the endovascular treatment. Short-term clinical results of the endovascular treatment of cerebral aneurysms indicate that this procedure is a useful alternative approach especially in selected patients with high risk aneurysm.