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.