Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center

Abstract

Despite increasing experience and improved material, endovascular treatment of cerebral aneurysms still has risks linked to the technique itself and to the specificity of the pathology treated. The purpose of this report is to examine procedural technical and clinical negative events, even minimal ones, occurring in this type of treatment. We considered 557 procedures carried out from January 1994 to December 2005 in 533 patients harboring 550 aneurysms. Of the patients, 448 presented with SAH and 85 with unruptured aneurysms. All procedures were performed under general anesthesia. The GDC-10 system was routinely used. Additional devices like the balloon remodeling technique, Trispan and stents were also occasionally used. Every procedural complication occurring during or soon after treatment was registered. Endovascular treatment was completed in 539 out of 557 procedures. There were 18 failures (3.3%). Occlusion of the aneurysm was judged complete in 343 (64%), near complete in 184 (34%) and incomplete in 12 (2%). Procedural complications occurred in 72 (13%) of the cases. The most frequent negative events were thromboembolisms (6.6%) and ruptures (3.9%). Other types (coil migration, transient occlusions of the parent vessel, dissections and early rebleeding) were rarer (2.5%). In the majority of cases there were no clinical consequences. Procedural morbidity and mortality were 1.1 and 1.8%, respectively. Considering the 449 procedures performed in ruptured and the 90 in the unruptured aneurysms separately, morbidity and mortality were 1.1 and 2.2% in the former group and 1.1 and 0% in the latter. Many factors influence the risk of complications. Being progressively aware of this and with increasing experience, the frequency can be limited. Negative events linked to the procedure have more significant serious clinical consequences in patients admitted in a critical clinical condition after SAH, because of the already present changes involving the brain parenchyma and cerebral circulation.

Comparative study of covered stent with coil embolization in the treatment of cranial internal carotid artery aneurysm: a nonrandomized prospective trial

“…Relatively low initial and final overall complete occlusion rates are the main drawbacks of coil treatment for intracranial aneurysms, particularly for large, giant, or wide-necked aneurysms. A 100% occlusion after the initial and final treatment only occurs in ∼60-65% of cases [2][3][4][5][6][7][8][9][10][11][12][13][14][15]20]. However, even with 100% aneurysmal occlusion after initial treatment, there still remains a relatively high recanalization rate (26.4%) on long-term follow-up angiography [22] and aneurysm sac perfusion on the initial and follow-up rotation digital angiographs [23].…”

“…Additionally, GDC use is associated with a better clinical outcome than surgical clipping, in terms of disability-free survival [1]. The clinical and angiographic results of endovascular coil occlusion of intracranial aneurysms are reportedly positive [2,3], with initial and final overall complete occlusion rates of 35.9-76.8% [2][3][4][5][6][7][8][9][10][11][12][13][14][15] and 38.3-87.8% [5-9, 11, 12], respectively. However, mid-and long-term aneurysm recanalization occurs in up to one-third of cases, due to neck remnants or incomplete occlusion [4,9,13,[16][17][18].…”

Comprehensive Stroke Center Quality Metrics

“…38 -40 Endovascular rates were based on literature published in the Journal of Neurosurgery, Neurosurgical Review, Neuroradiology, and the Journal of Neuroradiology. [41][42][43][44] Benchmarks for secondary complications could not be set to a specific rate because hospitals have different case mix-indices that distinguish their general population from their stroke population. Preliminary data showed artifactually inflated secondary complication rates because diagnosis codes for "history of" versus "hospital acquired" secondary comorbidities were not clearly differentiated.…”

Interleukin-1 Cluster Gene Polymorphisms and Aneurysmal Subarachnoid Hemorrhage

“…Advances in the management of SAH have resulted in a relative decrease in the mortality rate. 4 However, half of the survivors have major neurological deficits. 5 Several recent studies suggest that inflammation plays an important role in the pathogenesis of IAs.…”