Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils

Abstract

Results in nine patients with large or giant fusiform intracranial aneurysms that were treated with Guglielmi detachable coils (GDCs) are reported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic and located in an arterial feeder of an arteriovenous malformation. Five aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preservation of the parent artery was attempted in three cases, and complete occlusion of the aneurysm and the parent artery was performed in six patients. The tolerance to parent artery occlusion was assessed by angiography, balloon test occlusion, and amytal testing. Six aneurysms were permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with SAH made an excellent clinical recovery. Three of the four patients presenting with mass effect recovered completely and one remained unchanged. The patient with an incidental aneurysm remained asymptomatic. There were no permanent complications. In conclusion, GDCs were useful for the occlusion of large and giant intradural fusiform aneurysms. Occlusion of the aneurysm and the parent artery afforded the greatest opportunity for a complete cure. Advantages of GDCs compared to balloons include: occlusion of a shorter segment of normal artery, no traction on the parent vessel, and safer and easier catheterization techniques.

Evolution of Flow-Diverter Endothelialization and Thrombus Organization in Giant Fusiform Aneurysms after Flow Diversion: A Histopathologic Study

“…15 Among the endovascular techniques, parent artery occlusion remains the best option for those with good collateral circulation. 16 Reconstructive endovascular techniques, including FD-supported coiling or double-FD implantation, have been successfully applied for smaller fusiform aneurysms 17,18 but not for giant ones.…”

Sole Stenting Technique for Treatment of Complex Aneurysms

“…Due to fragile aneurysm wall, deep location, circumferential shape and incorporated perforators, fusiform aneurysms are too difficult and dangerous to be treated by clip or coil. In past years, proximal occlusion (or trapping) had been treatment of choice 7,9,12) . These deconstructive techniques are risky procedure itself and may need rigorous preoperative examination (etc balloon occlusion test), and if collateral circulation was insufficient, more complex procedure such as bypass surgery might be necessary.…”

“…Fusiform aneurysm also is difficult and dangerous to be treated by surgical clipping or endovascular coiling because it has fragile wall and indistinct neck. In past series, the "deconstructive" methods, described as proximal occlusion or trapping, had been treatment of choice for fusiform aneurysm 7,9,12) . With the development of stent material and technique, the new concept has been evolved recently into "endovascular bypass" or "endovascular reconstruction" which is enabled to preserve affected parent artery and perforators, and occlude aneurysm safely.…”

Treatment of vertebral artery dissecting aneurysms presenting with progressive myelopathy

“…[3][4][5]7,10,12 As we expected, the clinical symptoms progressively improved, but the follow-up MRI revealed no improvement of the lesion. The mechanism for symptom improvement could be the reduction of the persistent pulsation of the aneurysm in close contact with the medulla.…”

“…13,14,15 Sometimes, the intramural hematoma compresses the brainstem and thus produces progressive myelopathy. 5,9 There are various options in the treatment of dissecting aneurysms of the VA. [1][2][3]5,6,11 However, selection of a treatment modality is difficult if the patient presents with myelopathy due to mass effect to the brainstem, and especially if the dissection involves the origin of the posterior inferior cerebellar artery (PICA). In this report, we describe our treatment of two patients with VA dissecting aneurysm in which PICA arose from the wall of the aneurysm.…”