Endovascular treatment of intracranial aneurysm - our eleven years experience

Abstract

Introduction: Spontaneous rupture of cerebral aneurysms typically results in subarachnoid hemorrhage and 10 % of patients die before reaching the hospital. Greatest risk to life is aneurysm re-bleeding although cerebral vasospasm makes a significant contribution to overall morbidity and mortality. The primary goal of treatment of cerebral aneurysms is to prevent future rupture. The best available data suggest that previously unruptured aneurysms carry a risk of hemorrhage of about 1-2 % per year, depending of size, location and other risk factors. The presence of multiple aneurysms and a family history of subarachnoid hemorrhage also raise the risk of rupture. Once an aneurysm has ruptured, the chance of re-hemorrhage dramatically increases. In 1991, Guglielmi detachable coil (GDC) embolization was introduced as an alternative method for treating selected aneurysm patients Goal of EVT is complete exclusion of the aneurysm from the flow of blood. Technological advances in endovascular treatment devices have also improved this method of treatment (assisted coiling-balloon, stent, flow-diverter, liquids itc.) The relative risk of death or significant disability at one year for patients treated with coils was 22.6 percent lower than in surgically-treated patients(ISAT). The only multi-center prospective randomized clinical trial - considered the gold-standard in study design - comparing surgical clipping and endovascular coiling of ruptured aneurysm is the International Subarachnoid Aneurysm Trial (ISAT). In our University Clinic of Radiology EVT with coil started 2005. Material and Method: At our clinic 158 patient witch underwent endovascular treatment of 176 intracranial aneurysm ruptured and unruptured from Jun 2010- Jun 2016. Interventions made by our protocol under general anesthesia. On anterior circulation, internal carotid and branches 129 and posterior, vertebrobazilar system 47. Endovascular treatment was mostly just coiling and small part stent assisted and five cases only with flow diverter. Result: We had good result in treated aneurysms with complication rate equivalent to world published numbers: morbidity 3-10% and mortality 1-2%. Conclusion: Endovascular therapy is a minimally invasive procedure that accesses the treatment area from within the blood vessel. This study provides compelling evidence that, if medically possible, all patients with ruptured brain aneurysms should receive an endovascular consultation as part of the protocol for the treatment of brain aneurysms. Although no multi-center randomized clinical trial comparing endovascular coiling and surgical treatment of unruptured aneurysms has yet been conducted, retrospective analyses have found that endovascular coiling is associated with less risk of bad outcomes, shorter hospital stays and shorter recovery times compared with surgery.