Artikel
Angiographic results and clinical outcome of the endovascular treatment of acutely ruptured intracranial aneurysms
Angiographische und klinische Ergebnisse der endovaskulären Behandung rupturierter intrakranieller Aneurysmen in der Akutphase
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Autoren
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H. Henkes
- Klinik für Neuroradiologie, Klinikum Stuttgart
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S. Fischer
- Klinik für Neuroradiologie, Klinikum Stuttgart
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J. Reinartz
- Robert Janker Klinik, Bonn
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G. Albes
- Klinik für Neuroradiologie, Alfried Krupp Krankenhaus, Essen
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L. Büntjen
- Klinik für Neurochirurgie, Alfried Krupp Krankenhaus, Essen
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D. Kühne
- Klinik für Neuroradiologie, Alfried Krupp Krankenhaus, Essen
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Evaluation of the angiographic and clinical results of endovascular coil treatment of patients with acutely ruptured intracranial aneurysms and the statistical analysis of determining factors.
Methods: From November 1992 through September 2006, a total of 3038 aneurysms in 2599 patients were treated by endovascular coil occlusion. In 1363 patients (52%) treatment was performed within 30 days after aneurysm rupture. Data registration was carried out at the time of treatment.
Results: 1375 acutely ruptured aneurysms were occluded with detachable coils. The mean fundus diameter was 8 mm. 75% of the patients were in a good clinical condition (Hunt and Hess I – III). Vasospasm was noted in 34% of the patients. Using single catheter treatment in 88% of the procedures, a 90 – 100% occlusion rate of the aneurysm was achieved in 91% of the patients. The rate of a periprocedural aneurysm rupture and thromboembolic events was 5.2% and 6.6% respectively. Significant morbidity and mortality was related to the endovasculat treatment in 3.6% of the patients and resulted from the aneurysm rupture in 23%. In 764 aneurysms (56%) angiographic follow-up after 14 months (median) was available. The rate of (sub-) occlusion had decreased to 74%. The occlusion rate was stable in 60%, coil compaction was observed in 25%. In 9% of the aneurysms, an improved occlusion was found. Endovascular re-treatment was required in 11%, amongst those a stent rate of 19%. The rate of (sub-) total occlusion of the aneurysm was 88% and uneventful treatment was found in 86%. The clinical outcome of the first treatment correlates with patient age, aneurysm location, fundus diameter, Hunt and Hess grade, Fisher grade, the occurrence of vasospasm, the use of CSF drainage, and the occurrence of endovascular complications.
Conclusions: The clinical results of the acute treatment of ruptured intracranial aneurysms are good. Neck remnants and neck reperfusion are mostly irrelevant. The key is complete and permanent occlusion of the aneurysm fundus. About 10% of ruptured aneurysms will require more than one treatment session.
