CAUSES AND MANAGEMENT OF ANEURYSMAL HEMORRHAGE OCCURRING DURING EMBOLIZATION WITH GUGLIELMI DETACHABLE COILS

Object. The purpose of this review is to describe the incidence, cause s, management, and outcome of aneurysmal hemorrhage that occurred in p atients during endovascular treatment with the Guglielmi detachable co il (GDC) system. Methods. At the authors' institution between Septembe r 1991 and August 1995, more than 200 patients were treated using GDCs for intracranial aneurysms. The first 200 patients treated in this fa shion were reviewed and all who experienced new subarachnoid hemorrhag e (SAH) during the procedure were identified. Angiographic studies wer e also reviewed and patients were contacted for longer-term follow up when possible. Four patients who experienced intraprocedural SAH were identified. The causes of hemorrhage were believed to be perforation o f the aneurysm by the guidewire in one patient, perforation by the mic rocatheter in a second, and perforation by the delivery wire in a thir d. The fourth patient had a hemorrhage during injection of contrast ma terial for control angiographic studies after placement of the final c oil. One patient died, but the other three experienced no neurological symptoms or recovered without acquiring additional deficits. Overall a procedural hemorrhage rate of 2% was seen, with permanent morbidity and mortality rates of 0% and 0.5%, respectively. Conclusions. Althoug h SAH during endovascular treatment of intracranial aneurysms remains a significant risk, its incidence is low and a majority of patients ca n survive without serious sequelae.