THROMBOEMBOLIC EVENTS ASSOCIATED WITH THE TREATMENT OF CEREBRAL ANEURYSMS WITH GUGLIELMI DETACHABLE COILS

BACKGROUND AND PURPOSE: The purpose of this study was to document the prevalence, radiologic appearance, and treatment of thromboembolic eve nts related to GDC embolization of cerebral aneurysms. METHODS: The cl inical and radiologic records of all patients undergoing GDC treatment of intracranial aneurysms at our institution were reviewed. All cases in which unexpected complications occurred were selected. Those compl ications related to presumed thromboembolic events were analyzed. RESU LTS: Of 59 patients (60 aneurysms) treated with GDCs, 17 (28%) experie nced thromboembolic events. Seven patients had transient ischemic atta cks and 10 had strokes. In 10 patients, the deficits occurred during o r immediately after the procedure; in the rest, the complications were delayed. In six patients, all radiologic investigations were negative for infarction and in seven patients, CT scans showed new ischemic le sions. In four patients, MR imaging alone showed infarcts, and in four of nine patients who underwent subsequent angiography, acute ischemic findings were demonstrated. Eight patients were treated with volume e xpansion, eight,vith full heparinization, and one patient underwent in traarterial thrombolysis. Clinical outcome was excellent or good in 14 of 17 patients, with only three patients (5%) incurring permanent neu rologic deficits. CONCLUSION: Thromboembolic events related to GDC tre atment may be more common than has been reported in the literature. In our experience, this rate was 28%, with persisting deficits in 5%. Th ese events can occur after uncomplicated procedures and may be unaccom panied by radiologic findings. Clinical outcome is usually favorable.