TRANSCRANIAL COLOR-CODED DOPPLER SONOGRAPHY OF INTRACRANIAL ANEURYSMSBEFORE AND AFTER ENDOVASCULAR OCCLUSION WITH GUGLIELMI DETACHABLE COILS

BACKGROUND AND PURPOSE: Our purpose was to evaluate the ability of tra nscranial color-coded Doppler sonography (TCCD) to 1) identify Gugliel mi detachable coils (GDCs) within intracranial aneurysms, 2) show endo vascular aneurysmal occlusion and patency of parent and branch arterie s, 3) determine the flow velocities within parent arteries and major b ranches before and after treatment, and 4) assess persistence of aneur ysmal occlusion. METHODS: The sonographic appearance of GDCs was estab lished experimentally by TCCD (2 to 2.5 MHz), which was then performed in 40 patients with 43 aneurysms occluded by GDCs. The patency of par ent arteries and major branches was assessed qualitatively and compare d with the immediate posttherapeutic angiographic appearance in every patient. Flow velocities were selectively measured and compared before and after treatment in 21 parent arteries and 24 major branches. Foll ow-up TCCD studies performed in 26 patients were compared with angiogr aphic (16 cases) and MR angiographic (10 cases) findings for signs of recanalization of the treated aneurysms. RESULTS: The GDCs were identi fied experimentally and in the patients as hyperechoic structures of t he size and shape, and in the location of, the treated aneurysm in 41 of 43 cases. TCCD in accordance with angiography showed a lack of flow in 42 aneurysms and the presence of flow signal in one large aneurysm . Patency of the parent artery was shown in 40 aneurysms and in all br anches. Follow-up TCCD showed the coils unchanged in 23 of 26 cases. I n three large aneurysms, TCCD indicated recanalization and reappearanc e of a flow signal separate from the parent artery. CONCLUSION: TCCD i s a reliable, noninvasive means to assess parent artery and major bran ch patency and to reveal a lack of hemodynamic compromise in the vicin ity of aneurysms after endovascular therapy. On follow-up examinations , TCCD was able to detect signs of aneurysmal recanalization.