R. Vanninen et al., Ruptured intracranial aneurysms: Acute endovascular treatment with electrolytically detachable coils - A prospective randomized study, RADIOLOGY, 211(2), 1999, pp. 325-336
Citations number
44
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
PURPOSE: To compare the use of electrolytically detachable coils versus sur
gical ligation for the management of acutely ruptured intracranial aneurysm
.
MATERIALS AND METHODS: A prospective randomized study included 109 patients
with acute (<72 hours) subarachnoid hemorrhage caused by a ruptured aneury
sm (Hunt and Hess grade I-II [n = 67], grade III [n = 26], or grade IV-V [n
= 16]). Ail patients were suitable candidates for both endovascular and su
rgical treatment and were randomly assigned to undergo coil embolization (n
= 52) or surgical ligation (n = 57).
RESULTS: Significantly better primary angiographic results were achieved af
ter surgery in patients with anterior cerebral artery aneurysm (n = 55, P =
.005) and after endovascular treatment in those with posterior circulation
aneurysm (n = 11, P = .045). No significant differences were seen in middl
e cerebral artery (n = 19) or internal carotid artery (n = 24) aneurysms. E
arly rebleeding occurred in one patient after incomplete coil embolization.
The technique-related mortality rate was 4% in the surgical group and 2% i
n the endovascular group. Clinical outcome (Glasgow Outcome Scale score) at
3 months was not significantly different between treatment groups in terms
of intended treatment modality. No late rebleedings had occurred at the ti
me of this writing.
CONCLUSION: In selected patients with a recently ruptured intracranial aneu
rysm, favorable results were achieved by using endovascular treatment. Subs
equent acute or late open surgery was sometimes required. The clinical outc
ome at 3 months was comparable in the endovascular and surgical treatment g
roups.