THE ENDOVASCULAR APPROACH IN THE MANAGEMENT OF PATIENTS WITH MULTIPLEINTRACRANIAL ANEURYSMS

To investigate the role of endovascular treatment we performed a retro spective study of our patients with multiple intracranial aneurysms se en in our institution between October 1992 and March 1995. This period was chosen to study a homogeneous group of patients since the appeara nce of controlled detachable coils, and to obtain the largest number o f patients with angiographic follow-up of the aneurysms treated. We st udied 53 patients with a total of 128 aneurysms, in 46 of whom we trea ted 67 aneurysms by the endovascular approach. Of these, 5 aneurysms i n 3 patients were treated by occlusion of the parent vessel and 62 ane urysms in 43 patients with coils, 52 with Guglielmi detachable coils a nd 10 with mechanically detachable spirals. Complete occlusion was obt ained in 58 aneurysms, and partial occlusion in 9. The therapy caused permanent neurological deficit in 3 cases (6.5%), and there was 1 case of rebleeding (incomplete occlusion of the aneurysm). No deaths occur red. All aneurysms were treated in 29 of the 53 patients. Endovascular procedures were used for 16 patients (30%), surgery was performed in 1 patient (2%) and the two were combined in 12 (23%). In 23 of 53 case s (43%), unruptured aneurysms were left untreated, usually because of their small size. In 1 patient with unruptured aneurysms, the endovasc ular approach failed and the patient refused surgery.