Endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils

Object: To describe the clinical and angiographic results of endovascular o cclusion of basilar bifurcation aneurysms with electrolytically detachable coils, and to identify factors which should be considered in deciding upon surgical or endovascular treatment. Methods: We report our experience with 40 patients in whom occlusion of basilar bifurcation aneurysms with electro lytically detachable coils was attempted. All patients underwent superselec tive angiography and attempted embolization with Guglielmi detachable coils (GDCs). Angiographic and clinical results mere prospectively recorded. Twe nty-eight aneurysms presented with subarachnoid hemorrhage (SAH), 2 were sy mptomatic and 10 were incidental. Results: Coils were not placed in 10 pati ents (25%) because of unfavorable anatomy. Complete aneurysm occlusion was achieved at the time of the initial procedure in 13 (32.5%), small neck rem nants were present in 13 (32.5%), and in 4 (10.0%) there was obvious residu al contrast filling of the aneurysm body. Of 23 patients successfully coile d after SAH, 20 were Grade 1 to 3 and 3 were grade 4 or 5 at the time of tr eatment. Eighteen (78%) made a good recovery. Procedural mortality was 2.5% and permanent morbidity was 7.5%. There were no permanent complications in patients with unruptured aneurysms. Complete aneurysm occlusion was possib le in 10 (56%) of 18 aneurysms with small necks and 3 (14%) of 22 with larg e necks. Follow-up angiography in 25 of 28 surviving patients (mean, 12 mon ths) demonstrated stability of all completely occluded aneurysms. Incomplet ely coiled aneurysms had variable results on follow-up angiograms: 15.4% im proved, 69.2% worsened, and 15.4% were stable. No aneurysm bled after treat ment during clinical follow-up averaging 22 months. Conclusions: Endovascul ar treatment of basilar bifurcation aneurysms appears to prevent early aneu rysm rebleeding with acceptable rates of morbidity and mortality, but long- term follow-up is required.