Endovascular treatment of ruptured posterior circulation cerebral aneurysms - Clinical and angiographic outcomes

Background and Purpose-We sought to describe the clinical outcome and angio graphic results obtained in the endovascular therapy of ruptured posterior circulation cerebral aneurysms using Guglielmi detachable coils (GDC) over a 7-year period. Methods-A retrospective analysis was performed of 112 patients evaluated at the University of California at San Francisco Medical Center between June 1991 and August 1998. The Hunt-Hess grade at presentation of treated patien ts was I in 26 patients (24%), II in 24 (22%), III in 27 (25%), IV-in 24 (2 2%), and V in 8 (7%. Clinical follow-up for the total population was achiev ed in 104 of 109 patients (96%), with a mean duration of 13.1 months. Angio graphic follow-up for the subset excluding parent vessel occlusion cases wa s obtained in 93% of cases, with a mean duration of 7.2 months. Results-Technical success, defined as the ability to catheterize and emboli ze the aneurysm with GDC, was achieved in 109 of 112 of cases (97%). The me an angiographic occlusion rate, or projected area of:the aneurysm occluded by the coils, for all 110 successfully treated aneurysms was 94.6%. At-late st clinical follow-up, 81 of 109 patients (74%) achieved good recovery with Glasgow Outcome Scale (GOS) score of I, 10 of 109 (9%) were moderately (GO S II) and 5 of 109 (5%) were severely (GOS III) disabled, 1 of 109 (1%) rem ained in a vegetative state (GOS IV), and 12 of 109 (11%) were dead. Of the subset of 77 patients with Hunt-Hess grades I to III, 68 (88%) achieved a good clinical outcome (GOS I). A statistically significant correlation was demonstrated between Hunt-Hess grade at presentation and final GOS outcome score (chi(2)=41.4, P<0.0005). Procedure-related permanent morbidity was 2. 8% (3/109 patients). Repeated hemorrhage was observed in a single patient ( 0.9%) with a partially treated aneurysm. Conclusions-The observed favorable outcome and low morbidity in this group of high-risk patients point to GDC embolization as an effective method for the endovascular management of patients with ruptured posterior circulation aneurysms.