Endovascular treatment of intracranial aneurysms with Guglielmi DetachableCoils: emphasis on new techniques

Endovascular therapy for intracranial aneurysms has evolved since Serbinenk o pioneered embolisation with latex balloons in the 1970s. The focus of mod ern endovascular therapy has shifted to the use of Guglielmi Detachable Coi ls (GDC; Boston Scientific Corporation, Natick, MA, USA) which are retrieva ble until the operator is satisfied with placement and they are detached. G DC therapy has been shown to be most efficacious in smaller aneurysms with relatively large dome:neck ratios which allow maximal coil packing within t he aneurysm lumen. Wide neck aneurysms with dome:neck ratios of less than 2 .0 and large aneurysms have a significantly lower incidence of complete tre atment, with higher rates of repeat rupture following GDC therapy. The geom etry of wide neck aneurysms is less favourable for retention of coils withi n the aneurysm lumen, resulting in greater risk of parent vessel compromise from coil herniation and difficulty obtaining maximal coil packing. This c hapter will summarise GDC therapy for intracranial aneurysms including newe r techniques designed to address the problem of wide neck aneurysms. (C) 20 00 Harcourt Publishers Ltd.