Endovascular treatment of basilar tip aneurysms using Guglielmi detachablecoils: Anatomic and clinical outcomes in 73 patients from a single institution

OBJECTIVE: Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatom ic and clinical outcomes are discussed. METHODS: Seventy-five basilar tip aneurysms were treated with the GDC syste m at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28-82 yr). F orty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 p atients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small w ith a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were lar ge, and 10 (13.3%) were giant aneurysms. RESULTS: Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic di fficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remai ned neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneury sms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlus ion. One incompletely embolized giant aneurysm ruptured during the follow-u p period. CONCLUSION: In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depe nds on the shape of the aneurysm, not its location. The results of this stu dy indicate that endovascular CDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of p atient age, clinical presentation, clinical status, or timing of treatment.