Endovascular treatment of paraclinoid aneurysms

BACKGROUND Paraclinoid aneurysms include those that are distal to the cavernous segmen t of the internal carotid artery and proximal to the posterior communicatin g artery. The purpose of this study was to review our experience with the e ndovascular treatment of this group of aneurysms, which are difficult to tr eat surgically. METHODS Between June 1994 and April 1999, 66 patients (56 female, 10 male) with a m ean age of 50.1 years (range 13-75, median 52) underwent endovascular treat ment for 71 paraclinoid aneurysms. The mean size of the dome was 8.9 mm (ra nge 3-25 mm, median 7) and the of neck was 3.8 mm (range 1.4-8 mm, median 4 ). Thirteen patients presented with acute subarachnoid hemorrhage, and 4 wi th previous subarachnoid hemorrhage. Six aneurysms produced mass effect wit h visual symptoms, 4 presented with transient ischemic attacks, and 44 were incidental. Nine patients had had previous unsuccessful surgery. All proce dures were performed under general anesthesia and with systemic heparinizat ion. RESULTS Ninety endovascular procedures were performed on 71 aneurysms: GDC coiling in 78 (including 45 with the remodeling technique), permanent balloon occlu sion in 9, and 3 had both GDC coiling and permanent balloon occlusion. In t en aneurysms it was not possible to place coils in the lumen of the aneurys m with the available technology and balloon occlusion was not indicated. Fi ve of these were treated surgically and 5 remain untreated. All patients ha d immediate post procedure angiography. Of the 61 aneurysms that were treat ed, 46 (75%) have angiographic follow-up of 6 months or more. Morphological outcome following endovascular therapy for 61 aneurysms at last available follow-up showed >95% occlusion in 52/61 (85.2%) and <95% in 9/61 (14.8%). Eight patients required surgery, 2 for partial coiling, 2 for refilling fil ling of a neck remnant, 2 for persistent mass effect and 2 for coil protrus ion. In the 90 procedures performed, 2 (2.2%) patients had major permanent deficits (I monocular blindness, I hemiparesis), 1 (1.1%) had a minor visua l field cut, and 2 (2.2%) patients died from major embolic events. CONCLUSION Properly selected paraclinoid aneurysms can be successfully treated by endo vascular technology. The morbidity and mortality rate of the endovascular a pproach in our experience is equal to or better than the published surgical series of similar aneurysms. We recommend that the endovascular approach b e given primary consideration in the treatment of paraclinoid aneurysms. (C ) 2000 by Elsevier Science Inc.