Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms

OBJECTIVE: Guglielmi detachable coiling (CDC) has quickly become the most c ommon endovascular method for the treatment of intracranial aneurysms. Alth ough several published case series describe various authors' successful exp eriences or complications, few have elaborated on failed attempts. We exami ned our experience with GDC, and we analyzed all failed attempts at coiling . METHODS: Patients who underwent endovascular procedures from September 1995 through July 1999 were identified using endovascular case logs and billing records. Patient charts were then reviewed retrospectively for failed atte mpts at GDC. A treatment failure was defined as an inability to place coils into an aneurysm, a CDC procedure-related complication resulting in death, or an acute rehemorrhage from a coiled aneurysm that indicated a failure o f coils to prevent rerupture. Thromboembolic events and other nonfatal sour ces of morbidity that did not preclude coiling of the aneurysm were analyze d only to the extent that they prevented successful coiling of the aneurysm . RESULTS: From September 1995 to June 1999, 241 patients underwent CDC embol izations or attempts. In these patients, 35 procedures were unsuccessful, i ncluding 7 deaths from intraoperative or postoperative aneurysmal rerupture . Sixteen aneurysms could not be microcatheterized, nine of which were ante rior communicating artery aneurysms. Coils from 13 wide-necked aneurysms (a verage fundus-to-neck ratio, <2) prolapsed into the parent vessel. Three pr ocedures were abandoned when the aneurysms were found to have normal branch es filling from the dome, and three additional procedures were abandoned fo r technical reasons. Five deaths resulted from intraoperative aneurysm rupt ure, and two patients died postoperatively from rerupture. CONCLUSION: The number of successful coiling procedures has increased with experience and improved technology. The procedure still involves risks, how ever, primarily for patients with subarachnoid hemorrhage.