Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: clinical experience with 41 aneurysms in 39 patients

Object. The authors present a retrospective analysis of their clinical expe rience in the endovascular treatment of basilar artery (BA) trunk aneurysms with Guglielmi detachable coils (GDCs). Methods. Between April 1990 and June 1999, 41 BA trunk aneurysms were treat ed in 39 patients by inserting GDCs. Twenty-seven patients presented with s ubarachnoid hemorrhage, six had intracranial mass effect, and in six patien ts the aneurysms were found incidentally. Eighteen lesions were BA trunk an eurysms, 13 were BA-superior cerebellar artery aneurysms, four were BA-ante rior inferior cerebellar artery aneurysms, and six were vertebrobasilar jun ction aneurysms. Thirty-five patients (89.7%) had excellent or good clinica l outcomes; procedural morbidity and mortality rates were 2.6% each. Thirty -six aneurysms were selectively occluded while preserving the parent artery , and in five cases the parent artery was occluded along with the aneurysm. Immediate angiographic studies revealed complete or nearly complete occlus ion in 35 aneurysms (85.4%). Follow-up angiograms were obtained in 29 patie nts with 31 aneurysms; the mean follow-up period was 17 months, No recanali zation was observed in the eight completely occluded aneurysms. In 19 lesio ns with small neck remnants, seven (36.8%) had further thrombosis, three (1 5.8%) remained anatomically unchanged, and nine (47.3%) had recanalization caused by coil compaction. In one patient (2.6%) the aneurysm rebled 8 year s after the initial embolization. Conclusions. In this clinical series the authors show that the GDC placemen t procedure is valuable in the therapeutic management of BA trunk aneurysms . The endovascular catheterization of these lesions tends to be relatively simple, in contrast with more complex neurosurgical approaches. Endosaccula r obliteration of these aneurysms also decreases the possibility of unwante d occlusion of perforating arteries to the brainstem.