Treatment of cerebral aneurysms by endovascular approach has been performed for over 20 years. Initial treatments with detachable balloons were associated with an unacceptably high complication rate when an attempt was made to spare the parent vessel. There was some improvement with the use of fiber coils. However, coil embolization and inadvertent distal vessel occlusion was a significant down side.

The Gugliemi detachable coil (GDC) underwent a multi-center trial in the early 90's and demonstrated a promising alternative as the coil which is electricolytically detached can be optimally positioned within the aneurysm lumen before it is permanently placed and can be retracted and removed if placement is suboptimal. The device is now commercially available with over 1,000 patients being treated nationally.

Large consecutive series suggest a morbidity/mortality of between 2-4% if non-giant aneurysms in a good clinical grade (Hunt Hess I-III) are in the treatment group. Greater than 90% occlusion of the aneurysm lumen can be accomplished in aneurysms less than 10 mm in size. Unfortunately, in aneurysms greater than this size only approximately 50% attain sustained satisfactory aneurysm packing. In addition, if the aneurysms have a poor ratio of the diameter of the aneurysm sac to the aneurysm neck (greater than 1.5) there is similarly only approximately 50% success (occlusion) rate.

Sample Case: Coiling of an anterior communicating artery aneurysm

68-year-old female who presented with grade IV subarachnoid hemorrhage. Four vessel angiogram demonstrated an anterior communicating artery aneurysm which filled only from the left internal carotid injection (Figures 1 and 2). The left Al segment of the anterior cerebral filled both A2 divisions as the right Al vessel was hypoplastic. Because of the patient's poor clinical grade as well as underlying respiratory problems she was referred for endovascular evaluation and subsequent treatment. Via guiding catheter in the left internal carotid, multiple detachable platinum coils were placed into the aneurysm completely packing the lumen (Figure 3). The immediate follow-up study demonstrated continued patency of both A2 segments of the anterior cerebral artery (Figures 4 and 5). Dr. Richard Haas, Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, has been treating patients with cerebral aneurysms using the GDC system and endovascular approach as described in the above case. He can be reached at 401-444-5184.