Abstract
We evaluate the effect of endovascular treatment at the acute stage with Guglielmi detachable coils on the outcome of the patients with severe SAH from ruptured cerebral aneurysm and on the incidence of symptomatic vasospasm. Twenty-five patients with aneurysmal SAH were treated at the acute stage with Guglielmi detachable coils. The reasons for adopting endovascular treatment in these cases were as follows: poor grade (Hunt & Kosnic grade IV and V), 16 cases; high age, 3 cases; basilar trunk aneurysms, 4 cases; and other reasons, 2 cases.
All the cases of Hunt & Kosnic grade II and III obtained good recovery in Glasgow outcome scale at discharge. The outcome of cases with poor grade (GCS at admission was 9 or less) was good recovery in 5 cases (31%), moderately disabled in 2 (13%), and severely disabled in 9 (56%). The overall outcome was better than that of surgically treated cases in the same condition. The difference in outcome between GDC and surgically treated cases is possibly caused by the difference in the degree of insult to the brain associated with treatment modalities.
The incidence of symptomatic vasospasm was smaller in GDC treated cases (8%) than in surgically treated cases (12%). In the cases treated with GDC and followed by an intratecal administration of urokinase, subarachnoid clots were cleared more rapidly than in those treated surgically with continuous cisternal irrigation. This improved clearance of subarachnoid clots in the GDC group might have acted favorably to prevent delayed vasospasm.
The long-term efficacy of GDC embolization in preventing recurrent aneurysmal bleeding has not yet been determined. However, this method is apparently less invasive to the brain, and suitable for the treatment in severe SAH patients who suffered serious primary brain damage.
