Semin intervent Radiol 2002; 19(4): 339-376
DOI: 10.1055/s-2002-36749
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Endovascular Treatment of Intracranial Aneurysms

Christopher J. Moran1 , DeWitte T. Cross, III2 , Colin P. Derdeyn3
  • 1Neuroradiology Section, Mallinckrodt Institute of Radiology at Washington University Medical Center, St. Louis, Missouri
  • 2Department of Interventional Neuroradiology, Mallinckrodt Institute of Radiology at Washington University Medical Center, St. Louis, Missouri
  • 3Department of Endovascular Surgical Neuroradiology, Neuroradiology Section, Mallinckrodt Institute of Radiology at Washington University Medical Center, St. Louis, Missouri
Further Information

Publication History

Publication Date:
21 January 2003 (online)

ABSTRACT

An intracranial aneurysm is a benign disorder that causes patients to have neurological deficits or to die. The sequelae develop because aneurysms rupture into the subarachnoid space or compress nervous tissue. Intracranial aneurysms occur in up to 8% of the population, more commonly in women, and the only modifiable risk factor for hemorrhage is cigarette smoking. Treatment is directed at the prevention of rupture or rebleeding and relief of mass effect. Surgical clipping has been the primary treatment, but in the past 6 years, endovascular therapy (Guglielmi detachable coil® [GDC]) has become widely available. Initially GDC treatment was directed at the nonsurgical candidate but recently has begun to compare with surgical clipping as a definitive mode of therapy. The primary consideration for successful GDC treatment of an aneurysm is the relationship of the aneurysm to its parent vessel and any branches. The size of the aneurysm dome in relation to the aneurysm neck, presence of thrombus, and the inflow zone are also significant factors. Coil compaction and aneurysm remnants at its neck are significant problems in GDC treatment. The technique and instruments are constantly improving: development of the remodeling technique; the introduction of softer, stretch-resistant coils; and the use of flexible coronary stents have permitted successful treatment of patients who once would have been considered poor candidates for this mode of therapy. Future development of more compliant balloons, coated coils, and liquid embolics will extend and improve endovascular therapy for patients with intracranial aneurysms.

REFERENCES

  • 1 Sahs A L, Perret, Locksley H B, Nishioka H. Intracranial Aneurysms and Subarachnoid Hemorrhage; First Cooperative Study of SAH.  Philadelphia, PA: JB Lippincott. 1969; 
  • 2 Schwartz T H, Solomon R A. Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature.  Neurosurgery . 1996;  39 433-440
  • 3 Schievink W I. Intracranial aneurysms.  N Engl J Med . 1997;  336 28-40
  • 4 Qureshi A I, Suarez J I, Parekh P D. Risk factors for multiple intracranial aneurysms.  Neurosurgery . 1998;  43 22-27
  • 5 Hunt W E, Hess R M. Surgical risk as related to time of intervention in the repair of intracranial aneurysms.  J Neurosurg . 1968;  28 14-20
  • 6 Fisher C M, Kistler J P, Davis J M. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning.  Neurosurgery . 1980;  6 1-9
  • 7 Khurana V G, Piepgras D G, Whisnant J P. Ruptured giant intracranial aneurysms. Part I. A study of rebleeding.  J Neurosurg . 1998;  88 425-429
  • 8 Piepgras D G, Khurana V G, Whisnant J P. Ruptured giant intracranial aneurysms. Part II. A retrospective analysis of timing and outcome of surgical treatment.  J Neurosurg . 1998;  88 430-435
  • 9 Gobin Y P, Viñeula F, Gurian J H. Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils.  J Neurosurg . 1996;  84 55-62
  • 10 Cross III T D, Moran C J, Brown A P. Endovascular treatment of epistaxis in a patient with tuberculosis and a giant petrous carotid pseudoaneurysm.  AJNR Am J Neuroradiol . 1995;  16 1084-1086
  • 11 Meyer F B, Morita A M, Puumala M R, Nichols D A. Medical and surgical management of intracranial aneurysms.  Mayo Clin Proc . 1995;  70 153-172
  • 12 Wiebers, Whisnant J P, Sundt Jr M T, O'Fallon W M. The significance of unruptured intracranial saccular aneurysms.  J Neurosurg . 1987;  66 23-29
  • 13 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture.  J Neurosurg . 2000;  93 379-387
  • 14 Obuchowski N A, Modic M T, Magdinec M. Current implications for the efficacy of noninvasive screening for occult intracranial aneurysms in patients with a family history of aneurysms.  J Neurosurg . 1995;  83 42-49
  • 15 The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention.  N Engl J Med . 1998;  339 1725-1733
  • 16 Jane J A, Kassell N F, Torner J C, Winn H R. The natural history of aneurysms and arteriovenous malformations.  J Neurosurg . 1985;  62 321-323
  • 17 Chyatte D, Fode N C, Sundt Jr M T. Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage.  J Neurosurg . 1988;  69 326-331
  • 18 Torner J C, Kassell N F, Haley Jr C E. The timing of surgery and vasospasm.  Neurosurg Clin North Am . 1990;  1 335-347
  • 19 Nichols D A, Meyer F R, Piepgras D G, Smith P L. Endovascular treatment of intracranial aneurysms.  Mayo Clin Proc . 1994;  69 272-285
  • 20 Solander S, Ulhoa A, Viñuela F. Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils.  J Neurosurg . 1999;  90 857-864
  • 21 Zubillaga A F, Guglielmi G, Viñuela F, Duckwiler G R. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results.  AJNR Am J Neuroradiol . 1994;  15 815-820
  • 22 Hope J K, Byrne J V, Molyneux A J. Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization.  AJNR Am J Neuroradiol . 1999;  10 391-399
  • 23 Litofsky N S, Viñuela F, Giannotta S L. Progressive visual loss after electrothrombosis treatment of a giant intracranial aneurysm: case report.  Neurosurgery . 1994;  34 548-551
  • 24 Halbach V V, Higashida R T, Dowd C. The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect.  J Neurosurg . 1994;  80 659-666
  • 25 Vargas M E, Kupersmith M J, Setton A. Endovascular treatment of giant aneurysms which cause visual loss.  Ophthalmology . 1994;  101 1091-1098
  • 26 Gurian J H, Martin N A, King W A. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization.  J Neurosurg . 1995;  83 843-853
  • 27 Civit T, Auque J, Marchal J C. Aneurysm clipping after endovascular treatment with coils: a report of eight patients.  Neurosurgery . 1996;  38 955-961
  • 28 Marks M P, Steinberg G K, Lane B. Combined use of endovascular coils and surgical clipping for intracranial aneurysms.  AJNR Am J Neuroradiol . 1995;  16 15-18
  • 29 David C A, Vishteh A G, Spetzler R F. Late angiographic follow-up review of surgically treated aneurysms.  J Neurosurg . 2001;  94 541-542
  • 30 Macdonald R L, Wallace M C, Kestle J R. Role of angiography following aneurysm surgery.  J Neurosurg . 1993;  79 826-832
  • 31 Derdeyn C P, Moran C J, Cross D T. Intraoperative digital subtraction angiography: a review of 112 consecutive examinations.  AJNR Am J Neuroradiol . 1995;  16 307-318
  • 32 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests.  J Neurosurg . 1987;  66 30-34
  • 33 Weir B. Aneurysms Affecting the Nervous System.  Baltimore, MD: Williams & Wilkins 1987
  • 34 King Jr T J, Berlin J A, Flamm E S. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis.  J Neurosurg . 1994;  81 837-842
  • 35 Brilstra E H, Rinkel G JE, van der Graaf Y. Treatment of intracranial aneurysms by embolization with coils; a systematic review.  Stroke . 1999;  30 470-476
  • 36 Vanninen R, Koivisto T, Saari T. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils-a prospective randomized study.  Radiology . 1999;  211 325-336
  • 37 Koivisto T, Vanninen R, Hurskainen H. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study.  Stroke . 2000;  31 2369-2377
  • 38 Dovey Z, Misra M, Thornton J. Guglielmi detachable coiling for intracranial aneurysms; the story so far.  Arch Neurol . 2001;  58 559-564
  • 39 van Gijn J, van Dongen J K. The time course of aneurysmal haemorrhage on computed tomograms.  Neuroradiology . 1982;  23 153-156
  • 40 Villablanca J P, Martin N, Jahan R. Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms.  J Neurosurg . 2000;  93 254-264
  • 41 White P M, Teasdale E M, Wardlaw J M, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detection-prospective blinded comparison in a large patient cohort.  Radiology . 2001;  219 739-749
  • 42 Newell D W, LeRoux P D, Dacey Jr G R. CT infusion scanning for the detection of cerebral aneurysms.  J Neurosurg . 1989;  71 175-179
  • 43 Noguchi K, Ogawa T, Inugami A. Acute subarachnoid hemorrhage: MR imaging with fluid-attenuated inversion recovery pulse sequences.  Radiology . 1995;  196 773-777
  • 44 Atlas S W, Sheppard L, Golldberg H I. Intracranial aneurysms: detection and characterization with MR angiography with use of an advanced postprocessing technique in a blinded-reader study.  Radiology . 1997;  203 807-814
  • 45 Adams W M, Laitt R D, Jackson A. The role of MR angiography in the pretreatment assessment of intracranial aneurysms: a comparative study.  AJNR Am J Neuroradiol . 2000;  21 1618-1628
  • 46 Cloft H J, Kallmes D F, Dion J E. A second look at the second-look angiogram in cases of subarachnoid hemorrhage.  Radiology . 1997;  205 323-325
  • 47 Iwanaga H, Wakai S, Ochiai C. Ruptured cerebral aneurysms missed by initial angiographic study.  Neurosurgery . 1990;  27 45-51
  • 48 Cloft H J, Joseph G J, Dion J E. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation.  Stroke . 1999;  30 317-320
  • 49 Strother C M. Interventional neuroradiology.  AJNR Am J Neuroradiol . 2000;  21 19-24
  • 50 Goto K, Halbach V V, Hardin C W. Permanent inflation of detachable balloons with a low-viscosity, hydrophilic polymerizing system.  Radiology . 1988;  169 787-790
  • 51 Guglielmi G, Viñuela F. Intracranial aneurysms; Guglielmi electrothrombotic coils.  Neurosurg Clin North Am . 1994;  5 427-435
  • 52 Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results.  J Neurosurg . 1991;  75 1-7
  • 53 Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience.  J Neurosurg . 1991;  75 8-14
  • 54 Hilal S K, Solomon R A. Endovascular treatment of aneurysms with coils (Letter).  J Neurosurg . 1992;  76 337-338
  • 55 Thielen K R, Nichols D A, Fulgham J R, Piepgras D G. Endovascular treatment of cerebral aneurysms following incomplete clipping.  J Neurosurg . 1997;  87 184-189
  • 56 Regli L, Uske A, de Tribolet N. Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series.  J Neurosurg . 1999;  90 1025-1030
  • 57 Eckard D A, O'Boynick P L, McPherson C M. Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms.  AJNR Am J Neuroradiol . 2000;  21 137-142
  • 58 Massoud T F, Guglielmi G, Viñuela F, Duckwiler G R. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation.  ANJR Am J Neuroradiol . 1996;  17 549-554
  • 59 Debrun G M, Aletich V A, Kehrli P. Aneurysm geometry: an important criterion in selecting patients for Guglielmi detachable coiling.  Neurol Med Chir Suppl . 1998;  38 1-20
  • 60 Gailloud P, Fasel J HD, Muster M. A case in favor of aneurysmographic studies: a perforating artery originating from the come of a basilar tip aneurysm.  AJNR Am J Neuroradiol . 1997;  18 1691-1694
  • 61 Shanno G B, Armonda R A, Benitez R P, Rosenwasser R H. Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms.  Neurosurgery . 2001;  48 1066-1072
  • 62 Turjman F, Massoud T F, Sayre J, Viñuela F. Predictors of aneurysmal occlusion in the period immediately after endovascular treatment with detachable coils: a multivariate analysis.  AJNR Am J Neuroradiol . 1998;  19 1645-1651
  • 63 Qureshi A I, Suri M FK, Khan J. Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients: safety and feasibility.  J Neurosurg . 2001;  94 880-885
  • 64 Satoh K, Satomi J, Matsubara S, Magahiro S. Measurement of volume ratio to predict coil compaction on aneurysmal embolization.  Intervent Neuroradiol . 1998;  4(Suppl 1) 179-182
  • 65 Reul J, Weis J, Spetzger U. Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils.  AJNR Am J Neuroradiol . 1997;  18 35-42
  • 66 Bavinzski G, Talozoglu V, Killer M. Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils.  J Neurosurg . 1999;  91 284-293
  • 67 Derdeyn C P, Cross D T, Moran C J. Procedural thrombus and postprocedural ischemic events after treatment of intracranial aneurysms with GDC.  J Neurosurg . 2002;  96 165A
  • 68 McDougall C G, Halbach V V, Dowd C F. Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils.  J Neurosurg . 1998;  89 87-92
  • 69 Ricolfi F, Le Guerinel C, Blustaijn J. Rupture during treatment of recently ruptured aneurysms with Guglielmi electrodetachable coils.  AJNR Am J Neuroradiol . 1998;  19 1653-1658
  • 70 Sluzewski M, Bosch J A, van Rooij J W. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors.  J Neurosurg . 2001;  94 238-240
  • 71 Nornes H. The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured aneurysm.  J Neurosurg . 1973;  39 226-234
  • 72 Halbach V V, Higashida R T, Dowd C F. Endovascular treatment of vertebral artery dissections and pseudoaneurysms.  J Neurosurg . 1993;  79 183-191
  • 73 Stahmer S A, Raps E C, Mines D I. Carotid and vertebral artery dissections.  Emerg Med Clin North Am . 1997;  15 677-698
  • 74 Yamaura I, Tani E, Yokota M. Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils.  J Neurosurg . 1999;  90 853-856
  • 75 Kurata A, Ohmomo T, Miyasaka Y. Coil embolization for the treatment of ruptured dissecting vertebral aneurysms.  AJNR Am J Neuroradiol . 2001;  22 11-18
  • 76 Drake C G. Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms.  J Neurosurg . 1975;  43 255-274
  • 77 Lylyk P, Ceratto R, Hurvitz D, Basso A. Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report.  Neurosurgery . 1998;  43 385-388
  • 78 Lylyk P, Cohen J, Ceratto R. Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils.  J Neurosurg . 2001;  94 427-432
  • 79 Mawad M E, Klucznik R P. Giant serpentine aneurysms: radiographic features and endovascular treatment.  AJNR Am J Neuroradiol . 1995;  15 1053-1060
  • 80 Graves V B, Peri II J, Strother C M. Endovascular occlusion of the carotid or vertebral artery with temporary proximal flow arrest and microcoils: clinical results.  AJNR Am J Neuroradiol . 1997;  18 1201-1206
  • 81 Barr J D, Lemley T J. Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: results in 19 patients.  AJNR Am J Neuroradiol . 1999;  20 1452-1456
  • 82 Masaryk T J, Perl II J, Wallace R C. Detachable balloon embolization: concomitant use of a second safety balloon.  AJNR Am J Neuroradiol . 1999;  20 1103-1106
  • 83 Mathis J M, Barr J D, Jungreis C A. Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases.  AJNR Am J Neuroradiol . 1995;  16 749-754
  • 84 Mericle R A, Lanzino G, Wakhloo A KK. Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report.  Neurosurgery . 1998;  43 1229-1234
  • 85 Wilms G, van Calenbergh F, Stockx L. Endovascular treatment of a ruptured paraclinoid aneurysm of the carotid siphon achieved using endovascular stent and endosaccular coil placement.  AJNR Am J Neuroradiol . 2000;  21 753-756
  • 86 Taki W, Nishi S, Yamashita K. Selection and combination of various endovascular techniques in the treatment of giant aneurysms.  J Neurosurg . 1992;  77 37-42
  • 87 Moret J, Cognard C, Weill A. The "remodelling technique" in the treatment of wide neck intracranial aneurysms; angiographic results and clinical follow-up in 56 cases.  Intervent Neuroradiol . 1997;  3 21-35
  • 88 Massoud T F, Turjman F, Ji C. Endovascular treatment of fusiform aneurysms with stents and coils; technical feasibility in a swine model.  Am J Neuroradiol . 1995;  16 1953-1963
  • 89 Geremia G, Bakon M, Brennecke L, Haklin M. Experimental arteriovenous fistulas: treatment with porous metallic stents.  AJNR Am J Neuroradiol . 1995;  16 1965-1973
  • 90 Jungreis C A. The use of stents in endovascular intervention.  AJNR Am J Neuroradiol . 1995;  16 1974-1976
  • 91 Wakhloo A K, Lanzino G, Lieber B B, Hopkins L N. Stents for intracranial aneurysms: the beginning of a new endovascular era?.  Neurosurgery . 1998;  43 377-384
  • 92 Higashida R T, Smith W, Gress D. Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature.  J Neurosurg . 1997;  87 944-949
  • 93 Lanzino G, Waklhoo A K, Fessler R D. Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms.  J Neurosurg . 1999;  91 538-546
  • 94 Phatouros C C, Sasaki T Y, Higashida R T. Stent-supported coil embolization: the treatment of fusiform and wide-neck aneurysms and pseudoaneurysms.  Neurosurgery . 2000;  47 107-113
  • 95 Murayama Y, Suzuki Y H, Viñuela F. Development of a biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part I: in vitro study.  AJNR Am J Neuroradiol . 1999;  20 1986-1991
  • 96 Murayama Y, Viñuela F, Suzuki Y. Development of the biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part II: an experimental study in a swine aneurysm model.  AJNR Am J Neuroradiol . 1999;  20 1992-1999
  • 97 Marx W F, Cloft H J, Helm G A. Endovascular treatment of experimental aneurysms by use of biologically modified embolic devices: coil-mediated intraaneurysmal delivery of fibroblast tissue allografts.  AJNR Am J Neuroradiol . 2001;  22 323-333
  • 98 Abrahams J M, Forman M S, Grady M S, Diamond S L. Delivery of human vascular endothelial growth factor with platinum coils enhances wall thickening and coil impregpnation in a rat aneurysm model.  AJNR Am J Neuroradiol . 2001;  22 1410-1417
  • 99 Raymond J, Desfaits A C, Roy D. Fibrinogen and vascular smooth muscle cell grafts promote healing of experimental aneurysms treated by embolization.  Stroke . 1999;  30 1657-1664
  • 100 Cognard C, Pierot L, Boulin A. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms.  Radiology . 1997;  202 783-792
  • 101 Weill A, Ducros V, Cognard C. Corrosion of tungsten spirals: a disturbing finding.  Intervent Neuroradiol . 1998;  4 337-340
  • 102 Reul J. Corrosion of tungsten spirals (Letter).  Intervent Neuroradiol . 1998;  4 341-342
  • 103 Pelz D. Potential hazards in the use of tungsten mechanical detachable coils (Letter).  Radiology . 2000;  214 602-603
  • 104 Murphy K J, Mandai S, Gailloud P. Neurovascular embolization: in vitro evaluation of a mechanical detachable platinum coil system.  Radiology . 2000;  217 904-906
  • 105 Murphy K J, Houdart E, Szopinski K T. Mechanical detachable platinum coil: report of the European phase II clinical trial in 60 patients.  Radiology . 2001;  219 541-544
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