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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
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Publication History

Publication Date:
21 January 2003 (online)

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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.

KEYWORD

Intracranial aneurysms - subarachnoid hemorrhage - saccular aneurysm (berry aneurysm) - dissecting aneurysm - endovascular therapy - Guglielmi detachable coil (GDC)

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