Murayama Y, Viñuela F, Duckwiler G R, Gobin Y P, Guglielmi G
Division of Interventional Neuroradiology, University of California, Los Angeles School of Medicine, 90024, USA.
J Neurosurg. 1999 Feb;90(2):207-14. doi: 10.3171/jns.1999.90.2.0207.
Guglielmi detachable coil (GDC) technology is a valuable therapeutic alternative to the surgical treatment of ruptured or incidental intracranial aneurysms. The authors describe their technical and clinical experience in the use of the GDC technique in patients who underwent endovascular occlusion for the treatment of incidentally found intracranial aneurysms.
One hundred fifteen patients with 120 incidentally found intracranial aneurysms underwent embolization by means of the GDC endovascular technique. Ninety-one patients were females and 24 were males. Patient age ranged from 13 to 80 years. In 64 patients the incidental aneurysms were discovered when unrelated nonneurological conditions signaled the need for angiography or magnetic resonance angiography (Group 1). Twenty patients who presented with incidental aneurysms that were discovered during treatment for an acutely ruptured aneurysm underwent treatment of both types of aneurysm during the acute phase of subarachnoid hemorrhage (SAH) (Group 2). Sixteen patients with incidental aneurysms were treated during the chronic phase of SAH (Group 3). Group 4 included 15 patients who had incidental aneurysms associated with brain tumors or arteriovenous malformations. Angiographic results revealed complete or near-complete occlusion in 109 aneurysms (91%) and incomplete occlusion in five aneurysms (4%). Guglielmi detachable coil embolization was attempted unsuccessfully in six aneurysms (5%). One hundred nine patients (94.8%) remained neurologically intact or unchanged from their initial clinical status. Five patients (4.3%) deteriorated as a result of immediate procedural complications. All these complications occurred in the first 50 patients treated in the series. No clinical complications were observed in the last 65 patients. In one patient, a partially embolized aneurysm ruptured 3 years postprocedure. In Groups 1 and 3, the average length of hospitalization was 3.3 days.
The evolution of GDC technology has proved to provide safe treatment of incidental aneurysms (a morbidity rate of 0% was achieved in the last 65 patients). The topography of the aneurysm and the clinical condition of the patient did not influence final anatomical or clinical outcomes. The GDC technology also confers a positive economic impact by decreasing hospital length of stay and by eliminating the need for postembolization intensive care.
Guglielmi可脱卸弹簧圈（GDC）技术是破裂或偶然发现的颅内动脉瘤外科治疗的一种有价值的治疗选择。作者描述了他们在使用GDC技术对偶然发现的颅内动脉瘤患者进行血管内栓塞治疗方面的技术和临床经验。
115例患者共120个偶然发现的颅内动脉瘤接受了GDC血管内技术栓塞治疗。其中女性91例，男性24例。患者年龄范围为13至80岁。64例患者在因非神经系统相关疾病行血管造影或磁共振血管造影时偶然发现动脉瘤（第1组）。20例在急性破裂动脉瘤治疗过程中偶然发现动脉瘤的患者在蛛网膜下腔出血（SAH）急性期对两种类型的动脉瘤均进行了治疗（第2组）。16例偶然发现动脉瘤的患者在SAH慢性期接受治疗（第3组）。第4组包括15例伴有脑肿瘤或动静脉畸形的偶然发现动脉瘤患者。血管造影结果显示，109个动脉瘤（91%）实现了完全或近乎完全闭塞，5个动脉瘤（4%）闭塞不完全。6个动脉瘤（5%）尝试Guglielmi可脱卸弹簧圈栓塞未成功。109例患者（94.8%）神经功能保持完整或与初始临床状态相比无变化。5例患者（4.3%）因即刻手术并发症病情恶化。所有这些并发症均发生在该系列治疗的前50例患者中。最后65例患者未观察到临床并发症。1例患者在术后3年部分栓塞的动脉瘤破裂。在第1组和第3组中，平均住院时间为3.3天。
GDC技术的发展已证明可为偶然发现的动脉瘤提供安全治疗（最后65例患者的发病率为0%）。动脉瘤的位置和患者的临床状况不影响最终的解剖或临床结果。GDC技术还通过缩短住院时间和消除栓塞后重症监护需求产生了积极的经济影响。
