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Endovascular coiling in acute aneurysmal subarachnoid hemorrhage in a community hospital: A retrospective outcomes analysis

1 August 2003


Objective: The purpose of this study is to retrospectively analyze the short-term and long-term results of endovascular coil embolization with ODCs for ruptured intracranial aneurysms in a community hospital over the past 4.5 years.

Methods: Between January 1999 and May 2003, 30 patients (mean age, 53.5 years) who were admitted to Maui Memorial Medical Center with an acute, aneurysmal subarachnoid hemorrhage were treated with endovascular ODC therapy. One patient was treated with a combination of ODCs and a neurovascular microstent. Majority of the patients were female (83%). The Hunt and Hess grading system was used to measure clinical presentation. Six (20%) had a HH grade I-Il, seven had a HH grade Ill, and seventeen (57%) had a HH grade IV-V. The Fisher Scale was used to estimate the amount of blood within the subarachnoid space on CT scanning. Twenty-eight (94%) had a Fisher grade 3 or 4, and two had a Fisher grade 1 or 2. Short-term clinical outcomes were measured at time of discharge or at 30 days, and long-term clinical outcomes were measured at a mean follow-up interval of 19.1 months using the Olasgow Outcome Scale (OOS). All patients had immediate postembolization angiography, and in most cases follow-up angiography was recommended in 6 months and again in I year. Results: In the short-term clinical outcomes, eleven patients (37%) had a OOS of 4-5, ten patients (33%) had a OOS of 2-3, and nine patients (30%) died. In the long-term clinical outcomes, sixteen patients (80%) had a OOS of 4-5, three patients (16%) had a OOS of 2-3, and there was only one death (5%). No treated aneurysms rebled dring the short-term and long-term follow-up periods. Immediate postembolization angiography demonstrated that fifteen aneurysms (45%) were completely occluded, and eighteen (55%) were partially occluded. Procedural complications occurred in only two patients (6.6%). Six (20%) had a second procedure completed.

Conclusion: Endovascular treatment of ruptured intracranial aneurysms with ODCs demonstrates good short-term safety and efficacy in preventing aneurysmal rebleeding. Overall, good outcomes were demonstrated in both the short-tern and long-term clinical follow-up in patients with acute subarachnoid hemorrhage. Long-term angiographic durability and prevention of rebleeding as compared to surgical clipping warrants further study. The newly introduced copolymer coated coils and neurovascular microstent system show great promise in the treatment of wide neck aneurysms and aneurysms with the potential to recanalize.


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