Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms.

OBJECTIVE

Guglielmi detachable coiling (GDC) has quickly become the most common endovascular method for the treatment of intracranial aneurysms. Although several published case series describe various authors' successful experiences or complications, few have elaborated on failed attempts. We examined our experience with GDC, and we analyzed all failed attempts at coiling.

METHODS

Patients who underwent endovascular procedures from September 1995 through July 1999 were identified using endovascular case logs and billing records. Patient charts were then reviewed retrospectively for failed attempts at GDC. A treatment failure was defined as an inability to place coils into an aneurysm, a GDC procedure-related complication resulting in death, or an acute rehemorrhage from a coiled aneurysm that indicated a failure of coils to prevent rerupture. Thromboembolic events and other nonfatal sources of morbidity that did not preclude coiling of the aneurysm were analyzed only to the extent that they prevented successful coiling of the aneurysm.

RESULTS

From September 1995 to June 1999, 241 patients underwent GDC embolizations or attempts. In these patients, 35 procedures were unsuccessful, including 7 deaths from intraoperative or postoperative aneurysmal rerupture. Sixteen aneurysms could not be microcatheterized, nine of which were anterior communicating artery aneurysms. Coils from 13 wide-necked aneurysms (average fundus-to-neck ratio, <2) prolapsed into the parent vessel. Three procedures were abandoned when the aneurysms were found to have normal branches filling from the dome, and three additional procedures were abandoned for technical reasons. Five deaths resulted from intraoperative aneurysm rupture, and two patients died postoperatively from rerupture.

CONCLUSION

The number of successful coiling procedures has increased with experience and improved technology. The procedure still involves risks, however, primarily for patients with subarachnoid hemorrhage.