GDC를 이용한 뇌동맥류의 혈관내 치료: 4년간의 경험

Abstract

Objective : The authors evaluate the usefulness, results, and technical problem of endovascular treatment of cerebral aneurysms with Guglielmi detachable coil(GDC). Methods : Forty patients with 31 ruptured and 11 unruptured aneurysms were treated with GDC embolization. Twenty-four aneurysms were located in the anterior circulation and 18 in posterior circulation. Aneurysms size was categorized small(n=31) or large(n=11) and neck size was categorized narrow(n=30) or wide(n=12). We statistically analyzed occlusion rate according to the location, rupture, size, and neck size of aneurysms, and investigated the procedure-related complications and clinical outcomes. Results : GDC treatment of aneurysms was successful in 40 aneurysms of 39 patients(95.2%). Total occlusion was achieved in 24(60.0%) cases, subtotal occlusion in 12(30.%), and incomplete occlusion in 4(10.0%). Each total occlusion rate was 69.0% in small-sized, 36.4% in large-sized, 69.0% in narrow-necked, and 36.4% in wide-necked aneurysms. Location and rupture of aneurysms did not influence occlusion rate. The technical complications included 4 thromboembolisms, 3 parent artery occlusions, and 1 perforation of aneurysms. Procedure-related morbidity and mortality were 10.3% and 2.6%. 3 subtotally or incompletely embolized aneurysms in posterior circulation rebled during the follow-up period. Conclusion : The result of this study indicate that endovascular GDC treatment is an appropriate therapeutic alternative in cerebral aneurysms. However, the rebleeding by aneurysms recanalization or regrowth is a major limitation of GDC treatment. Follow-up angiography and further improvement are mandatory to overcome rebleeding.