Limitation of Endovascular Treatment for Ruptured Cerebral Aneurysms: Results from the Protocol "GDC as the first choice".

SUMMARY: Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wideneck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.