Endovascular occlusion of intracranial aneurysms of the posterior circulation: comparison of balloons, free coils and detachable coils in 38 patients.

We treated 38 patients with 39 aneurysms of the posterior circulation by an endovascular technique using balloons, free coils or Guglielmi detachable coils (GDC) from 1986 to May 1993. The patients ranged in age from 10 to 71 years. Subarachnoid haemorrhage was the most frequent presentation (29 patients), followed by mass effect (5 patients) and epilepsy (2 patients). Treatment consisted of embolisation of the aneurysm with preservation of the parent vessel (in 29) or occlusion of the parent vessel (in 5). Multiple procedures were performed in 12 patients (32%, maximum 3 embolisations, total 17 treatments), because of incomplete initial aneurysm occlusion (in 8 cases) or re-opening of the aneurysm (in 9). Treatment could not be achieved in 5 patients. Good to excellent aneurysm occlusion was obtained in 28 patients (72%). Little or no neurological impairment occurred in 31 patients (82%). Complications related to treatment (11 patients, 29%) included 4 cases of transient cerebral ischaemia, 7 of stroke resulting in minimal neurological impairment (in 5), severe impairment (in 1) and one death. There were 6 patients who died, of rebleeding from the same aneurysm (2), basilar stroke (1) and unrelated causes (3). Comparison of the different occlusion techniques showed that the best angiographic results were obtained with balloons (good to excellent aneurysm occlusion was obtained in 17 of 22 patients treated) and the GDC (12 of 13 patients), and that less good results were given by free coils (4 of 9 patients). Complications related to treatment were fewest in patients treated with GDC (1 of 16 treatments, including multiple procedures) or free coils (2 of 12 treatments) and were more frequent with balloons (6 of 27 treatments). All five treatment failures occurred with balloon embolisation, whereas treatment was possible in all cases treated with free coils or GDC.