Embolization of cerebral aneurysms using Guglielmi detachable coils--problems and treatment plans in the acute stage after subarachnoid hemorrhage and long-term efficiency.

This study investigated the problems in treating ruptured aneurysms using Guglielmi detachable coils (GDCs) in the acute stage and evaluated the long-term efficacy in a series of 25 patients with 29 aneurysms. Eight patients with ruptured aneurysm treated within 2 weeks of the onset of subarachnoid hemorrhage (SAH) suffered no mortality or morbidity related to the procedure. Five patients achieved good outcomes despite severe SAH and returned to their previous lives. Three patients had poor clinical outcomes, two related to vasospasm and one related to pulmonary complication. More than 9 months follow-up was completed in 14 patients with 16 aneurysms. All six small aneurysms with small necks were completely obliterated and no recanalization was seen, and two of the eight large or giant aneurysms were completely obliterated. Recanalization was seen in four large or giant aneurysms and one small aneurysm due to coil compaction within 13 months. One patient died of rupture of a large aneurysm 18 months after complete obliteration of the aneurysm. Embolization using GDCs in the acute stage after SAH can prevent rerupture of cerebral aneurysms. However, recanalization due to coil compaction was the major problem in the chronic stage. Intensive follow-up and additional embolization, if necessary, is important.