Vascular and Interventional Radiology

Ruptured Intracranial Aneurysms: Acute Endovascular Treatment with Electrolytically Detachable Coils—A Prospective Randomized Study

PURPOSE: To compare the use of electrolytically detachable coils versus surgical ligation for the management of acutely ruptured intracranial aneurysm.

MATERIALS AND METHODS: A prospective randomized study included 109 patients with acute (<72 hours) subarachnoid hemorrhage caused by a ruptured aneurysm (Hunt and Hess grade I–II [n = 67], grade III [n = 26], or grade IV–V [n = 16]). All patients were suitable candidates for both endovascular and surgical treatment and were randomly assigned to undergo coil embolization (n = 52) or surgical ligation (n = 57).

RESULTS: Significantly better primary angiographic results were achieved after surgery in patients with anterior cerebral artery aneurysm (n = 55, P = .005) and after endovascular treatment in those with posterior circulation aneurysm (n = 11, P = .045). No significant differences were seen in middle cerebral artery (n = 19) or internal carotid artery (n = 24) aneurysms. Early rebleeding occurred in one patient after incomplete coil embolization. The technique-related mortality rate was 4% in the surgical group and 2% in the endovascular group. Clinical outcome (Glasgow Outcome Scale score) at 3 months was not significantly different between treatment groups in terms of intended treatment modality. No late rebleedings had occurred at the time of this writing.

CONCLUSION: In selected patients with a recently ruptured intracranial aneurysm, favorable results were achieved by using endovascular treatment. Subsequent acute or late open surgery was sometimes required. The clinical outcome at 3 months was comparable in the endovascular and surgical treatment groups.


  • 1 Schievink WI. Intracranial aneurysms. N Engl J Med 1997; 336: 28-40. Crossref, MedlineGoogle Scholar
  • 2 Kassell NF, Drake CG. Review of the management of saccular aneurysms. Neurol Clin 1983; 1: 73-86. Crossref, MedlineGoogle Scholar
  • 3 Hernesniemi J, Vapalahti M, Niskanen M, et al. One-year outcome in early aneurysm surgery: a 14 years experience. Acta Neurochir (Wien) 1993; 122: 1-10. Crossref, MedlineGoogle Scholar
  • 4 Fogelholm R, Hernesniemi J, Vapalahti M. Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage: a population-based study. Stroke 1993; 24: 1649-1654. Crossref, MedlineGoogle Scholar
  • 5 Viñuela F, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 1997; 86: 475-482. Crossref, MedlineGoogle Scholar
  • 6 Kassell NF, Torner JC, Haley EC, Jr, Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysm Surgery. I. Overall management results. J Neurosurg 1990; 73: 18-36. Google Scholar
  • 7 Kassell NF, Torner JC, Jane JA, Haley EC, Jr, Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. II. Surgical results. J Neurosurg 1990; 73: 37-47. Google Scholar
  • 8 Öhman J, Heiskanen O. Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. J Neurosurg 1989; 70: 55-60. Crossref, MedlineGoogle Scholar
  • 9 Malisch TW, Guglielmi G, Vinuela F, et al. Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 1997; 87: 176-183. Crossref, MedlineGoogle Scholar
  • 10 Guglielmi G, Vinuela F, Duckwiler G, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992; 77: 515-524. Crossref, MedlineGoogle Scholar
  • 11 Casasco AE, Aymard A, Gobin YP, et al. Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 1993; 79: 3-10. Crossref, MedlineGoogle Scholar
  • 12 McDougall CG, Halbach VV, Dowd CF, Higashida RT, Larsen DW, Hieshima GB. Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 1996; 84: 393-399. Crossref, MedlineGoogle Scholar
  • 13 Richling B, Gross C, Gruber A, Killer M. Early clinical outcome of patients with ruptured cerebral aneurysms treated by endovascular (GDC) or microsurgical techniques: a single center experience. Intervent Neuroradiol 1995; 1: 19-27. Crossref, MedlineGoogle Scholar
  • 14 Raymond J, Roy D, Bojanowski M, Moumdjian R, L'Esperance G. Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 1997; 86: 211-219. Crossref, MedlineGoogle Scholar
  • 15 Byrne JV, Molyneux AJ, Brennan RP, Renowden SA. Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 1995; 59: 616-620. Crossref, MedlineGoogle Scholar
  • 16 Tournade A, Courtheoux P, Sengel C, Ozgulle S, Tajahmady T. Saccular intracranial aneurysms: endovascular treatment with mechanical detachable spiral coils. Radiology 1997; 202: 481-486. LinkGoogle Scholar
  • 17 Moret J, Pierot L, Boulin A, Castaings L, Rey A. Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 1996; 38: 800-805. Crossref, MedlineGoogle Scholar
  • 18 Nichols DA, Brown RD, Jr, Thielen KR, Meyer FB, Atkinson JL, Piepgras DG. Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 1997; 87: 374-380. Crossref, MedlineGoogle Scholar
  • 19 Cognard C, Pierot L, Boulin A, et al. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology 1997; 202: 783-792. LinkGoogle Scholar
  • 20 Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 1998; 206: 499-510. LinkGoogle Scholar
  • 21 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28: 14-19. Crossref, MedlineGoogle Scholar
  • 22 Jennet B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975; 1: 480-484. Crossref, MedlineGoogle Scholar
  • 23 Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1-9. Crossref, MedlineGoogle Scholar
  • 24 Fernandez-Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 1994; 15: 815-820. MedlineGoogle Scholar
  • 25 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodeling technique” in the treatment of wide neck intracranial aneurysms: angiographic results and clinical follow-up in 56 cases. Intervent Neuroradiol 1997; 3: 21-35. Crossref, MedlineGoogle Scholar
  • 26 Levy DI, Ku A. Balloon-assisted coil placement in wide-necked aneurysms: technical note. J Neurosurg 1997; 86: 724-727. Crossref, MedlineGoogle Scholar
  • 27 Marotta TR, Buller C, Taylor D, Morris C, Zwimpfer T. Autologous vein–covered stent repair of a cervical internal carotid artery pseudoaneurysm: technical case report. Neurosurgery 1998; 42: 408-412. Crossref, MedlineGoogle Scholar
  • 28 Szikora I, Guterman LR, Wells KM, Hopkins LN. Combined use of stents and coils to treat experimental wide-necked carotid aneurysms: preliminary results. AJNR 1994; 15: 1091-1102. MedlineGoogle Scholar
  • 29 Perez-Cruet MJ, Patwardhan RV, Mawad ME, Rose JE. Treatment of dissecting pseudoaneurysm of the cervical internal carotid artery using a wall stent and detachable coils: case report. Neurosurgery 1997; 40: 622-625. Crossref, MedlineGoogle Scholar
  • 30 Hernesniemi J, Vapalahti M, Niskanen M, Kari A. Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 1992; 31: 857-861. Crossref, MedlineGoogle Scholar
  • 31 Peerless SJ, Hernesniemi JA, Gutman FB, Drake CG. Early surgery for ruptured vertebrobasilar aneurysms. J Neurosurg 1994; 80: 643-649. Crossref, MedlineGoogle Scholar
  • 32 Drake CG, Peerless SJ, Hernesniemi JA. Complications of surgery for vertebrobasilar artery aneurysms and final comments In: Surgery of vertebrobasilar aneurysms: London, Ontario, experience on 1,767 patients. New York, NY: Springer-Verlag, 1996; 300-311. Google Scholar
  • 33 Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Vinuela F. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 1995; 83: 843-853. Crossref, MedlineGoogle Scholar
  • 34 Mizoi K, Yoshimoto T, Takahashi A, Nagamine Y. A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 1996; 39: 165-168. Crossref, MedlineGoogle Scholar
  • 35 Niskanen MM, Hernesniemi JA, Vapalahti MP, Kari A. One-year outcome in early aneurysm surgery: prediction of outcome. Acta Neurochir (Wien) 1993; 123: 25-32. Crossref, MedlineGoogle Scholar
  • 36 Tapaninaho A, Hernesniemi J, Vapalahti M, et al. Shunt-dependent hydrocephalus after subarachnoid haemorrhage and aneurysm surgery: timing of surgery is not a risk factor. Acta Neurochir (Wien) 1993; 123: 118-124. Crossref, MedlineGoogle Scholar
  • 37 Gruber A, Ungersböck K, Reinprecht A, et al. Evaluation of cerebral vasospasm after early surgical and endovascular treatment of ruptured intracranial aneurysms. Neurosurgery 1998; 42: 258-268. Crossref, MedlineGoogle Scholar
  • 38 Lin T, Fox AJ, Drake CG. Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 1989; 70: 556-560. Crossref, MedlineGoogle Scholar
  • 39 Suzuki J, Kwak R, Katakura R. Angiographical consideration of residual aneurysms following direct operations on intracranial aneurysms. In: Suzuki J, eds. Cerebral aneurysms; experience with 1000 directly operated cases. Tokyo, Japan: Neuron, 1979; 619-630. Google Scholar
  • 40 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests. J Neurosurg 1987; 66: 30-34. Crossref, MedlineGoogle Scholar
  • 41 Ebina K, Suzuki M, Andoh A, Saitoh K, Iwabuchi T. Recurrence of cerebral aneurysm after initial neck clipping. Neurosurgery 1982; 11: 764-768. Crossref, MedlineGoogle Scholar
  • 42 Reul J, Weis J, Spetzger U, Konert T, Fricke C, Thron A. Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils. AJNR 1997; 18: 35-42. MedlineGoogle Scholar
  • 43 Spetzger U, Reul J, Weis J, Bertalanffy H, Thron A, Gilsbach JM. Microsurgically produced bifurcation aneurysms in a rabbit model for endovascular coil embolization. J Neurosurg 1996; 85: 488-495. Crossref, MedlineGoogle Scholar
  • 44 Reul J, Spetzger U, Weis J, Sure U, Gilsbach JM, Thron A. Endovascular occlusion of experimental aneurysms with detachable coils: influence of packing density and perioperative anticoagulation. Neurosurgery 1997; 41: 1160-1165. Crossref, MedlineGoogle Scholar

Article History

Published in print: May 1999