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Endovascular Treatment of Basilar Tip Aneurysms with Guglielmi Detachable Coils: Predictors of Immediate and Long-term Results with Multivariate Analysis—6-year Experience¹

¹ From the Department of Neuroradiology and Therapeutic Angiography, Lariboisière Hospital, Paris, France (J.N.V., A.A., M.R., J.J.M.), and Department of Biophysics and Medical Informatics, Fernand Vidal Hospital (E.V.), Lariboisière Saint Louis Medical University of Paris 7, France. Received November 30, 2001; revision requested February 6, 2002; revision received May 6; accepted June 27. Address correspondence to J.N.V., Department of Diagnostic and Interventional Neuroradiology, Groupe Hospitalo-Universitaire Pitié-Salpétrière, 47-83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France (e-mail: jean-noel.vallee@psl.ap-hop-paris.fr).

View larger version (18K): [in a new window]   Figure 1. Graph shows age distribution of 53 patients with 55 saccular basilar tip aneurysms.

View larger version (181K): [in a new window]   Figure 2a. Images obtained in a 56-year-old man who had a Hunt-Hess grade 2 SAH who underwent occlusion with the GDC 10 days after onset. (a) Anteroposterior and (b) lateral angiograms of the left vertebral artery show a basilar tip aneurysm (arrow) with a maximum sac size of 12 mm and a neck size of 3 mm. (c) Anteroposterior and (d) lateral posttreatment angiograms show complete occlusion of the aneurysm (arrow). (e) Anteroposterior and (f) lateral angiograms of the left vertebral artery obtained 20 months later show persistence of the complete occlusion (arrow).

View larger version (186K): [in a new window]   Figure 2b. Images obtained in a 56-year-old man who had a Hunt-Hess grade 2 SAH who underwent occlusion with the GDC 10 days after onset. (a) Anteroposterior and (b) lateral angiograms of the left vertebral artery show a basilar tip aneurysm (arrow) with a maximum sac size of 12 mm and a neck size of 3 mm. (c) Anteroposterior and (d) lateral posttreatment angiograms show complete occlusion of the aneurysm (arrow). (e) Anteroposterior and (f) lateral angiograms of the left vertebral artery obtained 20 months later show persistence of the complete occlusion (arrow).

View larger version (173K): [in a new window]   Figure 2c. Images obtained in a 56-year-old man who had a Hunt-Hess grade 2 SAH who underwent occlusion with the GDC 10 days after onset. (a) Anteroposterior and (b) lateral angiograms of the left vertebral artery show a basilar tip aneurysm (arrow) with a maximum sac size of 12 mm and a neck size of 3 mm. (c) Anteroposterior and (d) lateral posttreatment angiograms show complete occlusion of the aneurysm (arrow). (e) Anteroposterior and (f) lateral angiograms of the left vertebral artery obtained 20 months later show persistence of the complete occlusion (arrow).

View larger version (182K): [in a new window]   Figure 2d. Images obtained in a 56-year-old man who had a Hunt-Hess grade 2 SAH who underwent occlusion with the GDC 10 days after onset. (a) Anteroposterior and (b) lateral angiograms of the left vertebral artery show a basilar tip aneurysm (arrow) with a maximum sac size of 12 mm and a neck size of 3 mm. (c) Anteroposterior and (d) lateral posttreatment angiograms show complete occlusion of the aneurysm (arrow). (e) Anteroposterior and (f) lateral angiograms of the left vertebral artery obtained 20 months later show persistence of the complete occlusion (arrow).

View larger version (204K): [in a new window]   Figure 2e. Images obtained in a 56-year-old man who had a Hunt-Hess grade 2 SAH who underwent occlusion with the GDC 10 days after onset. (a) Anteroposterior and (b) lateral angiograms of the left vertebral artery show a basilar tip aneurysm (arrow) with a maximum sac size of 12 mm and a neck size of 3 mm. (c) Anteroposterior and (d) lateral posttreatment angiograms show complete occlusion of the aneurysm (arrow). (e) Anteroposterior and (f) lateral angiograms of the left vertebral artery obtained 20 months later show persistence of the complete occlusion (arrow).

View larger version (192K): [in a new window]   Figure 2f. Images obtained in a 56-year-old man who had a Hunt-Hess grade 2 SAH who underwent occlusion with the GDC 10 days after onset. (a) Anteroposterior and (b) lateral angiograms of the left vertebral artery show a basilar tip aneurysm (arrow) with a maximum sac size of 12 mm and a neck size of 3 mm. (c) Anteroposterior and (d) lateral posttreatment angiograms show complete occlusion of the aneurysm (arrow). (e) Anteroposterior and (f) lateral angiograms of the left vertebral artery obtained 20 months later show persistence of the complete occlusion (arrow).

View larger version (31K): [in a new window]   Figure 3. Graph shows percentage of aneurysms completely occluded according to sac size at completion of the initial embolization, at the 6-12-month follow-up, and at the final angiographic follow-up (mean follow-up, 2 years). The percentage (blue bar) was calculated by dividing the number of aneurysms with a sac size less than 5 mm that were completely occluded by the number of aneurysms with a sac size less than 5 mm that were treated. Colors of bars represent sac size as follows: blue = less than 5 mm, red = 5-9 mm, green = 10-14 mm, purple = 15-24 mm, yellow = 25 mm or larger.

View larger version (18K): [in a new window]   Figure 4. Graph shows percentage of aneurysms completely occluded with a neck size of 4 mm or smaller (black bar) and of larger than 4 mm (white bar) at completion of the initial embolization, at the 6-12-month follow-up, and at the final angiographic follow-up (mean follow-up, 2 years). The percentage (black bar) was calculated by dividing the number of aneurysms with a neck size of 4 mm or smaller that were completely occluded by the number of aneurysms with a neck size of 4 mm or smaller that were treated.

View larger version (98K): [in a new window]   Figure 5a. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).

View larger version (223K): [in a new window]   Figure 5b. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).

View larger version (209K): [in a new window]   Figure 5c. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).

View larger version (162K): [in a new window]   Figure 5d. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).

View larger version (192K): [in a new window]   Figure 5e. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).

View larger version (174K): [in a new window]   Figure 5f. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).

View larger version (179K): [in a new window]   Figure 5g. Images obtained in a 35-year-old man who had a Hunt-Hess grade 2 SAH and underwent occlusion with the GDC 6 days later. (a) Anteroposterior angiogram of the left vertebral artery shows a basilar tip aneurysm (arrow) with a maximum sac size of 10 mm and a neck size larger than 4 mm. (b) The subtracted posttreatment angiogram shows near complete occlusion (>95%) of the aneurysm with a tiny neck remnant (arrow). (c) The subtracted angiogram obtained 6 months later shows an incompletely occluded aneurysm with recanalization (arrow) of the neck and changes in the mesh of the coils due to coil compaction. (d) Image shows repeat treatment by means of the remodeling technique with a balloon occlusive device (arrow); as a result of this treatment, (e) subtracted posttreatment angiogram shows that complete occlusion (arrow) was achieved. At 38 months of follow-up, (f) anteroposterior and (g) lateral angiograms show persistence of the complete occlusion (arrow).