In the initial series of 735 aneurysms treated with GDCs presented for FDA evaluation, the procedure was successful in 75% of cases, with a greater than 90% occlusion of the lumen. Seventy-three percent of the treated patients had good outcomes. The overall morbidity/mortality was 14%. This series was, however, influenced by patient selection. The patients were required to be poor surgical candidates [17].

More recent series [10,18-20] show that ruptured aneurysms may be treated, with better or similar outcomes to surgical series.

According to Cognard et al. [10], 208 patients with 236 intracranial aneurysms underwent endovascular coil embolization. One hundred and fifty patients had SAH at the time of presentation. Follow-up in 152 aneurysms demonstrated total occlusion in 123, subtotal occlusion in 26 and incomplete occlusion in 3. Technique-related morbidity was 4% (seven patients with permanent neurological deficits due to clotting) and mortality 2% (peri-operative rupture in two, hematoma due to urokinase perfusion in one, re-bleeding of the initial hematoma after excessive uncontrolled anticoagulation in one). Re-bleeding occurred in one patient after incomplete occlusion.

A prospective randomized study from Finland [19] included 109 patients with acute (less than 72 hours) SAH caused by ruptured aneurysm. All were suitable candidates for both endovascular and surgical treatment and were randomly assigned to undergo coil emboliza-

tion. Significantly better primary angiographic results were obtained after surgery in patients with anterior cerebral aneurysms, and after endovascular treatment in those with posterior circulation aneurysms, with no significant difference seen in patients with middle cerebral artery aneurysms. Early re-bleeding occurred after incomplete coil embolization. The technique-related mortality was 4% in the surgical group and 2% in the endovascular group. Clinical outcome (Glasgow outcome score) at 3 months was not significantly different between treatment groups in terms of intended treatment modality.

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Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

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