Figure 8.5 AP vertebral arteriogram of vertebrobasilar junction aneurysm which has been successfully treated with endovascular coiling portion of the wall or hole. Eventually organised thrombus does form within the aneurysm and the aneurysm is excluded from the parent vessel by the formation of an endothelialised layer of connective tissue that covers the neck's ostium. This has been demonstrated by Mawad in experimental dog models and in our own human autopsy studies.124,185

While the indications for GDC coils are continually expanding as surgeons become more skilful in their placement and new products are developed, they tend to be most successful in cases of aneurysms with small necks or necks that are smaller in diameter than the maximal aneurysm diameter and aneurysms without significant intrafundal thrombus. Nevertheless, decisions concerning their applications are made on a case by case basis and few dogmatic rules exist.

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