Study Confirms Good Results of Coil Treatment for Aneurysms

Newswise — One of the largest studies to date confirms the high success rate and good safety record of coil occlusion therapy as an alternative to surgery for aneurysms of the brain, reports the February issue of Neurosurgery.

Dr. Hans Henkes and colleagues of Alfried Krupp Krankenhaus in Essen, Germany, report on the results of 1,579 patients undergoing endovascular coil occlusion at their hospital between 1992 and 2003. In this procedure, a catheter is threaded through the patients' arteries to block off the aneurysm using miniature platinum coils. A total of 1,811 aneurysms were treated.

In 86.5 percent of cases, the aneurysm was completely or nearly completely occluded using coil therapy. Three-fourths of patients were in excellent neurological condition when they left the hospital. Eighty-two percent of coil procedures were performed without complications.

The results were not as favorable in patients with wide-necked aneurysms. For these aneurysms, the coils often failed to remain in place, leading to a lower occlusion rate and a higher risk of complications. Complications were also more frequent when other types of endovascular devices were used, such as balloons or stents.

Ruptured aneurysm was a key risk factor. Just 42 percent of patients treated after aneurysm rupture achieved excellent clinical recovery, compared with 90 percent of those treated before aneurysm rupture. This reflected brain damage caused by subarachnoid hemorrhage, an extravasation of blood into the subarachnoid space, often due to aneurysm rupture and usually spreading throughout the cerebrospinal fluid pathways.

The rate of early complications after coil placement was about 5 percent. Although relatively safe, the procedure carried a 1.5 percent risk of death.

First introduced in the 1990s, endovascular coil treatment has become a widely used alternative to conventional surgery, in which a metallic clip is placed to seal off the aneurysm from the rest of the circulation. Most previous studies of this procedure have been relatively small, including at most several hundred patients. The new study represents one of the largest experiences of coil treatment reported so far.

The results suggest that the early results of coil treatment are at least as good as those reported for surgery. Coil occlusion has a high success rate and, especially if the patient is treated before aneurysm rupture, provides an excellent chance of full recovery with no neurological damage.

"Endovascular Coil Occlusion of 1811 Intracranial Aneurysms: Early Angiographic and Clinical Results" by Hans Henkes, MD, et.al.NeurosurgeryVol.. 54, No. 2, Pg. 268February 2004