Basilar tip aneurysm: endovascular treatment with Guglielmi detachable coils--midterm results.

Abstract

To determine the safety and effectiveness of Guglielmi detachable coils in the endovascular treatment of ruptured and nonruptured basilar tip aneurysms. A basilar tip aneurysm was occluded with Guglielmi detachable coils in 21 patients. The aneurysmal diameter was small (less than 12 mm) in 15 patients, large (12-25 mm) in four patients, and giant (more than 25 mm) in two patients. Angiographic follow-up ranged from 6 to 48 months (mean, 26 months); clinical follow-up ranged from 1 to 48 months. Embolization was technically successful in all patients. Complete occlusion was achieved in 14 (67%) patients; 90% occlusion was achieved in seven (33%) patients. There was partial reperfusion of the aneurysm in three patients (14%) after 6 months, which necessitated repeated embolization. The clinical results were excellent in 13 patients, good in six, and fair in one. One patient died 2 months after the embolization due to pulmonary complications. A posterior cerebral artery was occluded in five (24%) patients; one of these patients developed a permanent neurologic deficit, one developed a transient neurologic deficit, and three had no clinical symptoms. Endovascular treatment of a basilar tip aneurysm with Guglielmi detachable coils seems to be a safe and less invasive alternative to surgical clipping.