ENDOVASCULAR MANAGEMENT OF CEREBRAL ANEURYSMS

Background and purpose: Endovascular management of cerebral aneurysms has evolved rapidly worldwide within the last years and revolutionized the management of patients with intra-cranial aneurysms. The purpose of this study is to express our early experience in different endovascular techniques and to reinforce the use of them in management of ruptured cerebral aneurysms.Patients and methods: Between March 2008 and Feb. 2010, we conducted a retrospective review of our experience for a series of 25 patients harboring ruptured cerebral aneurysms undergone endovascular treatment in our institution, Deconstructive technique with parent artery occlusion is used in one patient, Two cases treated by balloon assisted technique and the rest of patients are treated by endo-saccular coil embolization. Patients are evaluated clinically by Hunt and Hess scale, Their CT scan evaluated according to Fisher scale, Short-term outcome was measured with Glasgow outcome scale.Results: 25 patients were included in our study, 15(60%) were female and 10(40%) were male with mean age was 48.16 years. Hypertension(52%) was the most commonly encountered risk factor. Average size of aneurysm treated was 8.6 mm. aneurysm perforation complicated 2 procedures(8 %), one patient (4%)showed parent artery occlusion with total peri-procedural complications(12%). Early rebleeding was documented in one case(4 %) and the patient died. 80% of our cases are completely occluded, 20% showed residual neck either intra-procedural or later.88% of our cases showed good recovery, 8% showed moderate disability. Our study revealed significant favorable clinical outcome correlated with good SAH grade on admission and low fischer grade on initial post-ictus CT.Conclusion: With rapidly evolving technology of endovascular embolization, accumulated experience, and good selection of patients with optimum angioanatomical criteria and endovascular accessibility, our results of morbidity and mortality associated with cerebral aneurysm treatment with short-term outcome show that endovascular embolization of cerebral aneurysms is a safe alternative and very feasible treatment method for the treatment of ruptured aneurysms.Keywords: Aneurysm treatment, Coiling, Peri-procedural complications, Clinical outcome.