Combined Endovascular Treatment for Both Intracranial Aneurysm

BACKGROUND AND PURPOSE: The best strategy for treatment of subarachnoid hemor-rhage due to ruptured cerebral aneurysm is obliteration of the aneurysm as soon as possible. Early surgery is desirable if the patient does not develop severe vasospasm or is clinically stable. However, if the patient has already developed severe vasospasm on admission, surgery may carry the risk of increasing the severity. We evaluated the safety and effectiveness of combined Guglielmi detachable coil (GDC) embolization and angioplasty in a single session for the treatment of ruptured aneurysms associated with symptomatic vasospasm. METHODS: From January 1992 to January 2001, 12 consecutive patients with ruptured aneurysms associated with symptomatic vasospasm were treated. Patients were classified as Hunt and Hess grade 2 (n 1), 3 (n 6), 4 (n 4), or 5 (n 1) and Fisher CT group 2 (n 1), 3 (n 10), or 4 (n 1). They underwent GDC aneurysm occlusion and balloon angioplasty (n 6), intraarterial papaverine infusion (n 2), or both (n 4) in a single session. In nine patients, aneurysm coil occlusion was performed first. RESULTS: Complete GDC occlusion was achieved in eight patients, a small neck remnant persisted in three, and embolization was incomplete in one patient. In all patients, angiographi