Introduction of GDC Embolization in the Clinical Practice as Treatment Synergical to Surgery: Impact on Overall Outcome of Patients with Subarachnoid Hemorrhage |
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Authors: | P P Versari M Cenzato F Tartara C Righi F Simionato E Sganzerla R Marina S M Gaini G Scotti M Giovanelli |
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Institution: | (1) Department of Neurosurgery, S. Raffaele Hospital, Milan, Italy, IT;(2) Department of Neuroradiology, S. Raffaele Hospital, Milan, Italy, IT;(3) Department of Neurosurgery, S. Gerardo Hospital, Monza, Italy, IT;(4) Department of Radiology, S. Gerardo Hospital, Monza, Italy, IT |
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Abstract: | Summary The GDC endovascular approach represent an effective alternative to surgery for treatment of intracranial aneurysms. Anyway
no data are available about the impact of endovascular embolization with GDC on overall outcome of patients with subarachnoid
hemorrhage. We analyse retrospectively a series of 234 patients admitted for ruptured intracranial aneurysm. Results were
then compared with results of three surgical series from the literature.
The 95,7% of patients underwent aneurysm treatment; 56,4% of patients were classified as good recovery, 12,8% presented moderate
disability, 10,3% were severely disabled, 3% were in persistent vegetative state and 17,5% were dead. Patients older than
60 years accounted for 37% of all cases and good outcome in this group accounted for 54,7%. Good results were obtained in
90,1%, 61,7% and 22,8% of patients with Hunt-Hess grade I–II, III and IV–V respectively. Finally good outcome was observed
in 82,8% of patients with aneurysms of the posterior circulation.
Introduction of GDC embolization in clinical practice contributed to the extension of indication for aneurysm treatment leading
to a reduction of overall mortality. GDC utilisation does not affect the overall percentage of patients with good outcome
reflecting an increase of severely disabled patients. Endovascular treatment seems an effective theraputic choice in selected
grade I–II patients. Results in grade III patients suggest that surgery may be advantageous because of washing and decompression
of the basal cisterns while results in grade IV and V patients are unsatisfactory. GDC embolization clearly improves the prognosis
of patients with posterior circulation aneurysms and probably is an advantageous theraputic choice in elderly patients. |
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Keywords: | : Subarachnoid hemorrage GDC embolization surgical clipping outcome |
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