Virgil B. Graves

Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding.

The major causes of mortality and morbidity in patients surviving the rupture of a saccular aneurysm are subsequent bleeding and vasospasm. The purpose of this study was to evaluate the influence of early treatment of ruptured aneurysms with Guglielmi detachable coils on the incidence of subsequent bleeding. Thirteen patients were treated within 72 hours of initial aneurysm rupture with Guglielmi detachable coils. Excluding three patients who died 2, 4, and 12 weeks after initial hemorrhage, all others have been followed up for intervals between 6 and 36 months (mean, 16 mo). None of these have had either clinical or radiographic evidence of subsequent bleeding. Assuming that there is a 30% incidence of subsequent bleeding in conservatively (nonsurgically) treated patients, the 0% subsequent bleed rate observed in this subgroup was significant at a P value of 0.01. Only one procedure-related complication occurred in this series, and 9 of 13 (69%) aneurysms were 100% occluded at the time of initial treatment. All aneurysms were at least 90% occluded at the end of initial treatment. In addition to reducing the risk of subsequent bleeding, early treatment facilitated the institution of an aggressive approach for management of both vasospasm and increased intracranial pressure. Patient outcome, as measured by the Glasgow Outcome Scale, was good in 9 of 13 (69%), poor in 1 of 13 (8%), and death in 3 of 13 (23%) patients. The results of this study suggest that early Guglielmi detachable coil treatment of ruptured aneurysms may be effective in reducing the incidence of subsequent bleeding and can be performed with a low incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Early Treatment of Ruptured Aneurysms with Guglielmi Detachable Coils

ABSTRACTTHE MAJOR CAUSES of mortality and morbidity in patients surviving the rupture of a saccular aneurysm are subsequent bleeding and vasospasm. The purpose of this study was to evaluate the influence of early treatment of ruptured aneurysms with Guglielmi detachable coils on the incidence of sub

A new guidewire with kink-resistant core and low-friction coating

A new guidewire constructed from kinkresistant titanium-nickel alloy, polyurethane, and hydrophilic polymer is described. We have used this wire in 119 angiographic and 49 interventional procedures without complications. In numerous applications, it offers significant advantages over other guidewires. It is particularly helpful for angiography and interventional procedures requiring catheterization through markedly tortuos vessels, tight stenoses, or occlusions.

Intracranial arteriovenous malformations. Current imaging and treatment.

Patients with intracranial arteriovenous malformations (AVM) can expect significant mortality (15% to 20%) and morbidity (20% to 30%) over a 15-year to 20-year period. Recent advances in interventional neuroradiology, neurosurgery, neuroanesthesia, and stereotactic radiotherapy provide the opportunity to obliterate many of these lesions that were untreatable previously. The overall risk from treatment is estimated to be less than 50% that associated with untreated AVMs. For these reasons, it is important for the diagnostic radiologist to understand the diagnosis, natural history, treatment choices, and risks associated with patients with intracranial AVMs.