Selective Endovascular Treatment of Intracranial Aneurysms with a Liquid Embolic: A Single-Center Experience in 39 Patients with 41 Aneurysms

Abstract

BACKGROUND AND PURPOSE: Although embolization with detachable coils is an accepted alternative to surgical clipping, a major long-term problem is aneurysm recanalization due to coil compaction. Liquid embolic agents are a possible alternative as filling material that might decrease the recanalization rate. We evaluated the use of a liquid embolic for endovascular treatment of intracranial aneurysms.

METHODS: During 1999–2003, 10 patients with 11 small aneurysms (group 1) and 29 patients with 30 large or giant aneurysms (group 2) were treated with a liquid embolic. Of 32 female and seven male patients, 20 had mass effect and two had subarachnoid hemorrhage; 17 were asymptomatic. All aneurysms were judged unsuitable for regular treatment; selective embolization was performed with a liquid embolic alone or with coils and liquid embolic. Stent placement was performed in 15 cases. Clinical and anatomic outcomes were assessed with the Modified Glasgow Outcome Scale and with angiography at 3, 12, and 24 months.

RESULTS: In group 1, good or excellent outcome and complete occlusion were observed in all patients. In group 2, clinical outcome was good or excellent in 26 patients and fair in one, and death occurred in two patients (one procedure related and one disease related). Technical complications occurred in four patients in group 1 (one permanent neurologic deficit) and in four patients in group 2 (one patient died, two remain hemiparetic, one remains asymptomatic). Follow-up images showed two recanalizations in group 1 and nine in group 2.

CONCLUSION: Selective embolization with a liquid embolic is useful to treat aneurysms unsuitable for coiling or for patients in whom previous treatment failed. This mostly applies to large and giant aneurysms in which morbidity and mortality rates are better than those associated with surgery, and the recanalization rate is lower than that previously described with coiling.