Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients.

Abstract

Treatment of intracranial arterial aneurysms by interventional neurovascular techniques is now being performed in selected cases. From a transfemoral approach, under local anesthesia, a detachable silicone microballoon can be guided through the intracranial circulation, directed into the aneurysm, inflated with a polymerizing agent for solidification, and detached. The goal is to exclude the aneurysm from the circulation and preserve flow through the parent artery. Since 1984, 84 patients have been treated by this technique. The patients ranged in age from 15 to 83 years (mean age, 48) and included 63 females and 21 males. The distribution of aneurysms included 59 in the anterior circulation and 25 in the posterior circulation. The presenting symptom or cause was mass effect in 45 patients (53.6%), subarachnoid hemorrhage in 31 patients (36.9%), carotid-cavernous sinus fistula resulting from rupture of an intracavernous aneurysm in six cases (7.1%), trauma in one case, and transient cerebral ischemia due to emboli in one case. Permanent complications directly related to therapy included 15 deaths and nine cases of stroke. Clinical and radiologic follow-ups were performed 1, 3, and 12 months after treatment; duration of follow-up ranged from 3 to 68 months (mean, 35.5 months). In 65 cases (77.4%) there was evidence of complete aneurysmal occlusion, and in 19 cases 922.6%) there was subtotal occlusion greater than 85%. Interventional techniques for treatment of intracranial aneurysms may be useful as a therapeutic alternative in those patients not amenable to standard surgical therapy.