Endovascular therapy of ruptured vertebrobasilar aneurysms [Endovaskulare therapie akut symptomatischer vertebrobasilarer aneurysmen]

Seventy-five patients with subarachnoid hemorrhage were studied. The patients were evaluated and found to have 76 vertebrobasilar aneurysms (1 posterior aneurysm, 20 vertebral aneurysms, 2 cerebelli posterior and 53 basilar aneurysms [50 tip and 3 middle segment]). All but one underwent a single session of endovascular treatment: 9 with balloon occlusion and 67 with Guglielmi detachable coils (GDC). All but one showed complete or near complete radiological occlusion. Two patients experienced recurrences, one at 12 and another at 33 months post GDC treatment. Clinical results ranged from good to very good in 76% cases per Glasgow Outcome Scale. Overall mortality was 12%. Of the patients initially presenting with a Hunt and Hess (H and H) Grade of 4 or 5, 56% ranged clinically good to very good. Follow-up: Out of 28 patients GCD-treated as well as monitored angiographically for longer than a year, 3 were retreated. Mean follow-up was 15 months. Patients presenting with an H and H Grade of 4 or 5 usually have a poor prognosis. This study showed that good clinical results may still be achieved in such cases. Therefore, endovascular treatment post subarachnoid hemorrhage is therapeutically effective, particularly in the acute phase. Long-term studies (follow-up > 15 months) on GDC treatment of vertebrobasilar aneurysms remain to be carried out.