Aneurysmal Subarachnoid Hemorrhage in Patients with Hunt and Hess Grade 4 or 5: Treatment Using the Guglielmi Detachable Coil System

• Published in: American journal of neuroradiology : AJNR 2003-04, Vol.24 (4), p.585-590
• Main Authors: Weir, Raymond U, Marcellus, Mary L, Do, Huy M, Steinberg, Gary K, Marks, Michael P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - classification; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - mortality; Aneurysm, Ruptured - therapy; Angioplasty, Balloon; Biological and medical sciences; Cerebral Angiography; Embolization, Therapeutic - instrumentation; Female; Follow-Up Studies; Humans; Interventional; Intracranial Aneurysm - classification; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - mortality; Intracranial Aneurysm - therapy; Male; Medical sciences; Middle Aged; Neurology; Prognosis; Prostheses and Implants; Recurrence; Retreatment; Retrospective Studies; Subarachnoid Hemorrhage - classification; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - therapy; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - mortality; Vasospasm, Intracranial - therapy
• ISSN: 0195-6108; 1936-959X

Patients in poor clinical condition (Hunt and Hess grade 4 or 5) after subarachnoid hemorrhage (SAH) have historically fared poorly and many often were excluded from aggressive treatment. Early aggressive surgical treatment of SAH can produce good-quality survival for a higher percentage of patients than previously reported. We assessed the outcome of patients with Hunt and Hess grade 4 or 5 who were treated with Guglielmi detachable coil (GDC) embolization. We retrospectively evaluated the records of 27 consecutive grade 4 and 5 patients with 29 aneurysms treated within 72 hours of SAH by using GDCs. Percentage aneurysm occlusion after embolization, perioperative complications, and symptoms of vasospasm were evaluated. Outcome was assessed with the Glasgow Outcome Scale. Sixteen patients (59%) were grade 4, and 11 (41%) were grade 5. Eighteen (67%) had one aneurysm, six (22%) had two aneurysms, and three (11%) had three aneurysms. Twenty-nine aneurysms were treated. Fourteen (48%) were completely occluded, and four (14%) were nearly completely occluded (>/=95% occlusion) at embolization. Eleven aneurysms (38%) had partial coiling (