Background and purpose: coiling occlusion has been widely recommended as a standard treatment for cerebral aneurysm. However, the experience of this technique in Vietnam is still limited. We report the prospective case series of coiling occlusion at 2 military hospitals. We studied outcome, recurrence and complications of coiling occlusion for cerebral ruptured aneurysms.

Method: a prospective analysis of all patients with endovascular coil occlusion aneurysms collected from June 2008 to April 2011. Long-term follow - up angiograms for 36 months.

Results: There were 110 patients with 127 aneurysms. Clinical characteristics: severe headache 96.4%, nausea and vomiting 95.5%, consciousness disorder 65.5%, Warning leak 48,2%. Outcome (12 months after discharge): good 94.8%, bad 5.2%, death 8.4%. Re-bleeding 40%. Recurrence 13%.

Conclusion: coiling is an effective method to prevent the aneurysm from re-rupturing. The complications is acceptable and outcome is good.

Key Words: cerebral aneurysm;  coiling occlusion

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PATIENTS AND METHODS

Patients

One hundred and ten intra-cerebral hemorrhage patients because of aneurysms rupturing at hospital 103 and Military central hospital 108 from June 2008 to April 2011.

Methods

Prospective study with long-term observation

All patients were examine thoroughly according to case report template. We used Hunt-Hess scale to rate the severe of clinical manifestation. Rankin scale was used to rate outcome. We observed complications, especially re-ruptured

We applied CT (or MRI), MRA and DSA for every patients. We collected data about location, shape, size, neck-diameter of aneurysms.

After coiling embolization we used heparin 500UI/h in the first 48 hours, and then aspirin 100mg/24h PO. Patients were maintain their systolic blood pressure 150-160mmHg, the central venous pressure 8-12cm H₂O, hematocrite 30-35%.

Re-examine and apply Angiographic follow-up at 3; 6; 12 and 36 months after treatment

We rated clinical state by Glasgow outcome scale: GOS IV-V = good; II-III = bad; I = death.

Statistic: we used SPSS 15.0

RESULTS AND COMMENT

Patients’ demographics

One hundred and ten patients were studied, their age from 27 to 79 year-old. Male/female 1.5/1.

Vascular headache is an important symptom in clinical practice, especially in young people.

“warning leak” sign appeared in 48.2% (fig 2). According to Forsting M, Wanke I, Pearse Morris 50% patients have warning leak sign. They have severe headache, nausea and/or vomiting 1-2 weeks. The symptom may disappear spontaneously. So most of those patient did not be diagnosed.

Most patients had Hunt-Hess scale I-III (66.4%). For more severe patients, we gave emergency aid first. Then we considered applying endovascular treatment if they became better.

Aneurysms characteristics

Most patients (86.4%) have 1 aneurysm.

There were 62.6% aneurysms have narrow neck and 37.4 have wide neck.

Shape of aneurysms: saccular aneurysm 98.2%; fusiform aneurysm 1.8%.

Outcome

Good outcome at discharge 68.2%, after 12 months 94.8%. In a study of Dai Dinh Pham, mortality rate of patient who was treated by internal medicine only (without endovascular therapy) is 55.7%.

In a study of Pierot L (138 patients): complete occlusion 61.5%, neck remnant 33.2%, incomplete occlusion 5.3%. In study of Pierot L. on 138 patients: complete occlusion 61.5%; neck remnant 33.2%; incomplete occlusion 5.3%.

COMPLICATIONS

There were 15.9% patients manifest complications. We treated successfully for 88.2% of them.

We detected 39.2% patients had vascular constriction on DSA but only 25.2% manifested clinical state of constriction.

Constriction expressed in 36.4% patients and 12.1% of them had ischemic injury because of vascular constriction.

ANEURYSM RECURRENCE AFTER COILING

We detected recurrence on 2.5% patients after 3 months; 4.8 after 4.8 months and 0% after 36 months.

CONCLUSION

After studying on 110 intra-cerebral hemorrhage patients because of aneurysms rupturing at hospital 103 and Military central hospital 108 from June 2008 to April 2011 we had conclusions:

- History of disease: hypertension 54.5%; vascular headache 45.5%.

- Onset symptoms: “warning leak” 48.2%; nausea/ vomiting 95.5%; severe headache 96.4%.

- Popular location of aneurysms is in anterior communicating arteries.

- Outcome: Good outcome at discharge 68.2%, after 12 months 94.8%.

- Complications: There were 15.9% patients manifest complications. We treated successfully for 88.2%. Among 8 patients (7.5%) re-rupture during endovascular treatment, we treated successful for 7 patients.

References

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7. 7. Pearse Morris. (2007), Practical Neuroangiography, Lipprincott Williams & Wilkins, Philadelphia USA, (Philadelphia. Baltimre, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo).
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Dinh Dai Pham; Phuc Duc Dang - from the Department of Stroke, Hospital 103, Hanoi, Vietnam