Endovascular Cerebral Aneurysm Coil Embolization: Technical And Clinical Outcomes At A Tertiary Hospital In Kenya Over A 10 Year Period

Abstract

Endovascular coiling of cerebral aneurysms is now mainstay management of cerebral aneurysms, with reported better outcomes when compared to traditional surgical clipping .Until 2012, this service was not available locally and began late 2012 with yours truly, with lots of initial cost and material challenges. The first coiling  case happened in December of 2012 with limited coils.  Cases were sporadic between  2013-2017 due to cost and coil constraints  .In between 2018 and  2022 I have seen a steady rise of numbers of cerebral aneurysms treated by my team. Twenty eight [28] cerebral aneurysms were treated between 2012 and 2022 by coil embolization: 6 between 2012-2016, 10 between 2017 to 2021, and 12 in the year 2022. Age ranged from 28 years to 72 years, with a male: female ratio of 1:1.5.There was technical success rate of 90% of all patients .Twenty five patients went on to full recover post coiling at 3 months follow up. Of these 20% [5 patients] had mild to moderate symptoms of vasospasms post procedure conservatively managed. Two patients died one week post coiling due to severe intraprocedural vasospasms, one other patient died within 24 hours due to aneurysmal perforation during the coiling procedure with signicant subarachnoid haemorrhage. Vasospasms either intraop or within 24 hours post procedure was the commonest complication and was commoner in patients with higher grades of subarachnoid haemorrhage preprocedure .Intra-op  aneurysmal perforation were  the most feared complication. We conclude that cerebral aneurysm coiling is now well established for treatment of intracerebral aneurysms locally. Our experience and learning curve has been long complicated with cost and material constraints, but now plateaued to the point that we are now comfortable with coil embolization of these aneurysms with better good  outcomes.