Since the introduction of the Gugliemli detachable coils (GDCs) in clinical research trials in 1991, over 40,000 patients worldwide with cerebral aneurysms have been treated with the device. The safety and efficacy of GDCs in preventing rehemorrhage of previously ruptured cerebral aneurysms was proved in the initial multicenter GDC trial, and subsequently has been substantiated in multiple published reports from major medical centers internationally. The multicenter GDC trial, which resulted in eventual Food and Drug Administration approval of the device in 1995, evaluated the GDCs for the treatment of aneurysms considered to be at increased risk for conventional surgical clipping. GDCs are being used with increasing frequency to treat aneurysms that are not considered to be at increased risk for surgical clipping. This is particularly true in Europe, but less so in North America. There are now 210 medical centers in the United States with the capability to use GDCs. Approximately 3500 aneurysms annually are being treated with GDCs in the United States; however, this represents only approximately 15% of all treated aneurysms. What is preventing endovascular coil occlusion from becoming the preferred method of treatment for aneurysms that are currently considered “surgical?”
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