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Journal articles on the topic 'Endovascular coil embolization'
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1
Lamano, Jonathan B., Grace G. Bushnell, Hongyu Chen, et al. "Force Characterization of Intracranial Endovascular Embolization." Neurosurgery 75, no. 6 (2014): 707–16. http://dx.doi.org/10.1227/neu.0000000000000525.
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Abstract Background: Intraoperative rupture (IOR) is a rare, but potentially morbid complication of endovascular aneurysm coil embolization. Yet, IOR predictors have remained relatively uninvestigated in relation to coil design. Objective: To develop a novel in vitro aneurysm model to characterize forces exerted by coils of different design on the aneurysm during endovascular embolization that are hypothesized to contribute to IOR. Methods: A 3-mm saccular aneurysm model was developed with flat latex membrane at the dome apex. Membrane deflection was observed throughout simulated embolization and converted to force measurement. Simultaneous coil insertion and force measurement were accomplished with a compression strength-testing machine. Membrane and insertion forces across coil type, microcatheter tip placement, and insertion rate were evaluated. Results: Insertion force and force directly on the aneurysm wall exhibited a difference, with framing coils exerting greatest force, followed by filling and finishing coils. Regarding microcatheter placement, a similar graded response in membrane and insertion forces was observed with positioning in the top-third of the aneurysm generating the greatest force compared with central and bottom-third placement. Insertion rate was also a factor with the slowest rate (10 mm/min) exhibiting the greatest membrane force, followed by lower forces at 30 and 50 mm/min. A multiple linear regression model was created to assess the contributions of each factor toward aneurysm forces. Conclusion: Increased force on the aneurysm is associated with framing coil use, microcatheter placement proximal to aneurysm dome, and slow insertion rate. Further characterization remains necessary to reduce IOR risk, especially concerning the contributions of insertion rate.
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Tsumoto, T., T. Terada, H. Yamaga, and T. Itakura. "Endovascular Coil Embolization for Cerebral Aneurysms Solely Using Ultrasoft Coils." Interventional Neuroradiology 12, no. 1_suppl (2006): 101–4. http://dx.doi.org/10.1177/15910199060120s115.
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We report a series of coil embolizations for small aneurysms solely using GDC ultrasoft coils and discuss the advantages of this method. Seven small aneurysms (<4.0 mm) were embolized solely with ultrasoft coils. Ultrasoft coils were sequentially inserted into aneurysms. Immediately after embolization, five aneurysms were completely occluded, and two exhibited body filling. All cases were treated successfully without any complications. In conclusion, ultrasoft coils were found efficacious for the treatment of small, irregular-shaped, and ruptured aneurysms; their softness and malleability facilitated their compaction into an aneurysm.
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Nakabayashi, K., M. Negoro, Y. Itou, and K. Ichihara. "Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms." Interventional Neuroradiology 3, no. 2_suppl (1997): 171–76. http://dx.doi.org/10.1177/15910199970030s236.
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We compare the results of detachable coil embolization with those of surgical clipping in patients with posterior circulation aneurysms. Surgical procedure was performed in 31 patients (basilar tip: 13 cases, SCA: 8 cases, basilar trunk: 1 case, VA: 9 cases). Thirty one aneurysms were treated by embolization with Guglielmi detachable coil (GDC) and interlocking detachable coil (IDC) (basilar tip: 14 cases, SCA: 1 case, basilar trunk: 6 cases, VA: 10 cases). In surgical cases, clinical outcome at discharge showed good recovery (GR) in 14 cases, moderate deficits (MD) in 11 cases, severe deficits (SD) in 2 cases, and dead (D) in 4 cases. In embolization cases, clinical outcome at discharge showed GR in 19 cases, MD in 4 cases, SD in 1 case, and D in 1 case. Embolization with detachable coils is less invasive than surgical clipping in the management of patients with posterior circulation aneurysms. Embolization with detachable coils in ruptured posterior circulation aneurysm cases at an early stage of SAH may improve clinical outcome.
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Bertges, Daniel J., Edward R. Villella, and Michel S. Makaroun. "Aortoenteric Fistula Due to Endoleak Coil Embolization after Endovascular AAA Repair." Journal of Endovascular Therapy 10, no. 1 (2003): 130–35. http://dx.doi.org/10.1177/152660280301000125.
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Purpose: To report a late complication associated with embolization coils used to treat an endoleak after endovascular abdominal aortic aneurysm (AAA) repair. Case Report: A 79-year-old man with a 5.8-cm AAA underwent endovascular repair with an Ancure graft in 1997. A persistent type I endoleak was identified on serial postoperative computed tomographic scans. Three transarterial coil embolization procedures were performed to treat an endoleak from the proximal and right distal attachment sites with outflow by the inferior mesenteric and lumbar arteries. Coil embolization was ultimately successful in sealing the endoleak, and the AAA decreased in size. Four years later, the patient developed an aortoenteric fistula due to erosion of the metallic embolization coils into the duodenum. The endograft was explanted and an extra-anatomical bypass inserted. Conclusions: Coil embolization to treat endoleaks can, on rare occasions, be the cause of aortoenteric fistula. Lifelong follow-up of stent-graft patients is required.
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Mase, M., K. Yamada, N. Aihara, T. Banno, and K. Watanabe. "Limitation of Endovascular Treatment for Ruptured Cerebral Aneurysms: Results from the Protocol “GDC as the First Choice”." Interventional Neuroradiology 6, no. 1_suppl (2000): 43–47. http://dx.doi.org/10.1177/15910199000060s104.
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Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wide-neck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.
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Zhang, Jiaqiang, Yang-Lan Lo, Ming-Chang Li, Ying-Hui Yu, and Szu-Yuan Wu. "Risk of Re-Rupture, Vasospasm, or Re-Stroke after Clipping or Coiling of Ruptured Intracranial Aneurysms: Long-Term Follow-Up with a Propensity Score-Matched, Population-Based Cohort Study." Journal of Personalized Medicine 11, no. 11 (2021): 1209. http://dx.doi.org/10.3390/jpm11111209.
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Scarce evidence is available in Asia for estimating the long-term risk and prognostic factors of major complications such as re-rupture, vasospasm, or re-stroke for patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing endovascular coil embolization or surgical clipping. This is the first head-to-head propensity score-matched study in an Asian population to demonstrate that endovascular coil embolization for aneurysmal SAH treatment is riskier than surgical clipping in terms of re-rupture, vasospasm, or re-stroke. In addition, the independent poor prognostic factors of vasospasm or re-stroke were endovascular coil embolization, male sex, older age (≥65 years; the risk of vasospasm increases with age), hypertension, congestive heart failure, diabetes, previous transient ischemic attack, or stroke in aneurysmal SAH treatment. Background: To estimate the long-term complications and prognostic factors of endovascular coil embolization or surgical clipping for patients with ruptured aneurysmal subarachnoid hemorrhage (SAH). Methods: We selected patients diagnosed with aneurysmal SAH between 1 January 2011 and 31 December 2017. Propensity score matching was performed, and Cox proportional hazards model curves were used to analyze the risk of re-rupture, vasospasm, and re-stroke in patients undergoing the different treatments. Findings: Multivariate Cox regression analysis revealed that the adjusted hazard ratio (aHR) of re-rupture for endovascular coil embolization compared with surgical clipping was 1.36 (95% confidence interval [CI]: 1.17–1.57; p < 0.0001). The aHRs of the secondary endpoints of vasospasm and re-stroke (delayed cerebral ischemia) for endovascular coil embolization compared with surgical clipping were 1.14 (1.02–1.27; p = 0.0214) and 2.04 (1.83–2.29; p < 0.0001), respectively. The independent poor prognostic factors for vasospasm and re-stroke were endovascular coil embolization, male sex, older age (≥65 years; risk increases with age), hypertension, congestive heart failure, diabetes, and previous transient ischemic attack or stroke. Interpretation: Endovascular coil embolization for aneurysmal SAH carries a higher risk than surgical clipping of both short- and long-term complications including re-rupture, vasospasm, and re-stroke.
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Ghosh, Sandipan, and Soumya Kanti Dutta. "Endovascular interventions in management of renal artery aneurysm." British Journal of Radiology 94, no. 1124 (2021): 20201151. http://dx.doi.org/10.1259/bjr.20201151.
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Renal artery aneurysm (RAA) is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females for in which case patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization (SACE), balloon-assisted coil embolization (BACE), selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-hystroacril and onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization has been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.
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Lipowski, Adam, Sleiman Aboul-Hassan, Zbigniew Krasiński, and Konrad Woronowicz. "Endovascular coil embolization of the left internal carotid artery aneurysm. Case report." Polish Journal of Surgery 92, no. 5 (2020): 1–5. http://dx.doi.org/10.5604/01.3001.0014.3019.
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In the current case report we present a novel case of a successful coil embolization of the left internal carotid artery aneurysm. Patient presented with neck pain and a palpable pulsating tumor was admitted to the vascular surgery clinic where neck Angio-CT scan was performed. Angio-CT revealed left internal carotid artery aneurysm with a narrow neck. Patient was admitted to the department of vascular surgery where the patient was enrolled into endovascular coil embolization. After the procedure, control angiography showed complete embolization of the aneurysm. Three months following the procedure, doppler ultrasonography of the carotid arteries showed no demonstrable flow into the aneurysm. Six months following the procedure, angio-CT confirmed complete aneurysm thrombosis. Based on this case, endovascular coil embolization of the carotid artery aneurysms is safe and effective method of treatment. Keywords: tumor, aneurysm, coile.
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Ueno, J., and N. Tohma. "Endovascular Treatment of Cerebral Aneurysm with Coils and Onyx." Interventional Neuroradiology 10, no. 1_suppl (2004): 51–56. http://dx.doi.org/10.1177/15910199040100s106.
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We investigated endovascular treatment of cerebral aneurysm by coil and Onyx in vivo experiment in order to promote the advantages of coil embolization,. The aim of this study was to clarify the advantages and problems of coil and Onyx embolization and to evaluate its potentials for application in clinical medicine. We set experimental aneurysms made of external jugular vein to bilateral carotid arteries of 10 Beagle dogs and embolized aneurysm with coils and Onyx. Two months later, the dogs were sacrificed and took out the experimental aneurysms and examined them histologically. We have experienced Onyx migration into the vessel at the beginning of our experiment. Technical problems were as follows; Onyx was not easily visible on DSA monitor particularly in tight coil packing. Catheter tip was often stuck to the Onyx in the aneurysm. Protect balloon could not completely protect the Onyx leakage into the vessel. Microscopic examinations were as follows; The aneurysm was filled with Onyx, coils, and inflammatory reactants. The orifice of the aneurysm was packed with augmented fibrous tissue. This method increased contact between the aneurysm wall and coils. Onyx filled the intra-aneurismal space more tightly. Coils prevented Onyx from flowing out into the vessel. In Onyx, intimal layer was more rapidly formed at the neck of the aneurysm than coils only. The most important problems during Onyx embolization is how to prevent Onyx migration into the vessel. We should like to propose the guideline for Onyx embolization.
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Haraguchi, K., S. Miyachi, N. Matsubara, et al. "A Mechanical Coil Insertion System for Endovascular Coil Embolization of Intracranial Aneurysms." Interventional Neuroradiology 19, no. 2 (2013): 159–66. http://dx.doi.org/10.1177/159101991301900203.
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Like other fields of medicine, robotics and mechanization might be introduced into endovascular coil embolization of intracranial aneurysms for effective treatment. We have already reported that coil insertion force could be smaller and more stable when the coil delivery wire is driven mechanically at a constant speed. Another background is the difficulty in synchronizing operators' minds and hands when two operators control the microcatheter and the coil respectively. We have therefore developed a mechanical coil insertion system enabling a single operator to insert coils at a fixed speed while controlling the microcatheter. Using our new system, the operator manipulated the microcatheter with both hands and drove the coil using foot switches simultaneously. A delivery wire force sensor previously reported was used concurrently, allowing the operator to detect excessive stress on the wire. In vitro coil embolization was performed using three methods: simple mechanical advance of the coil; simple mechanical advance of the coil with microcatheter control; and driving (forward and backward) of the coil using foot switches in addition to microcatheter control. The system worked without any problems, and did not interfere with any procedures. In experimental coil embolization, delivery wire control using the foot switches as well as microcatheter manipulation helped to achieve successful insertion of coils. This system could offer the possibility of developing safer and more efficient coil embolization. Although we aim at total mechanization and automation of procedures in the future, microcatheter manipulation and synchronized delivery wire control are still indispensable using this system.
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Park, Jae Hyo, Park In Sung, Dae Hee Han, et al. "Endovascular treatment of blood blister–like aneurysms of the internal carotid artery." Journal of Neurosurgery 106, no. 5 (2007): 812–19. http://dx.doi.org/10.3171/jns.2007.106.5.812.
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Object Because of its thin wall, an aneurysm arising from the posterior wall of the internal carotid artery (ICA), the so-called blood blister–like aneurysm (BBA), is difficult to manage surgically and is often associated with high morbidity and mortality rates. The authors treated these aneurysms endovascularly. In this paper, they present angiographic and clinical results obtained in patients with ICA BBAs treated endovascularly. Methods In seven patients with ICA BBAs who presented with subarachnoid hemorrhage, a total number of 12 endovascular treatments were performed, including seven endosaccular coil embolizations (four conventional, two stent-assisted and one balloon-assisted procedure) in four patients and five endovascular ICA trapping procedures in five patients. Repeated endovascular treatments were undertaken in four patients. In two patients, the endovascular treatment was performed after failure of surgical treatment (one case of rebleeding after clip placement and one aneurysmal regrowth after wrapping). A balloon occlusion test (BOT) was performed in all patients prior to ICA trapping. All four patients treated by endosaccular coil embolization showed aneurysmal regrowth. Neither stents nor balloons helpfully prevented aneurysmal regrowth. Of these four patients, two experienced rebleeding. These two patients remained vegetative at the last follow-up examination. After the BOT, ICA trapping was performed with coils and balloons without complication in five patients; excellent outcomes were achieved in all cases but one in which the patient had been in poor neurological condition due to rebleeding after surgical clip therapy. Conclusions All ICA BBAs that were treated by endosaccular coil embolization exhibited regrowth of the aneurysm. Some of the lesions rebled. The majority of patients who underwent ICA trapping experienced excellent outcomes. Based on the authors' experiences, they suggest that ICA trapping including the lesion segment should be considered as a first option for definitive treatment if a BOT reveals satisfactory results. Regarding trapping methods, endovascular treatment may be preferred because of its convenience and safety.
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Stefańczyk, Ludomir, Michał Polguj, Wojciech Szubert, Jarosław Chrząstek, Piotr Jurałowicz, and Jerzy Garcarek. "Arterio-biliary fistulas: What to choose as endovascular treatment?" Vascular 26, no. 4 (2017): 445–48. http://dx.doi.org/10.1177/1708538117743178.
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Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision. The results were monitored after six to seven days and one month after embolization. The embolizations were considered effective in all cases. One patient had four asynchronous fistulas requiring separate treatments sessions. Four patients required a revision of their biliary ducts after embolization and restoration of patency. In one patient, a migration of the coil to biliary ducts occurred. Conclusion Endovascular treatment of arterio-biliary fistulas is safe and effective. The use of embolization with soft and biodegradable materials like histoacrylic glue or thrombin may be the optimal method of treatment in comparison with coils which have a risk of migration or chronic infection.
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Ozawa, T., S. Tamatani, T. Koike, et al. "Histological Evaluation of Endothelial Reactions after Endovascular Coil Embolization for Intracranial Aneurysm." Interventional Neuroradiology 9, no. 1_suppl (2003): 69–82. http://dx.doi.org/10.1177/15910199030090s109.
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The purpose of this study was to evaluate the role of the endothelial cell reaction after endovascular coil embolization for the treatment of intracranial aneurysms. A scanning electron microscopic (SEM) study of the platinum coil, embolized into a middle cerebral aneurysm in a 35-year-old woman and subsequently removed surgically eight months later, revealed no endothelial coverage on the coil. This finding prompted us to perform experimental studies. In the first in vitro study, endothelial cells from gerbil brain microvessels and canine carotid arteries were co-cultured with either bare-form platinum coils or type-1 collagen-coated coils for up to three weeks, and the endothelial cell population on the coils was ascertained. In the second in vivo study, platinum coils coated with type-1 collagen were delivered endovascularly into canine carotid arteries, while the contralateral side was treated with bare-form coils, and endothelialization over the coil was investigated. SEM studies revealed that no endothelial cells, either from gerbil brain microvessels or from canine carotid artery, were found on the uncoated coils, whereas gerbil endothelial cells began to proliferate on the collagen-coated coils in three days, covering extensively in one week and reaching confluence in two weeks in vitro. The in vivo canine study demonstrated that bare-form platinum coils did not show endothelial coverage until two weeks, but endothelial cells proliferated directly on the collagen-coated coils in three days, and coils were completely covered in two weeks. These results supported the SEM study of our case and several human histopathological reports in the literature in that endothelial cell coverage in the orifice of the intracranial aneurysm is exceptional after endovascular treatment. But if some extracellular matrix, like collagen in our study, is prepared, coverage could be possible, as is seen in a few human cases. Biological modification of the platinum coils, such as collagen coating, is awaited for the better long-term results of endovascular coil embolization without recanalization of the treated intracranial aneurysms.
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Tadayon, Niki, Meisam Refaei, Sina Zarrintan, Saleh Shahsavari, Doras Najari, and Mohsen Sheikhzadeh. "Post-percutaneous nephrolithotomy pseudo aneurysm formation treated by coil embolization; A study of seven cases." Journal of Cardiovascular and Thoracic Research 16, no. 1 (2024): 55–59. http://dx.doi.org/10.34172/jcvtr.32905.
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Renal artery pseudoaneurysm is a rare complication of percutaneous nephrolithotomy (PCNL) with symptoms of flank pain and hematuria. Endovascular coil embolization has been proposed as a safe management option. We report Seven male patients, aged 36 to 65 years, with post-PCNL pseudoaneurysms presenting as gross hematuria. They all underwent CT angiography prior to endovascular intervention. The access was from common femoral artery in 6 cases and from left brachial artery in one case. Selective angiography of affected renal artery and branches were performed by suitable catheter. Coil embolization was performed by MicroNester and MReye coils (Cook, Inc.). Size of coils was selected based on angiography results. Completion angiography revealed embolized pseudoaneurysm in all cases. Gross and microscopic hematuria disappeared in all patients in the following days. Endovascular angioembolization with coil is an effective technique for managing post-PCNL pseudoaneurysms in renal artery and its branches.
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Gölitz, P., T. Struffert, M. Arc Saake, F. Knossalla, and A. Doerfler. "Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas." Interventional Neuroradiology 18, no. 3 (2012): 326–32. http://dx.doi.org/10.1177/159101991201800313.
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This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multiplanar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.
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Levy, Elad, Christopher J. Koebbe, Michael B. Horowitz, et al. "Rupture of Intracranial Aneurysms during Endovascular Coiling: Management and Outcomes." Neurosurgery 49, no. 4 (2001): 807–13. http://dx.doi.org/10.1097/00006123-200110000-00005.
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Abstract OBJECTIVE In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed. METHODS A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge. RESULTS Of 274 patients with intracranial aneurysms treated with coil embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52–85 yr). Mean follow-up time was 8 months (range, 0–25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, and 5 in two patients. CONCLUSION The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.
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Kervancioglu, Selim, Feyza Gelebek Yilmaz, and Sakip Erturhan. "Endovascular management of vascular complications after percutaneous nephrolithotomy." Vasa 43, no. 6 (2014): 459–64. http://dx.doi.org/10.1024/0301-1526/a000393.
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Background: Bleeding is one of the most common and most important complications of percutaneous nephrolithotomy (PCNL), which is mainly controlled with conservative treatment options. Transcatheter arterial embolization is required in less than 1 % of the patients undergoing PCNL. There are only a few studies about endovascular treatment of vascular complications of PCNL. The purpose of this study was to evaluate renal arterial complications of PCNL and treatment outcomes with endovascular coil embolization. Patients and methods: This retrospective study evaluated 16 patients who underwent endovascular management for complications after PCNL, including diagnostic angiography. We analyzed the angiographic appearances of the vascular lesions that caused hemorrhages, treatment outcomes for endovascular coil embolization, and renal parenchymal loss rate following this treatment. Results: Seven patients had a pseudoaneurysm, two patients had an arteriocaliceal fistula (ACF), five patients had a pseudoaneurysm and an arteriovenous fistula (AVF), and two patients had a pseudoaneurysm and an ACF. Of the 14 patients with pseudoaneurysms, five had more than one pseudoaneurysm. Endovascular coil embolization was successful in all patients, and it was able to stop the bleeding. After embolization, 12 patients had less than 10 % parenchymal loss, and 4 patients had 10–20 % parenchymal loss. Mean hospital stay after embolization was 2.3 ± 0.7 days (range, 1 to 3 days). Conclusions: The injuries seen in the intrarenal arterial system during the PCNL procedure can result in pseudoaneurysms and/or AVFs and/or ACFs, and more than one artery can be harmed. Arterial complications of PCNL can be treated with endovascular coil embolization while preserving renal function at a maximum level.
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Kang, Hyun-Seung, Moon Hee Han, Bae Ju Kwon, O.-Ki Kwon, and Sung Hyun Kim. "Repeat Endovascular Treatment in Post-Embolization Recurrent Intracranial Aneurysms." Neurosurgery 58, no. 1 (2006): 60–70. http://dx.doi.org/10.1227/01.neu.0000194188.51731.13.
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Abstract OBJECTIVE: The purpose of this study was to describe clinical situations requiring repeat embolization in patients previously treated by endovascular coil embolization for intracranial aneurysms, and to report on our experiences of repeat embolization (RE). METHODS: A total of 466 patients harboring 522 intracranial aneurysms were treated by endovascular coil embolization at our institution during the period between December 1992 and August 2004. We studied 32 patients who underwent repeat coil embolization (RE) owing to recanalization or aneurysm recurrence. Radiological and clinical data were reviewed to determine the reasons, results, and technical problems of RE. RESULTS: Thirty-nine sessions of RE were performed in 32 patients; four patients underwent RE twice and another patient three times. The major reason for RE was asymptomatic aneurysmal recanalization owing to coil compaction and/or loosening. The time interval between RE and the previous embolization was 12 months or less in 27 sessions. Complete or near complete occlusion of the aneurysm was achieved in all cases without procedure-related morbidity or mortality. Radiolucent gaps between the coil masses were observed in 17 cases. CONCLUSION: RE is a safe and effective treatment option in cases of recanalized or recurrent aneurysms. Close follow-up evaluation is essential in patients with intracranial aneurysms after coil embolization.
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Tsumoto, T., T. Terada, H. Yamaga, and T. Itakura. "Coil Embolization Training Using a Rabbit Saccular Aneurysm Model." Interventional Neuroradiology 12, no. 1_suppl (2006): 57–60. http://dx.doi.org/10.1177/15910199060120s107.
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We developed a rabbit saccular aneurysm model for coil embolization training. Elastase-induced aneurysms were created successfully in about 80% of the rabbits. The aneurysms were usually broad in the neck and lengthy. At the 28th postoperative day, the aneurysms were about 1.5 times larger in both width and height than they had been at the 14th day. All aneurysms were successfully embolized with 18-sized electrically detachable (ED) platinum coils. After embolization, almost all aneurysms had a neck remnant. In conclusion, this model is useful not only for learning the technique of coil embolization but also for testing new embolic materials. The rabbit aneurysm model proved to be an efficacious training modality for endovascular coil embolization.
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Kurata, A., S. Suzuki, H. Ozawa, et al. "Application of the Liquid Coil as an Embolic Material for Arteriovenous Malformations." Interventional Neuroradiology 11, no. 3 (2005): 287–95. http://dx.doi.org/10.1177/159101990501100315.
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The purpose of this paper is to clarify advantages and disadvantages of platinum liquid coils as an embolic material for AVMs. During the last eight years, 50 endovascular procedures using liquid coils were conducted in our institute for 19 cases with AVMs, 15 of which were located in the eloquent area. All but one presented with haemorrhage, the exception demonstrating repeated ischemic symptoms. Only liquid coils were used as the embolic material to obliterate the nidus and feeders. In ten of the 15 patients with AVMs located in the eloquent area and one case rejecting surgery, liquid coil embolization was applied one to 11 times (average 3.5 times) to achieve decrease in size and this was then followed by radiosurgery. The remaining eight AVM patients underwent total removal after liquid coil embolization. No complications were encountered during the peri-embolization period. In all cases, the purpose of embolization was to diminish the size to facilitate radiosurgery and decrease bleeding during surgery. The liquid coil has advantages as a material for embolization of AVMs; it is non-toxic and bioinart material; it seldom occludes normal minute vascular channels; when it used in a nidus, it seldom to migrates in the venous direction, and it has good radio-opacity and offers good marking for surgery. Appropriate applications include preoperative embolization or pre-radiosurgical embolization of AVMs, especially when staged embolizations are performed to reduce risk of perfusion pressure breakthrough in patients which are large or located in the eloquent area.
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Vrachliotis, Thomas G., and Matthew E. Falagas. "Infections After Endovascular Coil Embolization." Journal of Endovascular Therapy 14, no. 6 (2007): 805–6. http://dx.doi.org/10.1583/07-2219c.1.
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Pukenas, Bryan, Felipe C. Albuquerque, John B. Weigele, Robert W. Hurst, and Michael F. Stiefel. "Use of a New Double-Lumen Balloon Catheter for Single-Catheter Balloon-Assisted Coil Embolization of Intracranial Aneurysms: Technical Note." Operative Neurosurgery 69, suppl_1 (2011): ons8—ons13. http://dx.doi.org/10.1227/neu.0b013e3182181e3a.
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Abstract BACKGROUND: The prevalence of intracranial aneurysms is approximately 2% with an annual rupture rate of 0.7%. OBJECTIVE: We describe our initial feasibility experience using a new double-lumen balloon catheter for single-catheter balloon-assisted coil embolization of wide-neck intracranial aneurysms. METHODS: Two patients with large wide-neck intracranial aneurysms were referred for endovascular therapy. Endovascular treatment in the form of coil embolization alone was not feasible given the angioarchitecture of the aneurysms. Balloon-assisted coil embolization was planned. RESULTS: The patients underwent balloon-assisted coil embolization using the Ascent double-lumen balloon catheter (Micrus, San Jose, California). The balloon portion of the catheter was placed into the proximal neck of the aneurysm. The balloon was inflated and coil embolization performed through the inner lumen of the catheter. There were no procedural complications. CONCLUSION: Both aneurysms were successfully coiled by using the Ascent balloon occlusion catheter. The single-catheter balloon-assisted coil embolization technique can be performed safely and effectively with the Ascent double-lumen balloon catheter.
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Naito, I., S. Takatama, H. Shimaguchi, and T. Iwai. "Endovascular Treatment of Vertebral Artery Dissecting Aneurysms Using Stents." Interventional Neuroradiology 10, no. 1_suppl (2004): 181–86. http://dx.doi.org/10.1177/15910199040100s131.
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We report on five patients who were treated by stent-assisted coil embolization to preserve the patency of the parent artery. Three patients presented with subarachnoid haemorrhage and two with ischemic symptoms. Four patients were treated with stenting and then followed by coil embolization of the aneurysmal dilatation, and the remaining patient with stenting alone because the aneurysmal dilatation was too small to insert coils. Complete obliteration of the aneurysm was achieved in three patients, but in one patient an aneurysmal rupture occurred during the insertion of the first coil and a parent artery occlusion was therefore performed. In the one patient treated with stenting alone, a small aneurysmal dilatation remained patent, but complete obliteration was confirmed by the follow-up angiography. Subsequent subarachnoid haemorrhage was not observed in any of the patients. Four of them achieved a good recovery, but one patient suffered severe disability due to the aneurysmal rupture during the procedure. Parent artery occlusion remains the treatment of choice. Stent-assisted coil embolization has a higher risk of rupture than does the parent artery occlusion during the procedure. Furthermore, recanalization or subsequent subarachnoid haemorrhage is more likely to occur in a stent-assisted coil embolization after the procedure. However, this procedure, which can maintain the patency of the parent artery, will become an alternative for patients who are at a high risk of developing ischemic symptoms in parent artery occlusions.
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Kung, David K., Taylor J. Abel, Karthik H. Madhavan, et al. "Treatment of Endovascular Coil and Stent Migration Using the Merci Retriever: Report of Three Cases." Case Reports in Medicine 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/242101.
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Background.Coil and stent migration is a potentially catastrophic complication in endovascular neurosurgery, which may lead to cerebral thromboembolism. Techniques for removing migrated coil and stent are not well established.Methods and Results.We present three cases in which coil or stent migration occurred during endovascular embolization of a cerebral aneurysm. The Merci Retrievers were used successfully in all cases to remove the displaced foreign bodies. Technical details are described.Conclusion.The Merci Retriever device can be utilized successfully for removal of migrated coils and stents in endovascular neurosurgery.
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Nomura, M., S. Kida, N. Uchiyama, et al. "Aneurysm Clipping after Partial Endovascular Embolization for Ruptured Cerebral Aneurysms." Interventional Neuroradiology 6, no. 1_suppl (2000): 49–58. http://dx.doi.org/10.1177/15910199000060s105.
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The aim of this study was to investigate the advantages and disadvantages of a two-stage treatment for ruptured cerebral aneurysms; partial embolization in acute stage followed by clipping in chronic stage of subarachnoid hemorrhage. Between April 1997 and August 1999, twenty ruptured cerebral aneurysms were initially treated endovasculary using Guglielmi detachable coils in our institution. Among them, complete embolization could not be achieved in 6 lesions. For these lesions, subsequent clipping was added. The radiological and operative findings, and outcomes of these cases were retrospectively reviewed. In 1 case, rerupture occurred during the endovascular procedure. Rerupture was not observed in any cases in the postembolization period. In 2 cases, complications related to the clipping but not the endovascular procedure occurred. These complications included impaired visual acuity for unverified reasons, and memory disturbance due to sacrifice of a perforator arising from the anterior communicating artery. In 3 cases, coil extraction was needed during the clipping, because the loops of the coil extended into the residual neck. Complications related to coil extraction were not observed in these 3 cases. Acute partial embolization of ruptured aneurysm appears to be effective for the prevention of subsequent rerupture during the subacute period, in which treatment for vasospasm should be performed, and the clipping procedure. However, in the case of relatively large aneurysms, small arteries or other normal structures behind the aneurysm cannot be observed directly during surgery, because of the immovability of the embolized aneurysm. Further, complete clip closure is impossible when loops of coil herniate into the neck. In such situations, coil extraction with or without resection of the aneurysm might be necessary, and care must be taken not to damage parent artery and surrounding vessels.
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Satoh, K., J. Satomi, N. Nakajima, and S. Nagahiro. "Endovascular Treatment Using Detachable Coils for Non-Ruptured Intracranial Aneurysm." Interventional Neuroradiology 5, no. 1_suppl (1999): 67–70. http://dx.doi.org/10.1177/15910199990050s112.
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Detachable coil embolization was performed on 34 non-ruptured cerebral aneurysms in 33 patients. Patients consisted of 28 females and five males, with an age range of 26 to 77 years. Angiographic examination after coil embolization revealed complete or near-complete occlusion in 24 aneurysms (70.5%) and partial occlusion in three (8.8%). Detachable coil embolization was attempted unsuccessfully in seven aneurysms (20.5%). Transient ischemic attack occurred in one case with coil migration. The combined mortality/morbidity rate was 0%.
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Wilseck, Zachary, Luis Savastano, Neeraj Chaudhary, et al. "Republished: Delayed extrusion of embolic coils into the airway after embolization of an external carotid artery pseudoaneurysm." Journal of NeuroInterventional Surgery 10, no. 7 (2018): e18-e18. http://dx.doi.org/10.1136/neurintsurg-2017-013178.rep.
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Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.
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Figueroa-Sanchez, Jose A., Hector R. Martinez, Pablo J. Avalos-Montes, Carlos A. Arreola-Aldape, Jose Alberto Moran Guerrero, and Enrique Caro-Osorio. "A simple but effective solution for proximal mark absence on some microcatheters in intracranial aneurysm embolization: Technical note." Surgical Neurology International 14 (July 21, 2023): 257. http://dx.doi.org/10.25259/sni_381_2023.
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Background: Endovascular coil embolization is increasingly being used for the treatment of intracranial aneurysms and other pathologies such as arteriovenous (AV) malformations and AV fistulas. Appropriate embolization technique requires a microcatheter with two radiopaque marks, one proximal and one distal. We present an alternative coils deployment technique for intracranial aneurysms, using a microcatheter without a proximal radiopaque mark. Methods: We describe the technique for embolization that was used in a 36-year-old female patient, in which we used a microcatheter without a proximal radiopaque mark for coil embolization of an intracranial aneurysm. Results: We used a Headway Duo flow directed microcatheter for a coiling embolization of an intracranial aneurysm, solving the absence of the proximal radiopaque mark by cannulating the microcatheter with a Traxcess 0.014 microguidewire, and placing an external mark on the screen in the proximal portion of the microguidewire 30 mm radiopaque tip to indirectly mark the proximal mark of the microcatheter. Conclusion: There is scarce evidence supporting the use of microcatheters with no proximal radiopaque mark for coil embolization. This report attempts to disclose how an easy and simple technique can be used as a rescue method to solve the proximal radiopaque mark absence during endovascular coil release procedures. To the best of our knowledge, this technique has not been previously described; therefore, its use is not widespread among neurointerventionists.
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Nasi, Davide, Mauro Dobran, Lucia di Somma, Alessandro Di Rienzo, Maurizio De Nicola, and Maurizio Iacoangeli. "Coil Extrusion into the Naso- and Oropharynx Ten Years after Internal Carotid Artery Pseudoaneurysm Embolization: A Case Report." Case Reports in Neurology 11, no. 1 (2019): 4–9. http://dx.doi.org/10.1159/000496283.
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Coil migration and extrusion outside the cranial compartment after embolization of cerebral aneurysms represents a very rare complication of the endovascular procedures and few cases are reported in the literature. Instability of the vascular malformation wall and the resolution of the intramural hematoma, especially in pseudoaneurysm, might generate extravascular migration of the coils in the first months after embolization. However, to the best of our knowledge, an extrusion of coil 10 years after embolization has never been reported. We reported the unique case of a patient with coil extrusion into the naso- and oropharynx 10 years after internal carotid artery pseudoaneurysm embolization. The pseudoaneurysm occurred after an internal carotid artery injury during an endoscopic endonasal surgery for a clival giant cell tumor.
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Lanzino, Giuseppe, Yassine Kanaan, Paolo Perrini, Hayan Dayoub, and Kenneth Fraser. "Emerging Concepts in the Treatment of Intracranial Aneurysms: Stents, Coated Coils, and Liquid Embolic Agents." Neurosurgery 57, no. 3 (2005): 449–59. http://dx.doi.org/10.1227/01.neu.0000170538.74899.7f.
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ABSTRACT ENDOVASCULAR TECHNIQUES FOR the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.
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Kaku, Y., H. Watarai, J. Kokuzawa, T. Tanaka, and T. Andoh. "Treatment of Cerebral Aneurysms: Surgical Clipping and Coil Embolization." Interventional Neuroradiology 13, no. 1_suppl (2007): 68–72. http://dx.doi.org/10.1177/15910199070130s109.
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The present series provides a balanced overview of the treatment of aneurysms in surgical clipping and coil embolization. Between January 2004 and March 2006, 76 consecutive patients with cerebral aneurysms underwent endovascular embolization and/or surgical clipping. Of these, 42 patients suffered an aneurysmal subarachnoid hemorrhage (SAH), while the remaining 34 patients had nonruptured cerebral aneurysms. Of the 23 surgically treated patients, 17 (73.9%) achieved a favorable outcome. Of the 19 patients who underwent endovascular embolization, 12 (63.2%) achieved a favorable outcome. Three patients (15.8%) who underwent endovascular embolization needed to undergo re-treatments, while no re-treatment was needed in the surgically treated patients. Of the 34 nonruptured aneurysms, 12 (35.3%) were treated using surgical clipping, while 22 (64.7%) underwent endovascular embolization. The complication rates of the two treatment modalities demonstrated no significant difference. A combined microsurgical-endovascular team approach is thus considered to provide the most effective means to achieve favorable outcomes for patients with cerebral aneurysms.
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Khatri, Rakesh, Saqib A. Chaudhry, Gustavo J. Rodriguez, M. Fareed K. Suri, Steve M. Cordina, and Adnan I. Qureshi. "Frequency and Factors Associated With Unsuccessful Lead (First) Coil Placement in Patients Undergoing Coil Embolization of Intracranial Aneurysms." Neurosurgery 72, no. 3 (2012): 452–58. http://dx.doi.org/10.1227/neu.0b013e3182804ad1.
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Abstract BACKGROUND: There is limited knowledge about associated rates, aneurysm characteristics, technical factors, and immediate impact of unsuccessful placement of the lead (first) coil during endovascular embolization of intracranial aneurysms. OBJECTIVE: To determine the rates, associated risk factors, and consequences of lead coil placement failure in consecutive embolization procedures. METHODS: We reviewed clinical and procedural aspects of all endovascular coil embolizations performed at our 2 academic centers over a period of 3.5 years (2006-2010). Morphologic characteristics of the aneurysm and technical aspects of the treatment were recorded. We also performed a flow model analysis to assess the relationship between aneurysm dimensions, length of coil, packing density with first coil, and occurrence of lead coil placement failure. RESULTS: There were 24 (14%) lead coil placement failure procedures in 172 aneurysm embolization procedures; in 23 of 24 (96%) patients with lead coil placement failure, the failure occurred in aneurysms less than 10 mm in size. The main technical factors associated with lead coil placement failure were related to the coil (length, diameter, and type) followed by microcatheter support failure. Among these patients, 21 (87.5%) required change in the coil length, 17 (70.8%) change in coil diameter, and 10 (41.7%) change in coil type (brand and/or configuration) for successful placement of the lead coil. A total of 4 (16.7%) patients required change in microcatheter, and 6 (24.9%) patients had balloon/stent assistance for successful lead coil placement. Two of 24 (8.3%) patients had rupture of their aneurysms during the attempt to reposition the lead coil. In our flow model, these clinical observations were reproduced with higher risk of lead coil failure in smaller aneurysms. CONCLUSION: Lead coil placement failure is not infrequent during embolization of intracranial aneurysms and may increase the risk of complications. Appropriate coil selection, particularly coil length in small aneurysms, may reduce the rate of lead coil placement failure and associated complications.
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Ota, Keisuke, Noriaki Matsubara, Shigeru Miyachi, et al. "Evaluation of the characteristics of various types of finishing coils for the embolization of intracranial aneurysms in an experimental model with radiolucent coils." Interventional Neuroradiology 23, no. 2 (2017): 143–50. http://dx.doi.org/10.1177/1591019916685713.
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In endovascular coil embolization of intracranial aneurysms, very soft coils, often called “finishing coils,” are usually selected in the final stage of coil embolization. The authors developed a radiolucent coil made of thin nylon thread to evaluate the performance of coils under a situation simulating the course of embolization. The characteristics of various types of finishing coils were investigated using radiolucent coils. Experimental embolization was performed with a silicone aneurysm filled with radiolucent coils simulating the final stage of embolization. Three indices, i.e. area, perimeter, and circularity of the inserted coils, were investigated on the X-ray images after coil insertion. The coils used were as follows: Target Ultra Helical, MicroPlex Hypersoft, Axium Helix, ED Coil Extrasoft, and DeltaPlush. In the analysis of area and perimeter, there were significant differences in multiple comparisons. There was no significant difference in circularity, although it was generally ranked in order by coil brand. Target Ultra and MicroPlex Hypersoft had higher scores for area and perimeter and lower scores for circularity, in contrast to DeltaPlush, which had lower scores for area and perimeter and a higher score for circularity. Based on these results, the finishing coils were divided into three groups: Target Ultra Helical and MicroPlex Hypersoft; Axium Helix and ED Coil Extrasoft; DeltaPlush. They are better for use in early, midst, and end of finishing, respectively. The characteristics of various finishing coils were evaluated, and the results obtained reflected actual clinical experience and provide useful information to appropriately select finishing coils.
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Leonardi, M., M. Dall'Olio, O. Ortiz Vasquez, and C. Quercetti. "Preliminary Experience of Cerecyte Coils in the Treatment of Intracranial Aneurysms." Interventional Neuroradiology 14, no. 3 (2008): 285–92. http://dx.doi.org/10.1177/159101990801400308.
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Coil embolization of intracranial aneurysms is the first choice treatment in many centres worldwide. The ISAT study reported in favour of endovascular treatment even though coil embolization carries a higher risk of revascularization than surgical clipping. Bioactive coils boosting fibrosis within the aneurysm and neointimal production could counteract the tendency of embolized aneurysms to re-open. We reviewed our cohort in a retrospective study based on the following inclusion criteria: 1) Cerecyte coils (Micrus Endovascular, San Jose, Calif) were the only bioactive coils deployed. 2) Cerecyte coils were used in the first embolization procedure. Between July 2005 and December 2007 39 patients matched these inclusion criteria, 15 men and 24 women (average age 63.5 years) with 44 aneurysms. Treatment outcomes were: 30 aneurysms completed excluded from the circulation, 13 aneurysms almost completed excluded from the circulation, one incomplete aneurysm occlusion. Two aneurysms out of 44 recurred during follow-up (4.54%) and were re-embolized. The radio-opacity and conformational memory of the Cerecyte coils were satisfactory and they were easy to manoeuvre and detach.
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Gao, Bu-Lang, Hui Li, Cong-Hui Li, Ji-Wei Wang, Jian-Feng Liu, and Song-Tao Yang. "Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization." Journal of Neurological Surgery Part A: Central European Neurosurgery 81, no. 03 (2019): 207–12. http://dx.doi.org/10.1055/s-0039-1685513.
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Objective Intracranial aneurysms treated with endovascular coil embolization may recur. We investigated the factors affecting aneurysmal recurrence after embolization and effects of endovascular retreatment within 1 year. Methods In 3 years, 1,335 patients with 1,385 intracranial aneurysms were treated with coil embolization. Factors affecting aneurysm recurrence and the effects of endovascular retreatment were analyzed. Results Angiography immediately following embolization showed total occlusion in 1,030 aneurysms (74.4%), neck remnant in 207 (14.9%), and partial occlusion in 148 (10.7%), with a total peri-procedure complication rate of 4.2%. Overall, 145 patients with 151 aneurysms recurred within 1 year and the other 1,234 aneurysms remained occluded (89.1%). A significant (p < 0.05) difference existed in aneurysm size, rupture status, use of stent and immediate occlusion outcome between the two groups, with significantly (p < 0.05) lower recurrence rates in aneurysms with smaller sizes, no rupture and stent-assistance coiling. Neck remnant, partial occlusion, coiling without stent assistance, large and giant aneurysms were significant (p < 0.05) risk factors for aneurysm recurrence during the first year. The rate of recurrence was 4.7% (11/232) in aneurysms with total occlusion and 35.9% (23/64) in aneurysms with neck remnant and partial occlusion. Of the 34 recurrent aneurysms, 6 were re-embolized with detachable coils alone, 12 with stent-assisted coiling, 8 with balloon-assisted embolization, and the remaining 8 aneurysms with covered stents, resulting in total occlusion in 28 aneurysms and neck remnant in 6. Conclusion Recurrence of previously-coiled cerebral aneurysms is significantly affected by aneurysm size, use of stent and degree of immediate occlusion. Endovascular retreatment with balloon-or stent-assisted techniques or with covered stents can be safe and effective for recurrent cerebral aneurysms.
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French, Bryce, and Danielle Hayes. "Endovascular Coil Migration Into the Intestinal Lumen: Two Cases of Successful Nonoperative Management." Vascular and Endovascular Surgery 53, no. 2 (2018): 157–59. http://dx.doi.org/10.1177/1538574418805224.
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Endovascular embolization of visceral arteries is commonly performed as treatment for aneurysms, pseudoaneurysms, and emboloradiation of liver tumors; while considered relatively safe, it is not without complications. We are reporting 2 cases of coil migration into the gastrointestinal tract. Patients were successfully managed without endoscopic or surgical coil removal. Patients were followed after discharge and noted to have no further complications from their migrated coils. These cases highlight the success of expectant management for coil migration. We recommend against invasive intervention for coil removal as first-line treatment for endovascular coil migration into the intestinal tract. We urge providers to weigh the risks and benefits of coil removal, prior to invasive intervention.
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Bellows, Charles F., Yong U. Choi, John F. Sweeney, Bernard M. Jaffe, and Edward P. Dominguez. "Splenic Artery Embolization and Endovascular Stapler Integrity in a Porcine Model." American Surgeon 74, no. 4 (2008): 322–26. http://dx.doi.org/10.1177/000313480807400409.
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Splenic artery embolization is often used before laparoscopic splenectomy in cases of splenomegaly to reduce blood loss and facilitate the procedure. The aim of this study was to examine the general reliability of endovascular staplers when fired at the site of embolization coil deployment using a porcine model. Ex vivo and in vivo experiments were conducted on porcine abdominal aortas, which are similar in diameter to those of the splenic artery in the human. When the endovascular staplers were fired across the porcine vessels at the area of embolization coil deployment ex vivo, the staple lines all failed. In contrast, in vivo, the staple lines remained intact with no bleeding despite resistance imposed by the intravascular coils. Despite consistent failure in the ex vivo studies, in vivo all staple lines held and permitted safe transection of the vessel. We presume that the hemostatic properties of the coils caused sufficient thrombosis in this model, which mimics the clinical situation, to permit division of the previously embolized splenic vessel.
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Asif, Kaiz S., Ahsan Sattar, Marc A. Lazzaro, Brian-Fred Fitzsimmons, John R. Lynch, and Osama O. Zaidat. "Consecutive Endovascular Treatment of 20 Ruptured Very Small (<3 mm) Anterior Communicating Artery Aneurysms." Interventional Neurology 5, no. 1-2 (2016): 57–64. http://dx.doi.org/10.1159/000444662.
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Background: Small aneurysms located at the anterior communicating artery carry significant procedural challenges due to a complex anatomy. Recent advances in endovascular technologies have expanded the use of coil embolization for small aneurysm treatment. However, limited reports describe their safety and efficacy profiles in very small anterior communicating artery aneurysms. Objective: We sought to review and report the immediate and long-term clinical as well as radiographic outcomes of consecutive patients with ruptured very small anterior communicating artery aneurysms treated with current endovascular coil embolization techniques. Methods: A prospectively maintained single-institution neuroendovascular database was accessed to identify consecutive cases of very small (<3 mm) ruptured anterior communicating artery aneurysms treated endovascularly between 2006 and 2013. Results: A total of 20 patients with ruptured very small (<3 mm) anterior communicating artery aneurysms were consecutively treated with coil embolization. The average maximum diameter was 2.66 ± 0.41 mm. Complete aneurysm occlusion was achieved for 17 (85%) aneurysms and near-complete aneurysm occlusion for 3 (15%) aneurysms. Intraoperative perforation was seen in 2 (10%) patients without any clinical worsening or need for an external ventricular drain. A thromboembolic event occurred in 1 (5 %) patient without clinical worsening or radiologic infarct. Median clinical follow-up was 12 (±14.1) months and median imaging follow-up was 12 (±18.4) months. Conclusion: This report describes the largest series of consecutive endovascular treatments of ruptured very small anterior communicating artery aneurysms. These findings suggest that coil embolization of very small aneurysms in this location can be performed with acceptable rates of complications and recanalization.
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Hyodo, A., N. Kato, I. Anno, et al. "Intra-Aneurysmal Embolization for the Treatment of Cerebral Aneurysms Using Detachable Coils." Interventional Neuroradiology 4, no. 1_suppl (1998): 67–69. http://dx.doi.org/10.1177/15910199980040s112.
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From October 1993 to February 1998, intraaneurysmal embolization by endovascular treatment with detachable coils was performed for 41 cases of cerebral aneurysm. As a detachable coil, interlocking detachable coils (IDC) were used in the initial 15 cases and Guglielmi detachable coils (GDC) were used in the subsequent 26 cases. As for 15 cases treated with IDC, complete occlusion was performed in 9 cases, subtotal occlusion in 4 cases and partial occlusion in 2 cases. In one of the partial occluded cases, a coil compaction occurred 6 months after embolization. Distal emboli were recognized on CT after embolization in 3 cases, however, only one case was symptomatic. Intra-operative bleeding occurred in one case, but no obvious hemorrhage after coil embolization in any case. As for 26 cases treated with GDC, complete occlusion was performed in 18 cases, subtotal occlusion in 8 cases. In one case of basilar-tip aneurysm, a mild coil compaction occurred 6 months after embolization. Distal emboli were recognized on CT after embolization in 3 cases, however, only one case was symptomatic (minor stroke). No intra-operative bleeding and no obvious hemorrhage after coil embolization occurred in any case. From our experiences, treatment for poor-grade ruptured aneurysm is still difficult, but intra-aneurysmal embolization for cerebral aneurysms using detachable coils is possible and a useful alternative, especially for surgically difficult aneurysms. The results of treatment of aneurysm with GDC are much better than those with IDC, so the indications for intra-aneurysmal embolization with GDC might increase in the future.
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Kitahara, Takahiro, Taketo Hatano, Makoto Hayase, Etsuko Hattori, Akinori Miyakoshi, and Takehiko Nakamura. "Jailed double-microcatheter technique following horizontal stenting for coil embolization of intracranial wide-necked bifurcation aneurysms: A technical report of two cases." Interventional Neuroradiology 23, no. 2 (2017): 117–22. http://dx.doi.org/10.1177/1591019916685080.
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The horizontal stenting technique facilitates endovascular treatment of wide-necked bifurcation intracranial aneurysms. Previous literature shows, however, that subsequent coil embolization at initial treatment results in incomplete obliteration in many cases. The authors present two consecutive cases of wide-necked large bifurcation aneurysms to describe an additional coil embolization technique following horizontal stenting. The patients were a 53-year-old female with an unruptured internal carotid artery terminus aneurysm and a 57-year-old female with a recurrent basilar artery tip aneurysm. Both patients underwent endovascular treatment with horizontal stenting followed by coil embolization with jailed double-microcatheters. Immediate complete obliteration was achieved with no complications, and no recanalization was observed at the one-year follow-up in both cases. Coil embolization with jailed double-microcatheter technique following horizontal stenting is a safe and effective strategy for wide-necked bifurcation aneurysms.
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Motegi, Hiroaki, Masanori Isobe, Toyohiko Isu, and Hiroyasu Kamiyama. "A Surgical Case of Delayed Coil Migration After Balloon-Assisted Embolization of an Intracranial Broad-Neck Aneurysm: Case Report." Operative Neurosurgery 67, suppl_2 (2010): onsE516—onsE521. http://dx.doi.org/10.1227/neu.0b013e3181f82588.
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ABSTRACT BACKGROUND AND IMPORTANCE: Balloon-assisted coil placement is an important technique for coil embolization of broad-neck aneurysms. With this technique, we can prevent coil migration into a parent artery during a procedure. Complications of intraprocedural coil migration have been reported in the literature. However, delayed coil migration is extremely rare. We present a case of delayed coil migration after balloon-assisted coil embolization and describe our management of this complication. CLINICAL PRESENTATION: A 59-year-old man presented with hypertension and a tension headache. Clinical evaluation incidentally discovered an unruptured broad-neck aneurysm at the left internal carotid bifurcation. Endovascular embolization of the aneurysm was performed with a balloon-assisted technique. The patient had a transient ischemic attack, and a skull radiograph showed coil migration 3 months after the procedure. We performed an operation to remove the coils and to clip the aneurysm with superficial temporal artery and middle cerebral artery bypass. The patient was discharged without neurological deficit. CONCLUSION: This is a rare case in which delayed coil migration into the parent artery occurred after balloon-assisted coil embolization, highlighting the importance of surgical management of delayed coil migration.
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Ishibashi, T., Y. Murayama, T. Saguchi, et al. "Thromboembolic Events during Endovascular Coil Embolization of Cerebral Aneurysms." Interventional Neuroradiology 12, no. 1_suppl (2006): 112–16. http://dx.doi.org/10.1177/15910199060120s117.
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Thromboembolic events was most important adverse event for coil embolization for intracerebral aneurysm. The present study investigated possible risk factors for thromboembolic events during coil embolization using diffusion-weighted imaging (DWI), comparing unruptured and ruptured lesions.
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Regli, Luca, Antoine Uske, and Nicolas de Tribolet. "Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series." Journal of Neurosurgery 90, no. 6 (1999): 1025–30. http://dx.doi.org/10.3171/jns.1999.90.6.1025.
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Object. The goal of this study was to delineate the angioanatomical features that determine whether a patient with an unruptured middle cerebral artery (MCA) aneurysm is treated using endovascular coil placement or surgical clipping.Methods. Thirty consecutive patients harboring 34 unruptured MCA aneurysms were evaluated. Patients with unruptured aneurysms are managed prospectively according to the following protocol: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempts at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy.Of 34 unruptured MCA aneurysms, two (6%) were successfully embolized and 32 (94%) were clipped. Of these 32 surgically treated aneurysms, in 11 (34%) an attempt at GDC embolization had failed, whereas in 21 (66%) primary clipping was performed because of unfavorable angioanatomy. Of the 13 aneurysms treated endovascularly, two (15%) were successfully excluded, whereas GDC treatment failed in 11 (85%). An unfavorable dome/neck ratio (< 2) and an arterial branch originating at the aneurysm base were the reasons for embolization failure.Conclusions. Careful evaluation of the angioanatomy of unruptured aneurysms allows selection of the most appropriate treatment. However, for unruptured MCA aneurysms, surgical clipping appears to be the most efficient treatment option. Series of unruptured aneurysms are ideal for comparing treatment results.
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Suzuki, S., A. Kurata, M. Yamada, et al. "Outcomes Analysis of Ruptured Distal Anterior Cerebral Artery Aneurysms Treated by Endosaccular Embolization and Surgical Clipping." Interventional Neuroradiology 17, no. 1 (2011): 49–57. http://dx.doi.org/10.1177/159101991101700108.
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Although endovascular surgery is now widely used to treat intracranial aneurysms, no comparative studies of clipping versus endovascular surgery to address distal ACA aneurysms at the same institution are available. We compared the results of these treatment modalities to address distal ACA aneurysms at our institution. We treated 68 patients with ruptured distal ACA aneurysms (endovascular surgery, n=13; clipping surgery, n=55). We performed a retrospective comparison of the treatment outcomes. To study the efficacy of endovascular surgery we classified all our cases into three types: type A were small-necked aneurysms, type B were wide-necked aneurysms on the parent artery, and type C were aneurysms in which the A3 portion of the ACA arose from the aneurysmal dome near the neck. Intraoperative hemorrhage occurred in 7.7% of aneurysms treated by endovascular surgery and in 34.5% treated by clipping surgery. In 7.7% of the endovascularly-treated aneurysms we noted coil migration during embolization surgery; venous infarction due to cortical vein injury occurred in 7.3% of clipped aneurysms. Of the endovascularly-treated aneurysms, 7.7% manifested post-embolization hemorrhage; 23.1% manifested coil compaction. In clipping surgery, postoperative rerupture occurred in 1.8% of the aneurysms; one patient presented with postoperative acute epidural hematoma. Clip dislocation was noted in 1.8% of aneurysms. Angiography was indicative of post-treatment vasospasm in 7.7% of aneurysms treated endovascularly and in 50.9% of the clipped aneurysms. The clinical outcome showed no significant difference between endovascular surgery and clipping surgery.
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Takeshita, Tomonori, Tomoaki Nagamine, Kohei Ishihara, and Yasuhiko Kaku. "Stent-assisted coil embolization of a recurrent posterior cerebral artery aneurysm following surgical clipping." Neuroradiology Journal 30, no. 1 (2016): 99–103. http://dx.doi.org/10.1177/1971400916678243.
Full textAbstract:
Posterior cerebral artery (PCA) aneurysms are rare, and direct surgery of these is considered difficult. Coil embolization of PCA aneurysms is becoming popular. However, it is difficult to completely obliterate the aneurysm while preserving the flow of the parent artery in large or giant PCA aneurysms with a wide neck with this technique. We report a case of a large and wide-necked PCA aneurysm with multiple recurrences following successful surgical clipping and coil embolization. A 77-year-old man with a large unruptured right PCA (P2) aneurysm was successfully treated by surgical clipping. Postoperative digital subtraction angiography (DSA) showed complete aneurismal occlusion. Four years afterward, the aneurysm recurred and grew toward the contralateral. Surgical retreatment of this complicated aneurysm was considered difficult, with a substantial risk of complications. Therefore, the aneurysm was treated with an endovascular procedure. Because simple coil embolization was not expected to achieve satisfactory obliteration of the aneurysm with preservation of parent artery patency, we used stent-assisted coil embolization. The patient tolerated the treatment well. On DSA obtained six months after the first endovascular treatment, coil compaction and recanalization of the aneurysm were detected. A second coil embolization was successfully performed without any complications. The aneurysm was stable during the next six-month follow-up. Stent-assisted coil embolization may be feasible and effective for such postoperatively complicated aneurysms.
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Du, Zhihua, Bin Lv, Xiangyu Cao, et al. "AngioSuite-Assisted Volume Calculation and Coil Use Prediction in the Endovascular Treatment of Tiny Volume Intracranial Aneurysms." BioMed Research International 2021 (July 29, 2021): 1–8. http://dx.doi.org/10.1155/2021/5514608.
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Background and Purpose. Ruptured tiny volume intracranial aneurysms (TVIAs) are associated with high risk of intraprocedural perforation. Aneurysm volume measuring is important for treatment planning and packing density calculation. We aim to assess the ability of the AngioSuite software in calculating TVIAs and guiding the selection of suitable coil. Methods. Thirty-three consecutive patients with 34 TVIAs were prospectively recruited and treated with endovascular techniques. The volume of TVIAs and the required length of coils were calculated by the AngioSuite software before embolization. The treatment efficacy of TVIAs was assessed using the Raymond scale (Rs) and the modified Rankin scale (mRs). Results. Of the 34 aneurysms with an average volume of 7.16 mm3, 13 aneurysms were treated with sole coil embolization, 19 by stent-assisted embolization, and 2 by balloon-assisted embolization. The average coil length was 5.32 cm, and the average packing density was 41.21%. The immediate DSA showed that total occlusion ( Rs = 1 ) was achieved in 15 aneurysms, subtotal ( Rs = 2 ) in 9, and partial ( Rs = 3 ) in 11. Total occlusion was achieved in 30 aneurysms and subtotal in the other 4 aneurysms at 6-month follow-up. Baseline volume and diameter of aneurysms were significantly correlated with the coil length ( r = 0.801 , P < 0.001 ; r = 0.711 , P < 0.001 ). Conclusions. Coil embolization of TVIAs was easy to achieve high packing density. According to the data from AngioSuite, relative few coils can increase the safety in procedure and stenting may reduce risk of aneurysmal recurrence.
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Vávrova, Jonszta, Czerný, et al. "Endovascular treatment of mycotic pseudoaneurysms." Vasa 39, no. 3 (2010): 256–61. http://dx.doi.org/10.1024/0301-1526/a000038.
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The surgical correction of ruptured intracranial infectious pseudoaneurysms is associated with high morbidity and mortality. An endovascular therapeutic approach has been introduced recently. This treatment is, compared to surgical intervention, less invasive, faster, more effective and safer, thus making it a gentler option, particularly for pediatric patients. Lower morbidity and mortality have been achieved thanks to the combination of prolonged administration of antibiotics, coil embolization, and parent artery occlusion. Two pediatric cases of bleeding mycotic pseudoaneurysm treated successfully with fibered coil embolization and long-term antibiotics are dealt with in this manuscript.
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Akan, H., U. Belet, and A. Enel. "Coil-Induced Perforation of Recently Ruptured Cerebral Aneurysm during Embolization." Interventional Neuroradiology 9, no. 1 (2003): 83–86. http://dx.doi.org/10.1177/159101990300900115.
Full textAbstract:
Most coil-induced aneurysmal ruptures during endovascular treatment occur in small, recently ruptured aneurysms, and after placement of at least one coil. In cases where the distal part of the microcatheter cannot move back due to its straightness and tightness, the last coil deployed may advance towards the aneurysmal wall through intercircles of deposited coils. To solve this problem, after complete occlusion of the sac is obtained, the microcatheter is slightly withdrawn until the tip of the catheter is placed in the neck, and then the neck is occluded with the appropriate coil.
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Ecker, Robert D., Ricardo A. Hanel, Elad I. Levy, and L. Nelson Hopkins. "Contralateral vertebral approach for stenting and coil embolization of a large, thrombosed vertebral–posterior inferior cerebellar artery aneurysm." Journal of Neurosurgery 107, no. 6 (2007): 1214–16. http://dx.doi.org/10.3171/jns-07/12/1214.
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✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.
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Luehr, Maximilian, Aida Salameh, Josephina Haunschild, et al. "Minimally Invasive Segmental Artery Coil Embolization for Preconditioning of the Spinal Cord Collateral Network before One-Stage Descending and Thoracoabdominal Aneurysm Repair." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 1 (2014): 60–65. http://dx.doi.org/10.1097/imi.0000000000000038.
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Objective Paraplegia remains the most devastating complication after thoracic and thoracoabdominal aortic aneurysm (TAA/A) repair. The collateral network (CN) concept of spinal cord perfusion suggests segmental artery (SA) occlusion to mobilize redundant intraspinal and paraspinal arterial sources and ultimately trigger arteriogenesis, leading to spinal cord blood flow restoration within 96 to 120 hours. This principle is used by the two-staged approach to TAA/A-repair—which has lead to an elimination of paraplegia in an experimental model. However, the clinical implementation of a two-staged surgical procedure is challenging, particularly in the absence of an appropriate vascular segment for a “staged” open anastomosis or an appropriate endovascular landing zone. Selective, transfemoral minimally invasive SA coil embolization (MISACE) could provide the solution for one-stage repair of extensive aortic pathologies by triggering arteriogenic CN preconditioning and thereby allowing for recruitment of otherwise redundant arterial collaterals to the spinal cord. Methods The feasibility of MISACE was explored in a single animal using an established piglet model. A 6F sheet was introduced via the femoral artery, and a 4F standard Judkins catheter was used for selective angiography and coil insertion. All thoracic and lumbar aortic SAs (15 pairs; Th4–L5) were successfully identified by dye injection. Pediatric platinum endovascular coils (Trufill Pushable Coils, 3 × 20 mm; Cordis, Waterloo, Belgium) were deployed to serially occlude the SA mimicking a CN preconditioning procedure. Results All intercostal (thoracic) and lumbar aortic SAs (Th4–L5) were successfully identified and occluded by coil embolization. Successful SA coil embolization was verified intraoperatively by selective dye injection on angiography. No intraoperative coil dislodgement occurred. Autopsy revealed complete occlusion of all embolized SAs enhanced by early local thrombus formation. Thrombotic material was found only distally to the coils. No SA dissection was observed at the aortic SA origins. Conclusions The MIS ACE technique allows for rapid serial endovascular occlusion of all thoracic and lumbar SAs. This new innovative approach bares the potential to CN preconditioning at the respective level of aortic pathology—to allow for adequate perioperative spinal cord blood supply—before conventional open or endovascular surgery. Selective, transarterial MISACE might lead to a dramatic reduction of ischemic spinal cord injury after open and endovascular TAA/A repair in the future.