scholarly journals Angiographical Change of Guglielmi Detachable Coils

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 161-166 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
T. Takigawa ◽  
T. Yamazaki ◽  
S. Okamoto ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Medical Condition ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

scholarly journals Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 47-50 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
K. Sugita ◽  
Y. Matsumaru
Keyword(s):  
Morphological Changes ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Detachable Coils ◽  
Aneurysm Occlusion

The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms. Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms. At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged. There were significant differences of the long-term angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.

scholarly journals Clearance of Subarachnoid Clots after GDC Embolization for Acutely Ruptured Cerebral Aneurysm

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 57-60 ◽  
Author(s):  
S. Kobayashi ◽  
A. Satoh ◽  
Y. Koguchi ◽  
M. Wada ◽  
H. Tokunaga ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Intrathecal Administration ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Mortality And Morbidity ◽  
Symptomatic Vasospasm ◽  
Group 12 ◽  
Cisternal Irrigation ◽  
Detachable Coils ◽  
Causes Of Mortality

It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery. Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage. The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly. GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.

Embolisation of Ruptured Cerebral Aneurysms with Interlocking Detachable Coils in Acute Stage

1997 ◽  
Vol 3 (1) ◽  
pp. 49-63 ◽  
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
T. Hatayama ◽  
H. Ohkuma ◽  
S. Suzuki ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Good Recovery ◽  
Coil Embolisation ◽  
Detachable Coils ◽  
Occlusion Rate ◽  
Technical Complication ◽  
Proximal Occlusion ◽  
Coil Migration

Twelve cases of ruptured cerebral aneurysm were treated in acute stage with interlocking detachable coils (IDC, Target Therapeutics, Fremont, California) and the outcome was assessed. IDCs were placed intra-aneurysm for intra-aneurysmal occlusion, or intra-artery for proximal occlusion. Cases: age 36–84 (mean; 60) y.o., 11 females and 1male; 1, 5, 4 and 2 patients were categorised (Hunt and Hess) as grades 1, 2, 3 and 4 respectively. An intra-aneurysmal occlusion in ten cases and a proximal occlusion in two were performed on day 1–11 (mean 4). On angiograms and CT findings, the ruptured point seemed to have occluded in all cases. The occlusion rate was 100% in five cases, 95% in two, 90% in three, 80% in one, and less than 50% in one. There were two cases of technical complication, one a coil migration and the other an aneurysmal perforation with IDC. Their Glasgow Outcome Scale six months after embolisation was graded as good recovery in four cases, moderately disabled state in two, severely disabled state in one, and dead in five. Follow-up angiograms taken four to six months after embolisation showed an intra-aneurysmal coil compaction in five cases. Two of these were treated by a second embolisation or by neck clipping followed by aneurysmal resection, but another two were observed without any treatment and the last one died of rebleeding. Histological examination of the resected embolised aneurysm revealed slight organization around coils but no endothelialisation over the aneurysmal orifice. In our experience, coil embolisation with IDC for acute ruptured aneurysm is a promising means of preventing rerupture during subacute stage.

scholarly journals Efficacy of 3-D Reconstructed Time of Flight MRA Follow-up of the Embolized Cerebral Aneurysms

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 45-48 ◽  
Author(s):  
T. Saguchi ◽  
Y. Murayama ◽  
T. Ishibashi ◽  
M. Ebara ◽  
K. Irie ◽  
...  
Keyword(s):  
Time Of Flight ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Morphological Examination ◽  
Tof Mra ◽  
Detachable Coils ◽  
Similar Images ◽  
A Current

A follow-up of the embolized cerebral aneurysm with Guglielmi Detachable Coils (GDC) were performed mainly using craniograms and digital subtraction angiograms (DSA) so far. Recently, several authors have reported about efficacy of the time of flight (TOF) magnetic resonance angiogram (MRA) as a follow-up for the embolized cerebral aneurysms. In our institution, 3-D reconstructed TOF MRAs have been performed as a follow-up of the embolized cerebral aneurysms. We examined efficacy of 3-D reconstructed TOF MRA. 3-D TOF MRA was performed for a follow-up of the embolized cerebral aneurysms at our outpatient clinic in 35 patients. Morphological examination of the 3-D images between 3-D TOF MRA and 3-D DSA was performed. Almost similar images of 3-D MRA were obtained after 3-D reconstruction as compared with those of 3-D DSA. In three cases, recanalization was suspected in the 3-D TOF MRA. And recanalization was confirmed in the 3-D DSA actually. A quality of 3-D TOF MRA for a diagnosis of recanalization was good and practical. However, in two cases, arteries were partially disappeared in the 3-D TOF MRA. These were the artifact due to coil mass and this is a current limitation of 3-D TOF MRA. The images of 3-D TOF MRA that were reconstructed in the 3-D workstation were very similar to those of 3-D DSA. 3-D reconstructed TOF MRA was very useful for a less-invasive diagnosis of a recanalization of the embolized cerebral aneurysms.

Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils

1998 ◽  
Vol 11 (1) ◽  
pp. 19-25 ◽  
Author(s):  
E. Cotroneo ◽  
M. Dazzi ◽  
R. Gigli ◽  
G. Guidetti ◽  
G.P. Cantore ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Mr Angiography ◽  
Cerebral Aneurysms ◽  
Digital Subtraction ◽  
Contrast Injection ◽  
Guglielmi Detachable Coils ◽  
Non Invasive ◽  
Mri Angiography ◽  
Detachable Coils

Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later. In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.

Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial

1998 ◽  
Vol 89 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Joseph M. Eskridge ◽  
Joon K. Song ◽  
_ _
Keyword(s):  
Clinical Trial ◽  
Drug Administration ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Platinum Coil ◽  
Detachable Coils ◽  
Fine Print

Object. To assess the safety and efficacy of aneurysm embolization performed using Guglielmi detachable coils (GDCs), the authors reviewed the results of a cohort of 150 patients with either ruptured (83 patients) or unruptured (67 patients) basilar tip aneurysms treated with these detachable platinum coil devices in the early part of the United States multicenter GDC clinical trial that led to Food and Drug Administration approval for the device. Methods. The most common presentation in this cohort of patients was headache (53%). All patients were entered into the trial after neurosurgical assessment excluded them as candidates for surgical clipping of their aneurysms. Greater than 90% coil packing was achieved in 75% of the patients. For those patients in whom follow-up information was available, the mean angiographic and clinical evaluation follow-up time for 61 patients with ruptured aneurysms was 13.7 months (range 0–43 months) and that for the 49 patients with unruptured aneurysms was 9.8 (range 0–40 months). Conservative mortality rates included up to 23% for the ruptured aneurysm group and up to 12% for the unruptured aneurysm group; the rebleeding rate for treated ruptured aneurysms was up to 3.3% and the bleeding rate for unruptured aneurysms up to 4.1%. Permanent deficits due to stroke in patients with ruptured or unruptured aneurysms occurred in up to 5% and 9%, respectively. Vasospasm occurred in 8% of the patients; it was associated with two deaths. Periprocedural mortality was 2.7% (four patients with ruptured aneurysms). Conclusions. Detachable platinum coil embolization is a promising treatment for ruptured basilar tip aneurysms that are not surgically clippable; in selected patients it offers lower incidences of morbidity and mortality compared with conservative medical management. The role of this procedure in unruptured basilar tip aneurysms is unclear with less supportive results. More long-term follow-up evaluation is necessary and results are expected to improve.

Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience

1999 ◽  
Vol 90 (5) ◽  
pp. 843-852 ◽  
Author(s):  
Gerhard Bavinzski ◽  
Monika Killer ◽  
Andreas Gruber ◽  
Andrea Reinprecht ◽  
Cordell E. Gross ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Thrombotic Complication ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Poor Grade ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Fine Print

Object. The authors retrospectively analyzed the results of their 6-year experience in the treatment of basilar artery (BA) bifurcation aneurysms by using Guglielmi detachable coils (GDCs).Methods. This analysis involved 45 BA tip aneurysms in 16 men and 29 women who ranged in age from 23 to 78 years (mean 50 years). Seventy-five percent of the aneurysms had ruptured and 25% remained unruptured. Of the group whose aneurysms hemorrhaged, 14 patients were Hunt and Hess Grade I or II and 20 were Hunt and Hess Grades III to V; 32 patients were treated within 2 weeks of their subarachnoid hemorrhage (SAH). Initially, treatment with GDCs was limited to poor-grade high-risk patients who refused surgery or patients in whom surgery proved unsuccessful. Later in the study, good-grade patients with narrow-necked aneurysms were also treated using GDCs.The length of clinical follow up ranged from 1 to 72 months (average 27.4 months) in the 37 surviving patients. In 33 of the 45 aneurysms treated with coil placement, good to excellent results were achieved. There were 12 poor results (27%) including one in a patient from the non-SAH group who suffered a thrombotic complication due to an underlying vasculitis. Eight deaths were recorded in this group of 45 patients. One of these deaths was caused by a complication related to anesthesia, one by unknown causes, and six resulted from complications of the disease. One patient rebled on the 2nd day after the endovascular procedure. The mortality and permanent morbidity rates directly related to the intervention were 2.2% and 4.4%, respectively.Angiographic studies obtained immediately postintervention demonstrated 99 to 100% occlusion in 30 (67%) of the aneurysms; nine (20%) were more than 90% occluded; and six (13%) were less than 90% occluded by the GDCs. Follow-up angiograms were obtained in 31 patients between 2 and 72 months after coil placement. Nineteen (61%) of the follow-up angiograms revealed stable results (that is, no change from initial treatment). Twelve of the 31 showed coil compaction, but only eight of these lesions could accept additional coils.In large aneurysms recanalization was seen in 57%, and some of the larger lesions required as many as four embolizations (mean 1.7) to achieve optimal occlusion. When small-necked aneurysms were analyzed as a subset, a stable angiographic result was seen in 92%.Conclusions. Use of GDCs led to excellent clinical and angiographic results in the majority of patients with BA tip aneurysms included in this limited follow-up study. Rebleeding was encountered in one of the 34 previously ruptured BA aneurysms treated with GDCs, and no hemorrhages have been documented in the 11 unruptured aneurysms treated with GDCs in this series. Long-term follow-up studies are necessary before it is possible to compare adequately the treatment of aneurysms with coil placement to the gold standard of aneurysm clipping.

Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 118-120
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
K. Akasaka ◽  
S. Suzuki
Keyword(s):  
Cerebral Aneurysms ◽  
Critical Factor ◽  
Dissecting Aneurysm ◽  
Acute Stage ◽  
Saccular Aneurysm ◽  
Long Term Results ◽  
Complete Occlusion ◽  
Detachable Coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.

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