scholarly journals A novel approach involving a microcatheter tip during aneurysmal coil embolization: The Γ (gamma) tip method

2019 ◽  
Vol 25 (6) ◽  
pp. 681-684 ◽  
Author(s):  
Tomotaka Ohshima ◽  
Shigeru Miyachi ◽  
Naoki Matsuo ◽  
Reo Kawaguchi ◽  
Ryuya Maejima ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Parent Artery ◽  
Hot Air ◽  
Dynamic Movement ◽  
Air Gun ◽  
Novel Approach ◽  
Endovascular Coil Embolization ◽  
Aneurysmal Neck ◽  
Novel Strategy

Complete and secure occlusion of the entire aneurysmal neck remains a problem despite major advances in the treatment of intracranial aneurysms using endovascular coil embolization. Here, we present our initial clinical experience using a novel strategy for endovascular coil embolization involving a microcatheter tip, known as the “Γ (gamma) tip method,” and compare the in vitro results of this technique with those of conventional straight microcatheters. The microcatheters were bent at a right angle starting 1–2 mm from the length of the tip using a catheter-shaping mandrel and a hot air gun. The tiny right-angled tip is the “Γ tip.” In aneurysm models, we assessed the efficacy of shaping during coil deployment. The Γ-tipped microcatheters demonstrated better movement and oscillation during insertion of the coil into the aneurysm compared with the straight-tipped catheters. Moreover, the Γ-tipped microcatheter provided less coil protrusion into the parent artery and less microcatheter kickback compared with the straight tip. With the Γ-tipped microcatheter, even if the first coil loop migrated into the parent artery, its subsequent dynamic movement routed it back into the aneurysm. The Γ tip method enabled smooth movement of the microcatheter into the aneurysm, demonstrating the safety and security of coil insertion using the Γ tip compared with the conventional straight tip.

Long-Term Histopathology of Intracranial Aneurysms after Endovascular Treatment with Coils

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 225-231 ◽  
Author(s):  
Y. Suda ◽  
K. Kikuchi ◽  
H. Shioya ◽  
K. Shindo ◽  
H. Nanjo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Microscopic Examination ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Electron Microscopic Examination ◽  
Parent Artery ◽  
Electron Microscopic ◽  
Endovascular Coil Embolization ◽  
Aneurysmal Neck ◽  
Scanning Electron

We describe the results of electron microscopic examination in two patients with ruptured intracranial aneurysms who were successfully treated by endovascular coil embolization. The aneurysms were seen completely occluded on the follow-up angiograms. Autopsies of these patients were performed five and 26 months after endovascular treatment when they died of pneumonia and thalamic hemorrhage, respectively. The aneurysms were densely filled with the coils, which were readily identified through the thin and transparent wall of the aneurysmal dome. The orifice of the aneurysm was completely occluded so that macroscopically the coils were not directly visualized through the orifice. To examine any evidence of endothelialization across the orifice of the aneurysms, scanning electron microscopic examination was performed. In both cases, evidence of well regenerative endothelialization was observed across the aneurysmal orifice, being contiguous with the endothelial layer of the adjacent parent vessels. These ultrastructural findings indicate that the aneurysms are completely isolated from the lumen of the parent artery by a continuous lining of the regenerated endothelial cells following the endovascular treatment with coils, and further suggest that aneurysms have a potential of being cured permanently by this treatment modality. This is, to the best of our knowledge, the first report in humans verifying a complete endothelialization of the luminal surface at the aneurysmal neck after coil embolization, as evidenced by scanning electron microscopy.

scholarly journals Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes

2021 ◽  
Vol 10 (2) ◽  
pp. 326
Author(s):  
Grégory Secco ◽  
Olivier Chevallier ◽  
Nicolas Falvo ◽  
Kévin Guillen ◽  
Pierre-Olivier Comby ◽  
...  
Keyword(s):  
Renal Artery ◽  
Success Rate ◽  
Coil Embolization ◽  
Preventive Treatment ◽  
Parent Artery ◽  
Technical Success ◽  
Technical Success Rate ◽  
Endovascular Coil Embolization ◽  
Lower Morbidity

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.

scholarly journals Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas

2012 ◽  
Vol 18 (3) ◽  
pp. 326-332 ◽  
Author(s):  
P. Gölitz ◽  
T. Struffert ◽  
M. Arc Saake ◽  
F. Knossalla ◽  
A. Doerfler
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Parent Artery ◽  
Angiographic Ct ◽  
Complex Anatomy ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Contrast Medium Injection ◽  
Carotid Cavernous Fistulas ◽  
Coil Migration

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.

scholarly journals Endovascular Surgery for Ruptured Aneurysms with Vasospasm

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 48-52 ◽  
Author(s):  
A. Kurata ◽  
S. Suzuki ◽  
J. Niki ◽  
H. Ozawa ◽  
M. Yamada ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Preliminary Report ◽  
Endovascular Procedures ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Ruptured Aneurysms ◽  
Number Of Patients ◽  
Endovascular Coil Embolization ◽  
The One

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed. Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture. For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.

scholarly journals Histological Evaluation of Endothelial Reactions after Endovascular Coil Embolization for Intracranial Aneurysm

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 69-82 ◽  
Author(s):  
T. Ozawa ◽  
S. Tamatani ◽  
T. Koike ◽  
H. Abe ◽  
Y. Ito ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Endothelial Cell ◽  
Coil Embolization ◽  
Carotid Arteries ◽  
Sem Study ◽  
Endovascular Coil Embolization ◽  
Platinum Coils

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.

In Vitro Evaluation of Pt-Coated Electrospun Nanofibers for Endovascular Coil Embolization

2019 ◽  
Author(s):  
Min-Woo Kim ◽  
Seongpil An ◽  
Hyunjun Seok ◽  
Hyunchul Jung ◽  
Dong-Hyuk Park ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Electrospun Nanofibers ◽  
In Vitro Evaluation ◽  
Endovascular Coil Embolization

In vitro evaluation of Pt-coated electrospun nanofibers for endovascular coil embolization

2020 ◽  
Vol 101 ◽  
pp. 285-292 ◽  
Author(s):  
Min-Woo Kim ◽  
Seongpil An ◽  
Hyunjun Seok ◽  
Hyunchul Jung ◽  
Dong-Hyuk Park ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Electrospun Nanofibers ◽  
In Vitro Evaluation ◽  
Endovascular Coil Embolization

Nonoverlapping Y-Configuration Stenting Technique With Dual Closed-Cell Stents in Wide-Neck Basilar Tip Aneurysms

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. ons244-ons249 ◽  
Author(s):  
Young Dae Cho ◽  
Sun-Won Park ◽  
Jong Young Lee ◽  
Jung Hwa Seo ◽  
Hyun-Seung Kang ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Posterior Cerebral Artery ◽  
Good Alternative ◽  
The Other ◽  
Parent Artery ◽  
Closed Cell ◽  
Aneurysmal Neck ◽  
Wide Neck

ABSTRACT BACKGROUND: Stent-assisted coiling is increasingly used to treat wide-neck intracranial aneurysms to protect the lumen of the parent artery from coil protrusion. This technique is insufficient for treating some aneurysms, depending on their configurations. OBJECTIVE: To describe a variant of the Y-configuration stent-assisted coiling technique for the treatment of basilar tip aneurysms with wide necks. METHODS: This technique, called the nonoverlapping Y stenting technique, consists of the deployment of a closed-cell self-expandable stent from the basilar trunk to a posterior cerebral artery and then placement of a second stent from the basilar bifurcation to the other posterior cerebral artery without overlapping the first stent. The proximal flared portion of the second stent was located at the neck of the aneurysm. Coil embolization was performed under dual-stent protection. RESULTS: We successfully filled wide-neck aneurysms with coils under stent protection by forming a bridge across the aneurysmal neck without overlapping 2 closed-cell stents. Six basilar tip aneurysms were successfully treated with this technique. CONCLUSION: The nonoverlapping Y stenting technique is a good alternative to traditional stent-assisted coiling. This technique is particularly suitable for the treatment of broad-neck bifurcation aneurysms.

scholarly journals Endovascular Treatment of Distal Posterior Cerebral Artery Infectious Aneurysm

2020 ◽  
Vol 17 (3) ◽  
pp. 50-54
Author(s):  
Manoj Bohara ◽  
Prakash Bista
Keyword(s):  
Infective Endocarditis ◽  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Cerebral Angiogram ◽  
Endovascular Coil Embolization ◽  
Intracranial Infectious Aneurysm ◽  
Infectious Aneurysm

Intracranial infectious aneurysms are rare entities accounting for approximately 1- 6 % of all cerebral aneurysms and have high propensity of rupture associated with mortality. The principal risk factor is infective endocarditis and the management includes antimicrobial treatment with or without obliteration of the aneurysm by microsurgical or endovascular means. We present a young patient with intracranial infectious aneurysm who was successfully treated with endovascular coil embolization. A 20-years-old female with history of rheumatic heart disease presented with subarachnoid hemorrhage due to rupture of IIA associated with infective endocarditis. Cerebral angiogram revealed right distal posterior cerebral artery aneurysm. Echocardiography showed vegetation in mitral valve and blood culture was positive for Enterococcus faecalis. Antibiotic treatment was administered for 6 weeks. The follow-up angiogram showed an enlarging aneurysm. So, the patient underwent endovascular coil embolization of the aneurysm preserving the parent artery. There were no post-procedure deficits. Intracranial infectious aneurysm should be considered as a differential diagnosis in a patient with infective endocarditis presenting with focal neurological deficits or altered consciousness. Early diagnosis and individualized approach are the key to successful treatment and endovascular treatment is an effective modality for such lesions.

scholarly journals A Mechanical Coil Insertion System for Endovascular Coil Embolization of Intracranial Aneurysms

2013 ◽  
Vol 19 (2) ◽  
pp. 159-166 ◽  
Author(s):  
K. Haraguchi ◽  
S. Miyachi ◽  
N. Matsubara ◽  
Y. Nagano ◽  
H. Yamada ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Force Sensor ◽  
Insertion Force ◽  
Single Operator ◽  
Endovascular Coil Embolization ◽  
New System ◽  
Excessive Stress

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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