Repositioning of Displaced Guglielmi Detachable Coils after Endosaccular Embolisation Using a Modification of the Neck Plastic Technique

1998 ◽  
Vol 4 (4) ◽  
pp. 317-322
Author(s):  
J.C. Chaloupka ◽  
D.C. Huddle
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Coil Embolisation ◽  
Surgical Clipping ◽  
Detachable Coils

After undergoing prior partial surgical clipping of an acutely ruptured internal carotid aneurysm, a 29-year-old woman was referred for endovascular treatment of the gradually enlarging aneurysm remnant. The aneurysm had a somewhat peculiar ellipsoid configuration due to placement of the clip, with the largest dimension measuring less than 4 mm, and the neck measuring approximately 2 mm. Using the conventional endosaccular coil embolisation technique, two small electrolytically detachable coils were carefully folded into the aneurysm sac to produce excellent tight packing. However, immediately after detachment, a loop of the second coil inadvertently herniated out of the aneurysm into the center of the parent artery, exhibiting substantial pulse synchronous displacement. This created a potentially unstable situation for the remaining coils within the embolised aneurysm. To correct this problem we attempted to reposition the loop into the aneurysm using a modification of the previously described neck plastic technique. This technique succeeded without untoward complication. Although there are theoretical risks and limitations, the modified neck plastic technique may be useful in selective cases of inadvertent coil misplacement during endosaccular coil embolisation of aneurysms with the GDC system.

scholarly journals Late Thromboembolic Events after Treatment of Intracranial Aneurysms with Guglielmi Detachable Coils

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 356-357
Author(s):  
Colin P Derdeyn ◽  
Christopher J Moran ◽  
DeWitte T Cross ◽  
Michael R Chicoine ◽  
Ralph G Dacey
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Additional Patient ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Imaging Data ◽  
Guglielmi Detachable Coils ◽  
Kaplan Meier ◽  
Detachable Coils

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

Endovascular treatment with Guglielmi detachable coils for basilar artery trunk aneurysms: clinical experience with 41 aneurysms in 39 patients

2001 ◽  
Vol 95 (4) ◽  
pp. 624-632 ◽  
Author(s):  
Ken Uda ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Fernando Viñuela
Keyword(s):  
Endovascular Treatment ◽  
Clinical Experience ◽  
Basilar Artery ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Cerebellar Artery ◽  
Detachable Coils ◽  
Fine Print

Object. The authors present a retrospective analysis of their clinical experience in the endovascular treatment of basilar artery (BA) trunk aneurysms with Guglielmi detachable coils (GDCs). Methods. Between April 1990 and June 1999, 41 BA trunk aneurysms were treated in 39 patients by inserting GDCs. Twenty-seven patients presented with subarachnoid hemorrhage, six had intracranial mass effect, and in six patients the aneurysms were found incidentally. Eighteen lesions were BA trunk aneurysms, 13 were BA—superior cerebellar artery aneurysms, four were BA—anterior inferior cerebellar artery aneurysms, and six were vertebrobasilar junction aneurysms. Thirty-five patients (89.7%) had excellent or good clinical outcomes; procedural morbidity and mortality rates were 2.6% each. Thirty-six aneurysms were selectively occluded while preserving the parent artery, and in five cases the parent artery was occluded along with the aneurysm. Immediate angiographic studies revealed complete or nearly complete occlusion in 35 aneurysms (85.4%). Follow-up angiograms were obtained in 29 patients with 31 aneurysms; the mean follow-up period was 17 months. No recanalization was observed in the eight completely occluded aneurysms. In 19 lesions with small neck remnants, seven (36.8%) had further thrombosis, three (15.8%) remained anatomically unchanged, and nine (47.3%) had recanalization caused by coil compaction. In one patient (2.6%) the aneurysm rebled 8 years after the initial embolization. Conclusions. In this clinical series the authors show that the GDC placement procedure is valuable in the therapeutic management of BA trunk aneurysms. The endovascular catheterization of these lesions tends to be relatively simple, in contrast with more complex neurosurgical approaches. Endosaccular obliteration of these aneurysms also decreases the possibility of unwanted occlusion of perforating arteries to the brainstem.

scholarly journals Endovascular Treatment of Direct Carotid-Cavernous Fistulas Using Detachable Coils

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 125-129
Author(s):  
I. Naito ◽  
T. Iwai ◽  
M. Negishi ◽  
T. Sasaki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Alternative Treatment ◽  
Internal Carotid ◽  
Endovascular Technique ◽  
Detachable Coils ◽  
Incomplete Closure ◽  
Carotid Cavernous Fistulas ◽  
Balloon Embolization

Five direct carotid-cavernous fistulas (direct CCFs) in four patients were treated by an endovascular technique using detachable coils. The embolizations were performed according to one of two strategies. 1) By embolizing the fistula, that is the compartment of the cavernous sinus adjacent to the fistula orifice, after embolization of the draining veins. 2) By embolizing the fistula only. The former strategy was used to treat first two cases and the latter to treat other three cases. In two of the cases in which only the fistula was embolized, a microcatheter was placed in the draining vein via a transvenous route before-hand, in the event that the embolization resulted in an incomplete closure and the draining veins became inaccessible. In four cases, a complete cure was achieved with preservation of the internal carotid artery and in one case, the internal carotid artery containing the fistula was occluded. The embolization of direct CCFs with detachable coils, which are suitable for both transarterial and transvenous approaches, has several advantages over balloon embolization. We believe this procedure will become an alternative treatment.

Endovascular Treatment with Guglielmi Detachable Coils and Permanent Balloon Occlusion for Paraclinoid Aneurysms

Neurosurgery ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 713-713
Author(s):  
John Thornton ◽  
Mukesh Misra ◽  
Zachary Dovey ◽  
Victor Aletich ◽  
Gerard Debrun ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Occlusion ◽  
Guglielmi Detachable Coils ◽  
Paraclinoid Aneurysms ◽  
Detachable Coils

scholarly journals Guidewire-Induced Carotid Cavernous Fistula

2001 ◽  
Vol 7 (2) ◽  
pp. 161-165 ◽  
Author(s):  
T.-S. Kim ◽  
M. Ezura ◽  
A. Takahashi ◽  
S. Nishimura ◽  
T. Yoshimoto
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Endovascular Embolization ◽  
Guglielmi Detachable Coils ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Small Branch ◽  
Detachable Coils

A rare case of carotid cavernous fistula occurring during endovascular embolization of the left carotid cave aneurysm in a 48-year-old female is reported. It was thought to be caused by the tear of a small branch derived from the intracavernous internal carotid artery while the guidewire was passing the sharp posterior bend of the intracavernous internal carotid artery. The left carotid cave aneurysm was completely occluded with five Guglielmi detachable coils assisted by neck plasty technique. It was decided to follow-up the carotid cavernous fistula since it was asymptomatic. Follow-up angiogram performed two weeks later revealed spontaneous obliteration of the carotid cavernous fistula.

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1332-1342 ◽  
Author(s):  
Satoshi Tateshima ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Single Institution ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils

Multiple clipping technique for large and giant internal carotid artery aneurysms and complications: angiographic analysis

1994 ◽  
Vol 80 (4) ◽  
pp. 635-642 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Shigeaki Kobayashi ◽  
Kazuhiko Kyoshima ◽  
Kenichiro Sugita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Internal Carotid ◽  
Parent Artery ◽  
Surgical Clipping ◽  
Content Type ◽  
Clipping Technique ◽  
Fine Print

✓ Experience with surgical clipping of 16 large and nine giant aneurysms of the intradural internal carotid artery (ICA) is described. Reconstruction of the parent artery with part of the aneurysmal wall was necessary in the majority of cases. Multiple clips were required for satisfactory clipping in 20 cases. Complications related to the clipping procedure comprised occlusion and stenosis of the parent carotid artery in isolated cases. Straightening of the parent carotid artery with consequent kinking of the middle cerebral artery was seen in three cases of an aneurysm with a dome directed ventrally in the proximal segment of the ICA. The factors that caused straightening of the ICA are analyzed. It was observed that an excessive change in the direction of the ICA can cause cerebral infarction.

Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils

1997 ◽  
Vol 87 (3) ◽  
pp. 374-380 ◽  
Author(s):  
Douglas A. Nichols ◽  
Robert D. Brown ◽  
Kent R. Thielen ◽  
Fredric B. Meyer ◽  
John L. D. Atkinson ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Occlusion ◽  
Additional Treatment ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Content Type ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of ruptured posterior circulation aneurysms. Twenty-six patients with 28 posterior circulation aneurysms were treated. All patients were referred for endovascular treatment by experienced vascular neurosurgeons. Patients underwent follow-up angiography immediately after treatment, 1 to 6 weeks posttreatment, and 6 months posttreatment. Six-month follow-up angiograms obtained in 19 patients with 20 aneurysms demonstrated that 18 (90%) of the 20 aneurysms were 99 to 100% occluded, one aneurysm (5%) was approximately 90% occluded, and one aneurysm (5%) was approximately 75% occluded. The patient with the aneurysm that was approximately 75% occluded needed additional treatment, consisting of parent artery balloon occlusion, and was considered a treatment failure (3.8% of patients). There was one treatment-associated mortality (3.8%) but no treatment-associated serious neurological or nonneurological morbidity in the patient group. There was no recurrent aneurysm rupture during treatment or during the mean 27-month follow-up period. Endovascular treatment of ruptured posterior circulation aneurysms with electrolytically detachable coils can be accomplished with low morbidity and mortality rates. The primary goal of treatment—preventing recurrent aneurysm—can be achieved over the short term. Endovascular coil occlusion will play an important role in the treatment of ruptured posterior circulation aneurysms, particularly if long-term efficacy in preventing recurrent aneurysm hemorrhage can be documented.

scholarly journals Embolisation of Orbital Varix via the Superficial Temporal Vein

2000 ◽  
Vol 6 (2) ◽  
pp. 137-140 ◽  
Author(s):  
N. Mavilio ◽  
A. Pau ◽  
R. Pisani ◽  
A. Casasco ◽  
M. Rosa
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Management ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils ◽  
Orbital Varix

A case of orbital varix is presented, in which the lesion was successfully treated by means of embolisation with Guglielmi detachable coils, via the superficial temporal vein. Reports of endovascular treatment via transvenous route of orbital varix are lacking, only one case having previously been presented in the literature. We stress endovascular management for such an entity.

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