Aneurysms detachable

New England Journal of Medicine 336 28-40 Schwartz TH, Solomon RA (1996). Perimesencephalic nonaneurysmal subarachnoid hemorrhage review of the literature. Neurosurgery 39 433-440 Sluzewski M, van Rooij WJ, Beute GN et al. (2005). Late rebleeding of ruptured intracranial aneurysms treated with detachable coils. American Journal of Neuroradiology 26 2542-2549 Smith ER, Carter BS, Ogilvy CS (2002). 

Matrix detachable coils (Boston Scientific Neurovascular) are another example of modified endovascular coils, employing a stainless steel delivery wire coated with a bioabsorbable copolymer of 90% polyglycolide and 10% polylactide. In a study by Murayama et al. (2003), matrix detachable coils were shown to accelerate the rate of aneurysm healing in swine aneurysm models, specifically by promoting the formation of a thick neointimal layer at the aneurysm neck more quickly bare platinum coils (Murayama et al, 2003). Taschner et al. (2005) evaluated the use of Matrix detachable coils in 25 patients with intracranial aneurysms. Again, stable emboUzed aneurysms were achieved over a six-month period, but only when Matrix coils were used in conjunction with bare platinum coils (Taschner et al, 2005). 

Kawanabe, Y., Sadato, A., Taki, W. Hashimoto, N. (2001) Endovascular occlusion of intracranial aneurysms with Gughelmi detachable coils correlation between coil packing density and coil compaction. Acta Neurochirurgica, 143, 451-455. 

Tamatani, S., Ito, Y., Abe, T., Koike, T., Takeuchi, S. Tanaka, R. (2002) Evaluation of the stability of aneurysms after embolization using detachable coils correlation between stabibty of aneurysms and embolized volume of aneurysms. American Journal of Neuroradiology, 23, 762—767. 

Taschner, C. A., Leclerc, X., Rachdi, H., Barros, A. M. Pruvo, J.-P. (2005) Matrix detachable coils for the endovascular treatment of intracranial aneurysms analysis of early angiographic and clinical outcomes. Stroke, 36, 2176-2180. 

Guglielmi G (1999) Treatment of an intracranial aneurysm using a new three-dimensional-shape Guglielmi detachable coil technical case report [comment]. Neurosurgery 45 959-961... 

Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54 1359-1367... 

For neurovascular use, the development of the Gugliemi detachable coil (GDC) without fibers was essential for treatment of intracerebral aneurysm [10]. This coil and subsequent variations remains the standard for occlusion of narrow neck aneurysms. Variations of the GDC coil continue to be developed for management of cerebral aneurysm and other narrow neck aneurysms throughout the body [11]. The downside to the widespread use of GDC type coils for occluding arteries and veins are their expense and lack of thrombogenicity [12]. 

Klein GE, Szolar DH, Karaic R et al (1996) Extracranial aneurysm and arteriovenous fistula embolization with the Guglielmi detachable coil. Radiology 201 489-494... 

Future perspectives Detachable coils can be repositioned until a focal and compact mechanical obstruction is achieved. Detachable coils may be covered with small Dacron strands to promote thrombus formation or with an expanding hydrogel to minimize dead space between the coil loops. Although dedicated detachable coils are available for intracranial aneurysm embolization, the high cost of these coils precludes its routine use in non-neurointerventional indications. 

Defreyne L, De Schrijver I, Vanlangenhove P, et al. (2002) Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal fistula. Eur Radiol 12 231-236... 

Emholic material Steel coils Platinum microcoils if co-axial system used 1. Glue 2. Thrombin 3. Long detachable coils or detachable balloons if the aneurysm must be packed Unless the haemorrhage is immediately life threatening (see Fig. 7.3) do not use Particles Gelfoam Autologous blood... 

Stainless steel or platinum coils and detachable balloons are rarely used as aprimaryembolicagentinbron-chial artery embolization. Although these can be used to occlude a pathologic bronchial artery efficiently, use of coils predudes repeat embolization, which is often needed as patients are prone to distal collateralization (Fig. 16.21) [43,44]. The primary indication for use of coils is in patients with a bronchial artery aneurysm. Secondly, in cases where a superselective position of a (micro) catheter cannot be reached, coils can be used to protect a normal distal vascular territory against inadvertent embolization [25]. 

In 1995, the Guglielmi detachable coil technique was approved by the FDA for endovascular treatment of aneurysms. This method involves the use of deploying metallic coils into the aneurysm to induce a clotting response and seal off the aneurysm from the artery. Since its inception, over 200,000 patients worldwide have been treated with this technique [52]. However, difficulties in multicoil placement, thromboembolic events during placement, coil-induced rupture, and incomplete filling of fhe aneurysm are some of the challenges associated with the procedure [52]. 

To support coil deposition of wide-necked aneurysms a detachable device, the TriSpan (Boston Scientific, Fremont, USA) was designed and approved for clinical use in Europe. The TriSpan can be placed at the base of the aneurysm prior to coil embolization which is delivered through a second microcatheter. The TriSpan acts as a supporting structure and bridges the neck for subsequent coils. However, experience with this new device is limited mainly to broad-based basilar tip aneurysms. Since it is combined with an additional catheter the procedure is somewhat more complex and not really widely used. 

Abrahams JM, Diamond SL, Hurst RW, Zager EL, Grady MS (2000) Topic review surface modifications enhancing biological activity of Guglielmi detachable coils in treating intracranial aneurysms. Surg Neurol 54 34-40 discussion 40-41... 

Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JI (2000) The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms experience at the University of Illinois at Chicago. J Neurosurg 93 388-396... 

Biondi A, Oppenheim C, Vivas E, Casasco A, Lalam T, Sourour N, Jean LL, Dormont D, Marsault C (2000) Cerebral aneurysms treated by Guglielmi detachable coils evaluation with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 21 957-963... 

Brunereau L, Cottier JP, Sonier CB, Medioni B, Bertrand P, Rouleau P, Sirinelli D, Herbreteau D (1999) Prospective evaluation of time-of-flight MR angiography in the follow-up of intracranial saccular aneurysms treated with Guglielmi detachable coils. J Comput Assist Tomogr 23 216-223... 

Doerfler A, Wanke I, Goericke SL, Wiedemayer H, Engelhorn T, Gizewski ER, Stolke D, Forsting M (2006) Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol... 

Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Be-renstein A, Strother C, Graves V, Halbach V, Nichols D et al. (1992) Endovascular treatment of posterior circulation aneurysms by electrofhrombosis using electrically detachable coils. J Neurosurg 77 515-524... 

---