Interlocking detachable platinum coils,a controlled embolization device: Early clinical experience

Purpose: To present the early clinical experience of a new mechanically controlled-release embolization device<+>—<+>the interlocking detachable coil (IDC)—in complex embolization outside the head. Methods: IDCs were used only when conventional embolization techniques were considered too risky or unsafe. The coils consist of unfibered coiled platinum (0.012 inch), mechanically connected to a pusher wire and deployed through a Tracker 18 catheter. IDCs come in a range of diameters (2<+>–<+>8 mm) and lengths (1<+>–<+>30 cm). Results: A total of 87 IDCs were used for 27 procedures in 25 patients (mean 14.5 years) to occlude 31 arteries or vascular lesions. Control of the coil and its release were satisfactory and all coils were fully retrievable up to the point of deployment. Two IDC coils embolized inadvertently but were retrieved; there were no other complications. The IDC coils could not be satisfactorily placed in one high-flow arteriovenous (AV) fistula, and in another case there was a small residual fistula. Occlusion was produced in 29 of 31 lesions. Ancillary techniques were needed in 5 patients: temporary balloon occlusion in 2 and 0.038-inch coils in 3. Conclusion: The IDC coil is an effective device that allows controlled embolization to be performed, especially in aneurysms and in high-flow AV fistulas in children.     

Venous sac embolization of pulmonary arteriovenous malformation: Preliminary experience using interlocking detachable coils

Purpose: To evaluate the indication and advantages of venous sac embolization of pulmonary arteriovenous malformations (PAVMs) using interlocking detachable coils (IDCs). Methods: We performed percutaneous embolization in 12 PAVMs in four patients using IDCs, initially placed in the venous sac or at the feeding artery to prevent systemic migration of additional coils. We placed the IDCs in the venous sac in PAVMs with the following vascular architecture: the draining vein was larger than the feeding arteries and both vessels were interposed with the venous sac or there were short feeding arteries. Results: Complete occlusion was achieved in all 12 PAVMs without significant complications. We deployed IDCs in the venous sac in eight PAVMs and in the feeding artery in four. Conclusion: Venous sac embolization may be beneficial in PAVMs with large out-flow vessels or short feeding arteries. IDCs are suitable for this procedure.     

Single-center experience with TruFill platinum coils for the embolization of cerebral aneurysms

Endovascular coiling has become a powerful alternative to neurosurgical clipping of cerebral aneurysms. Apart from the Guglielmi Detachable Coil (GDC) (Boston Scientific, Galway, Ireland), there is limited published data about the newer generation of detachable platinum coils, e.g., TruFill (Cordis, Johnson and Johnson, Miami, Fl.). We report our initial clinical experience with the embolization of aneurysms by TruFill coils. Included in this retrospective study were 26 patients (age 55.4±14.5 years; 9 male, 17 female) with 28 aneurysms, 21 ruptured and 7 unruptured. All patients were treated exclusively by embolization with TruFill platinum coils. Immediate angiographic and 6-month angiographic follow-up results were documented. Acute clinical outcome was recorded. Of the 28 aneurysms, 16 (57%) were completely occluded by TruFill embolization, 11 (39%) were incompletely occluded with residual necks, and 1 (4%) was partially occluded as residual aneurysm. There were no aneurysmal ruptures during the procedures. Follow-up at 6 months after the procedure was available in 18 patients and 19 aneurysms. Of the 19 aneurysms, 2 of 12 initially completely occluded aneurysms (17%) and 1 of 7 aneurysms with initial residual necks (14%) showed recanalization at the 6-month follow-up. One recanalized aneurysm was subsequently recoiled with consequent residual neck and remained unchanged at the 1-year follow-up. Embolization by TruFill platinum coils has a comparable total aneurysmal occlusion rate to that with GDC. The mid-term reintervention rate is low, and will require verification by future long-term studies.     

Bronchial artery embolization with detachable coils for the treatment of haemoptysis. Preliminary experience

PURPOSE: This paper reports our early experience in the treatment of haemoptysis with embolization of the bronchial arteries using detachable coils. MATERIALS AND METHODS: Ten patients (mean age 45 years, range 23-83) with haemoptysis due to bronchoscopic biopsy of indeterminate lung nodules, lung cancer, tubercular bronchiectasis, cystic bronchiectasis or sarcoidosis underwent embolization of the bronchial arteries responsible for the bleeding using detachable coils. Patients were followed-up for a median of 14 months. RESULTS: In all patients the procedure halted the bronchial bleeding within 24 hours. Eight patients had no recurrence of haemoptysis. In one patient with lung cancer and another with sarcoidosis, haemoptysis recurred within 1-3 months due to recruitment of additional feeding arteries and to a missed large feeding artery originating from the subclavian artery, which required a new procedure. CONCLUSIONS: Use of detachable coils for embolization of bronchial arteries in patients with haemoptysis is advantageous since it eliminates the risk of migration typical of other embolic materials and enables rapid and permanent vessel occlusion.     

Initial clinical experience with biopolymer-coated detachable coils (HydroCoil) in peripheral embolization procedures

PURPOSE: To evaluate the technical and clinical success of HydroCoils in patients who underwent peripheral embolization procedures. MATERIALS AND METHODS: Between July 2006 and June 2007, 12 peripheral embolization procedures with HydroCoils in 11 patients (six male patients and five female patients; age range, 4-74 years; mean age, 46 y) were available for this retrospective review. The indications for embolization were hemorrhage (n = 4), aneurysm (n = 1), recurrent pulmonary arteriovenous malformation (n = 1), and protection before radioembolization and chemoembolization (n = 5). HydroCoil-10, -14, and -18 systems were used. Procedural and postprocedural follow-up imaging were reviewed by two interventional radiologists. Digital subtraction angiography (DSA) images were used to evaluate embolization success and vessel diameter. DSA and computed tomography (CT) angiography were used for follow-up, which included evaluation for recanalization and migration of coils. Chart review was also performed. RESULTS: All procedures were successful in occluding the target vessels (100%), which ranged from 1.2 mm to 8.2 mm in diameter (median, 2.2 mm). Immediate clinical success was achieved in all procedures (100%). Follow-up imaging was available in seven cases (four CT angiography and three DSA) at 2-108 days (mean, 42 d). No recanalization or migration of coils was found. There were no procedure-related complications, no clinical evidence of nontarget embolization, and no recurrence of presenting symptoms. CONCLUSIONS: The use of HydroCoils in peripheral arterial embolization procedures is effective and safe. They are viable alternatives to standard coils, particularly in tortuous, small target vessels or in cases in which controlled release is desirable.     

电解可脱性微弹簧圈血管内栓塞颅内动脉瘤的临床研究

目的 总结以电解可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的技术要点、并发症及其防治经验，并客观评价其治疗效果。方法 对136例颅内动脉瘤患者采用经皮股动脉穿刺行全脑选择性血管造影术，应用电解可脱性弹簧圈进行动脉瘤囊内栓塞；术后早期处理出血并有效的对症治疗。结果 成功栓塞136个动脉瘤，132例痊愈，4例死亡，病死率2．9％。动脉瘤腔100％闭塞者123个，95％闭塞者8个，90％闭塞者5个。术中并发动脉瘤破裂3例，脑血管痉挛7例；术后2例弹簧圈末端逸出。3例复发者经二次补充栓塞而治愈。全组出现与栓塞技术相关的并发症13例。术后随访6～54个月均无再出血。结论 对颅内动脉瘤采用电解可脱性弹簧圈进行血管内囊内栓塞疗效可靠；早期诊断、早期治疗、正确处理术中并发症、提高栓塞技术及积极有效的术后处理是减少术后并发症、提高治愈率的重要方法。     

Superselective embolization with coils in high-flow priapism

Priapism can be divided into "low-flow" veno-occlusive priapism and, especially in children, rare "high-flow" arterial priapism. We report a 5-year-old boy who developed arterial priapism after blunt perineal trauma that was successfully treated by superselective embolization with microcoils.     

Splenic embolization for hypersplenism using steel coils

Splenic embolization using steel coils was performed in 28 patients with hypersplenism caused by portal hypertension. The patients were classified according to the site of placement of the steel coils: In group 1 (six patients), it was the proximal splenic artery; in group 2 (10 patients), the distal splenic artery in the hilum of the spleen; in group 3 (12 patients), the intrasplenic branches of the splenic artery. Platelet counts increased in 27 (96%) of 28 patients within 1 month after embolization; the mean platelet counts at 1 year after treatment were higher than before the procedure in all groups. In group 3, excellent increases in platelet counts were obtained both as short- and long-term results of embolization; however, minor complications lasted longer than in the other two groups. No serious complications resulted from this procedure. Splenic embolization using steel coils is a valuable alternative to splenectomy in patients with hypersplenism.     

Guglielmi detachable coils versus matrix coils: a comparison of the immediate posttreatment results of the embolization of 364 cerebral aneurysms in 307 patients: a single-center, single-surgeon experience

BACKGROUND: Matrix coils are based on Gugliemi detachable coils (GDC) but are covered with polyglycolic/polylactic acid. We present our experience regarding the immediate posttreatment results of aneurysm embolization using the 2 coil systems. PATIENTS: We embolized 219 aneurysms in 187 patients with the use of GDCs and 145 aneurysms in 120 patients with the use of Matrix coils. Age, sex distribution, unruptured aneurysm cases, and multiple aneurysm cases were similar in the 2 groups. The percentage of patients in severe clinical condition was significantly higher in the Matrix group. The mean aneurysm size was slightly larger in the GDC group but the mean neck size was larger in the Matrix group. RESULTS: Satisfactory occlusion (at least 90%) was achieved in 95.9% of GDC-treated aneurysms and in 98.6% of Matrix-treated aneurysms. Procedure-related complications occurred in 19.6% of GDC procedures and in 15.6% of the Matrix ones resulting in procedure-related mortality and morbidity of 3.7% and 2.7% for the GDC group and 2.5% and 1.7% for the Matrix group. In the GDC group, outcome was good (modified Rankin Scale 0-2) in 92.6% of patients with unruptured aneurysms, in 82.6% of patients with Hunt and Hess grade I-III, and in 20.5% of those with Hunt and Hess grade of IV-V. The respective figures were 95%, 85.7%, and 22.7% in the Matrix group. CONCLUSION: In our series, Matrix coils have yielded slightly better results regarding satisfactory occlusion rate and clinical outcome but these differences are not statistically significant and probably reflect our increased experience in aneurysm embolization during the period we used Matrix coils.     

一级微铜圈肾动脉栓塞的实验研究

目的 评价一级微铜圈在动物体内的栓塞性能和生物相容性.方法 用直径0.1 ～ 0.23 mm导电用铜丝(纯度99.9％)制成直径0.48 ～ 0.74 mm的一级微铜圈,经3F微导管释放栓塞兔肾动脉末梢支,于栓塞术后不同时间观察血管闭塞情况和病理学改变,同时对实验动物栓塞前后的实验室检查指标进行比较.结果 栓塞术后3d,1、2、4、6和12周,动脉造影血管管腔闭塞时可见到血栓形成.栓塞后4周,组织学检查均可见小动脉内微球,动脉周围有炎性反应,并可见肾实质梗死灶;栓塞术后,血清铜离子术后2周内较术前升高,差异有统计学意义(P＜0.05),术后4周与术前比较,差异无统计学意义(P＞0.05);肝、肾功能2周后恢复至术前水平.结论 自制一级微铜圈具有明确的栓塞效果和良好的生物相容性.     

Thrombin-soaked embolization coils: the effect on whole blood clotting time.

Embolization coils are well established as embolic agents for the treatment of various conditions. Several authors have commented on the increased 'thrombogenicity' of coils following soaking in thrombin solutions. We have carried out an in vitro study, carefully measuring the effect on whole blood clotting time (WBCT), of soaking coils in thrombin solutions of different concentrations (100, 200, 400, 1000 U/ml). Untreated steel coils are shown to have clot promoting activity (CPA) in vitro, reducing WBCT from 14.85 min to 5.53 min. Passing the coils down a saline-filled catheter slightly reduces their CPA, but not significantly (p = 0.21). With thrombin concentrations above 100 U/ml, a significant reduction in WBCT is recorded, but although there is a trend of increasing CPA with increasing thrombin concentration from 200-1000 U/ml, a plateau in WBCT is seen, and the difference is not significant. It therefore appears that the clot promoting activity of embolic coils is significantly increased by soaking them in a relatively weak thrombin solution. The use of such a solution (e.g. 200 U/ml) in vivo would have obvious value in limiting the potential systemic effects of thrombin.     

Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤36例

目的 探讨Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的经验和疗效.方法 2010年5月至2011年3月使用Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤患者36例39个动脉瘤,其中动脉瘤破裂出血15例.动脉瘤位于前交通动脉1个,颈内动脉后交通段13个,眼动脉段13个,海绵窦段4个,椎动...     

32P-oligodeoxynucleotide-coated coils to prevent arterial recanalization after embolization

BACKGROUND AND PURPOSE: Endovascular treatment of aneurysms with coils, a less invasive alternative to surgery, is too often associated with recurrences. In a canine model, recanalization after coil embolization can be inhibited by in situ beta radiation. METHODS: Radioactive platinum coils were produced by immersion in a (32)P-oligodeoxynucleotide solution. In vitro and in vivo (32)P-oligodeoxynucleotide elution profiles were assessed after incubation or arterial implantation for 14 days or less. Activities within arteries, thrombi, and coils were measured by scintillation counting. Angiographic and pathologic results no more than 12 weeks after standard platinum and radioactive coil embolization of canine maxillary, cervical, and vertebral arteries were compared among 17 animals. RESULTS: Exposure to (32)P-oligodeoxynucleotide solution at 65 degrees C yielded coils with an average activity of 0.3 microCi/cm. Elution profiles in vitro and in vivo showed that 50% of total activities eluted from coils within 24 hours at first, but coil activities then paralleled the natural decay of (32)P. Radioactivity was present in the thrombi and arterial wall throughout the 14-day observation period. Arteries that were embolized with standard coils recanalized at 2 weeks. Implantation of (32)P-oligodeoxynucleotide-coated coils produced total occlusions in 78.6% of arteries throughout the 12-week observation period. Most arteries that were implanted with radioactive coils were filled with fibrous tissue at 3 months. CONCLUSION: Radioactive coils can be produced by using the binding properties of a (32)P-oligodeoxynucleotide to platinum. Use of these coils in an animal model was effective in preventing recanalization. This method could be performed on site to provide coils tailored to each intervention.     

Percutaneous liver biopsy and track embolization with steel coils

Eight patients with liver disease and seriously abnormal blood coagulation underwent biopsy of the liver performed through a percutaneously introduced sheath, followed by embolization of the biopsy track with steel coils. In all cases the biopsy procedure produced profuse bleeding through the sheath. However, the bleeding ceased within a few minutes after coil insertion.     

Cystosarcoma phyllodes: our institutional experience

Twenty-six patients of Cystosarcoma phyllodes, treated between July 1994 and July 2001, were analysed retrospectively. Median age at presentation was 38 years (range 13-61 years). Mean size of the lesion was 6 cm. There were 77% left-sided lesions and 23% right-sided lesions. Histologically, 58% lesions were benign, 11% borderline and 31% malignant lesions. All patients underwent definitive surgical procedure in the form of wide local excision or mastectomy. Four patients received postoperative radiotherapy. Median follow-up period was 35 months. Six patients showed recurrence, and four of these were malignant. Median disease-free survival period was 34 months.     

Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate

PURPOSE: To evaluate the clinical efficacy of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA) for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone. MATERIALS AND METHODS: Ruptured pseudoaneurysms developed at the celiac trunk (n = 1), gastroduodenal artery (n = 2), pancreatic arcade (n = 1), hepatic artery (n = 3), renal artery (n = 1), and intercostal artery (n = 1) in nine patients. NBCA was mixed with iodized-oil (1:2) and injected via the 3-F microcatheter under fluoroscopic guidance, after the catheter was advanced close to the pseudoaneurysm. Coil embolization was performed to control blood flow before administration of NBCA in seven patients. NBCA was injected immediately after coil embolization in four patients. Embolization with NBCA was performed for recurrent bleeding that occurred within 1-21 days (mean, 10.7 days) after initial coil embolization in three patients. Two patients with peripheral pseudoaneurysms underwent embolization with NBCA alone. RESULTS: The NBCA mixture was visible under fluoroscopy, and was useful in monitoring the embolization process and deciding the endpoint. Embolization was technically successful without major complications in all patients. Pseudoaneurysms and afferent and efferent arteries were eliminated immediately after embolization. Bleeding was stopped after embolization in all cases. Rebleeding did not occur in any patient during their follow-up periods of 0.7-69.5 months (mean, 17.9 months). CONCLUSION: Embolization with NBCA is a feasible and useful treatment for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone.     

Aseptic meningitis after embolization of cerebral aneurysms using hydrogel-coated coils: report of three cases

SUMMARY: We report the development of aseptic meningitis in 3 patients with aneurysms treated with hydrogel-coated coils. Patients presented with febrile meningeal syndromes during the 24 hours following the procedures and responded to corticosteroids. One of them developed delayed hydrocephalus that required treatment with a ventriculoperitoneal shunt. Aseptic meningitis is one of the important complications related to hydrogel-coated coils that should be recognized. More information based on the posttreatment surveillance after use of hydrogel-coated coils is required.