Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels – three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses – by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. Received: 17 March 1999 Accepted: 27 April 1999     

Embolization of dural arteriovenous fistulas with interlocking detachable coils.

Our clinical experience with interlocking detachable coils for the embolization of high-flow dural arteriovenous fistulas is reported. Interlocking detachable coils are useful for transarterial and transvenous embolizations of dural arteriovenous fistulas because (a) immediate coil detachment is possible, (b) the coils can be replaced easily, (c) detached coils rarely migrate, and (d) fewer interlocking detachable coils than conventional fiber coils are required for successful embolization.     

Endovascular treatment of pseudoaneurysms with electrolytically detachable coils.

PURPOSEWe describe the clinical presentation, angiographic findings, and clinical outcome in a group of patients with pseudoaneurysms treated by a new endovascular technique using Guglielmi electrolytically detachable platinum coils (GDCs).METHODSWe retrospectively reviewed the angiographic and clinical findings in a series of 11 patients with pseudoaneurysms occurring in a variety of locations: seven in the cavernous carotid artery, one in the petrous carotid artery, two in the anterior cerebral artery, and one in the cervical vertebral artery.RESULTSAll aneurysms were cured with GDC embolization. The only complication was a branch occlusion, which resolved with heparinization and produced no clinical sequelae.CONCLUSIONPseudoaneurysms can be safely and effectively treated by embolization with GDCs. Consideration needs to be given to the anatomic location of the pseudoaneurysm and the acuity of onset. Treatment efficacy may by improved if there are bony confines around the aneurysm or if therapy takes place in the subacute period, when the wall of the pseudoaneurysm has matured and stabilized.     

Clinical use of mechanical detachable coils for dural arteriovenous fistula.

Seven dural arteriovenous fistulas were successfully embolized with mechanical detachable coils. Two lesions were located in the transverse-sigmoid sinus, four in the cavernous sinus, and one in the marginal sinus. All lesions were completely occluded on postembolization angiography. No recurrent symptoms appeared during a mean follow-up period of 11 months. Owing to the length and retrievability of the mechanical detachable coils, embolization was quicker and safer, and coils were packed more densely, than is possible with conventional coils. Coil migration was avoided because coils of the appropriate size were chosen before they were placed.     

Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils

BACKGROUND AND PURPOSE: Middle cerebral artery (MCA) aneurysms often have an unfavorable aneurysm geometry that might limit endovascular therapy. Our purpose was to analyze the feasibility, safety, and efficacy of coil embolization in a consecutive series of MCA aneurysms chosen for endovascular treatment. PATIENTS AND TECHNIQUES: Of 235 MCA aneurysms seen at our institution during the past 5 years, 36 patients harboring 38 MCA aneurysms were primarily selected for coil embolization: 18 patients had an acute subarachnoid hemorrhage (SAH), 16 of which were due to a ruptured MCA aneurysm. SAH was classified according to Hunt and Hess grade: I (5), II (7), III (5), IV (0), and V (1). RESULTS: Complete occlusion could be achieved in 33 of 38 aneurysms. In 5 aneurysms, coil embolization was not performed because of an unfavorable aneurysm geometry with a wide neck or incorporation of adjacent branches (3) or failed because of insecure coil placement (1) or severe vasospasm (1). Procedural complications included coil protrusion into the parent artery (1), and thromboembolic M2 occlusion (5), with recanalization in 4 of 5 cases. Of 8 aneurysms with initial subtotal occlusion, 3 progressed to total occlusion during follow-up. Three aneurysms had to be retreated, and no patient rebled. Glasgow Outcome Scale at 6 months for the patients with SAH (17/18) was good recovery (12), moderate disability (4), severe disability (0), persistent vegetative state (0), and death (1); outcomes for patients with an incidental aneurysm (17/18) were good recovery (16) and moderate disability (1). CONCLUSION: Endovascular coil embolization can be performed safely and effectively in selected MCA aneurysms. Initial subtotal aneurysm occlusion might progress to total occlusion.     

Transarterial balloon-assisted glue embolization of high-flow arteriovenous fistulas

Introduction We report here our experience in treating high-flow arteriovenous fistulas (AVFs) of the brain and spine using balloon-assisted glue injection. Methods During a 3-year period (2003–2005) five patients with high-flow AVFs were treated at our hospital using transarterial balloon-assisted glue injection. There were two pial AVFs, one dural AVF, one vein of Galen malformation and one perimedullary AVF of the cervical spine. All patients were clinically followed-up for 12–48 months. Results Immediate angiographic obliteration was achieved in all patients. The fistulas remained closed in all patients, as ascertained by follow up-angiograms. No new neurological deficits related to the procedure were detected. Clinically, one patient with severe pre-treatment neurological deficit experienced excellent recovery. Conclusion Transarterial balloon-assisted glue embolization of high-flow AVFs is a feasible and efficient treatment. This technique affords more control in the glue injection and minimizes the risk of distal embolization.     

Endovascular treatment of congenital brain arteriovenous fistulas with combination of detachable coils and onyx liquid embolic agent

Introduction  

Congenital brain arteriovenous fistulas (BAVFs) are rare vascular lesions, and conservative management was associated with a high mortality rate. We report our experience in the treatment of congenital BAVFs using detachable coils and Onyx liquid embolic agent.     

High-flow,small-hole arteriovenous fistulas: treatment with electrodetachable coils.

We present one case of carotid-cavernous fistula caused by percutaneous treatment of trigeminal neuralgia and one case of vertebrovertebral fistula caused by percutaneous internal jugular vein cannulation. Each fistula had a small arteriovenous communication that prevented the use of detachable balloons. Endovascular transarterial treatment of these two iatrogenic fistulas with electrically detachable platinum coils was performed. Both fistulas were occluded with preservation of the parent artery, and the patients have fully recovered.     

Treatment of post-traumatic carotico-cavernous fistulae using electrolytically detachable coils: technical aspects and preliminary experience

We treated six patients with post-traumatic cavernous carotid fistulae by electrothrombosis using Guglielmi's new electrolytically detachable coils. The transarterial endovascular route was chosen in five and the transvenous in one case. Exophthalmos, chemosis and/or an audible bruit disappeared immediately after therapy or in the following month in all patients suffering from these symptoms. Third and sixth cranial nerve palsies resolved in three of four patients. Clinical results were excellent in three, good in two and fair in one. In this last patient massive thrombosis of an enormously dilatated superior ophthalmic vein occurred after treatment of a giant longstanding fistula, leading to unilateral visual impairment and increased sixth nerve palsy. In our first patient the intracavernous carotid artery was occluded by balloons after coil embolisation because of improper coil position and the fear of possible thromboembolic events. Angiographic cure was demonstrated in all cases by angiograms 1–6 months after therapy. The characteristics of these new coils are easy use, manoeuvreability and retrievability. They conform ideally to the shape of the vessel lumen to be obliterated and produce practically no trauma to the vessel walls. Furthermore, they can be positioned in the sinus close to the orifice of the fistula. In the last two cases partial occlusion of the fistula was sufficient to initiate the process of complete thrombosis, and delayed, complete occlusion was observed after 1 month. In our opinion this new device is not only a major contribution to treatment of intracranial aneurysms, but may also improve the results of treatment of carotico-cavernous fistulae. Received: 11 July 1995 Accepted: 19 December 1995     

Interventional radiology in the treatment of high-flow renal arteriovenous fistulas. Report of two cases

PURPOSE: To describe the morphological and haemodynamic characteristics of high-flow idiopathic renal arteriovenous fistulas and the radiological treatment techniques. MATERIALS AND METHODS: Two cases of idiopathic renal arteriovenous fistula were treated with transcatheter embolization. In the first case, the anomalous arteriovenous communication was embolized with acrylic glue through the afferent artery while the efferent vein was temporarily occluded with a balloon catheter using the "stop flow" technique. In the second case, the fistula was occluded from the arterial side using Gianturco coils and the "free flow" technique. RESULTS: In both cases post-procedural angiography demonstrated occlusion of the fistula. A color-Doppler US examination 6 months later showed the regularization of flow parameters in the renal artery and vein. Angiographic follow-up showed occlusion of the arteriovenous fistula, regularization of the renal artery calibre and normal renal parenchymal flow. CONCLUSIONS: Embolization is the best treatment for rare, high-flow, renal arteriovenous fistulas. The "stop flow" technique with acrylic glue is fast and economical. The "free flow" technique with coils is more expensive and complex, but just as effective.     

Transcatheter occlusion of the arterial supply to arteriovenous fistulas with Gianturco coils.

Transcatheter occlusive therapy is finding widespread clinical application. Numerous types of occlusive devices have been described. This report details the first three cases of occlusion of the arterial supply to arteriovenous fistulas with Gianturco stainless steel coils. Patients benefiting from this approach include those who refuse or cannot tolerate surgery, those in whom previous surgery failed, and those with chronic fistulas in whom surgery is likely to fail. The angiographer should make sure the coil is completely within the desired vessel, the feeding vessel is smaller than the coil to prevent passage through the fistula, and there is adequate collateral flow to distal organs to prevent infarction after occlusion of a major artery. This technique is useful as a nonsurgical treatment for a variety of arteriovenous fistulas and is within the capability of any experienced angiographer.     

Preliminary experience with an electrolytically detachable fibered coil.

We report our preliminary experience with a new embolic device, the electrolytically detachable fibered coil, in the treatment of four patients with high-flow arteriovenous shunting.     

应用可脱性弹簧圈及Glubran 2丙烯酸胶经岩下窦行静脉入路栓塞治疗海绵窦硬脑膜动静脉瘘

目的阐述应用可脱性弹簧圈及Glubran 2丙烯酸胶经岩下窦(IPS)行静脉入路栓塞(TVE)治疗海绵窦硬脑膜动静脉瘘(CSDAVF)的技术、治疗效果及安全性。方法 8例自     

Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach

Objectives:  

To describe the technique, efficacy, and safety of transvenous embolisation (TVE) of cavernous sinus arteriovenous fistulas (CSDAVFs) via the inferior petrosal sinus (IPS) with detachable coils and acrylic glue.     

Use of the trispan device to assist coil embolization of high-flow arteriovenous fistulas

The Trispan device is a new tool designed for use in the endovascular treatment of wide-neck aneurysms with coils. We describe another application of this device to control coil deposition and to prevent coil migration during transvenous occlusion of high-flow arteriovenous fistulas.     

Multiple spinal arteriovenous fistulas in Klippel-Trenaunay-Weber syndrome treated with platinum fibre coils

Summary A 13-year-old girl with Klippel-Trenaunay-Weber syndrome and intradural extramedullary spinal arteriovenous fistulas is presented. Pre-embolization balloon test occlusions and embolization with platinum fibre coils were carried out in three sessions, after which the myelopathy and the intense back pain disappeared. Our conclusion is that spinal fistulas can be safely and effectively treated with fibre coils in combination with balloon testing.     

Transvenous treatment of spontaneous dural carotid-cavernous fistulas using a combination of detachable coils and Onyx

Three patients with spontaneous dural carotid-cavernous fistulas were treated by using a combination of detachable coils and Onyx liquid embolic agent. Cavernous sinus was accessed via the superior ophthalmic vein or inferior petrous sinus approach. In all cases, a complete angiographic closure of the fistulas was achieved with full recovery from neuro-ophthalmologic symptoms. This report suggests that the controlled and excellent penetration of Onyx is superb for blocking the intricate communication of dural carotid-cavernous fistulas.     

Clinical use of a new mechanical detachable coil system for percutaneous intravenous embolization of cavernous sinus dural arteriovenous fistulas

PURPOSE: The purpose of this study was to evaluate the usefulness of a new mechanical detachable coil system (Detach-18/-11) for percutaneous transvenous embolization (TVE) of dural arteriovenous fistulas (AVFs) involving the cavernous sinus. MATERIALS AND METHODS: Five patients with dural AVF involving the cavernous sinus were treated by TVE with the use of the Detach-18/-11 system alone. All procedures were analyzed with regard to the processes of introduction, delivery, and/or retrieval of the Detach-18/-11 system, and angiographical and clinical outcome. RESULTS: A total of 70 detachable coils (37 spiral-type coils and 33 J-type coils) were used. Two coils were easily retrieved after introduction. The remaining 68 coils were easily delivered within 30 seconds. Neither premature detachment nor coil migration was observed. Of the five dural AVFs, three were completely occluded and two were nearly completely occluded immediately after embolization. Follow-up angiography showed complete occlusion in all cases. Clinical symptoms had disappeared within one month, and no recurrent symptoms were observed during follow-up (from 5 to 36 months). CONCLUSION: Our results support the safety and reliability of the Detach-18/-11 system for TVE of dural AVF. The availability of various types of this coil system allows sufficient packing of the involved sinus.     

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.