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Objective To summarize the experience in treating coronary artery fistula (CAF) by using Guglielmi detachable coils. Methods During the period from July 2009 to November 2014 at the Affiliated Changhai Hospital of Second Military Medical University, interventional treatment of CAF by using Guglielmi detachable coils was performed in 40 patients. The clinical data were retrospectively analyzed. The feasibility, safety and effectiveness of this technique were evaluated. Results Successful transcatheter closure of CAF with Guglielmi detachable coils was achieved in all 40 patients; the average Guglielmi detachable coils used in each patient was(2.33±1.38) coils. No procedure-related complications occurred. Intra-operative angiography showed that residual shunt completely disappeared in 12 patients (30%) and blood flow was significantly decreased in 28 patients (70%). All the patients were followed up for 1-65 months, neither complications such as recurrent bleeding and ischemia nor stenosis and occlusion of related arteries, or fistula cavity rupture occurred. Conclusion The use of Guglielmi detachable coil in interventional treatment of CAF is safe and effective, although its long-term effect needs to be further verified.
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Background Coronary artery fistula (CAF) is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil (GDC).The advantage of using GDC for transcatheter CAF closure is more controllable,therefore much safer when compared to other coils.This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital.Methods & Results From 2002 to 2007,there were 10 patients with CAFs (age range:28 to 56 year-old,7 males) who underwent transcatheter CAF closure.There were a total of 19 CAFs which originated from right coronary (n =5),left circumflex (n =3),left anterior descending artery (n =10) and left main trunk (n =1).Median number of coil deployment for each fistula was 3 (range:1 to 6).The pulmonary artery was the most common site of the distal communication of CAFs (n =14),followed by right atrium (n =3),left atrium (n =1) and left ventricle (n =1).Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2％) CAFs,significant reduction of the flow in 5 (26.3％),while 2 (10.5％) could not be closed due to small size.Nine (90％) patients underwent a repeated angiography within 3 to 8 months.Among 12 CAFs that were occluded immediately post-deployment,there were 2 CAFs with insignificant residual flow.Among 6 CAFs with significantly decreased flow immediately post-deployment,2 were occluded totally in the follow-up angiography.In total,12 (70.5％) CAFs were occluded completely and 5 (29.5％) CAFs still had insignificant residual flow,which did not need any additional coil deployment.During a mean follow up of 4.3 ± 0.7 year,all patients remained symptom and complication free.Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.
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Objective To investigate the risk factors and treatment experience of cerebral aneurysms rupture in the course of Gugliemi detachable coil (GDC) embolization. Methods From August 2000 to June 2010,420 patients with aneurysmal subarachnoid hemorrhage (SAH) received GDC embolization and their clinical data were retrospectively reviewed to analyse the risk factors of cerebral aneurysms rupture in the course of treatment. Results Sixteen patients had intraoperative aneurysm rupture, the incidence rate was 3.8%(16/420),including 13 cases density filling,3 cases partial filling postoperative.Univariate analysis showed:SAH episodes ≥2 times,tumor size ≤4 mm,the presence of pseudoaneurysm,Hunt-Hess grade Ⅳ - Ⅴ as well as history of hypertension were the risk factors of cerebral aneurysms rupture in the course of GDC embolization. Logistic regression analysis showed:SAH episodes ≥2 times (P = 0.0424,OR =6.798)and the presence of pseudoaneurysm (P = 0.0069, OR = 4.423) were the independent risk factors of cerebral aneurysms rupture. Conclusions Rupture of intracranial aneurysm in the course of GDC embolization is mainly related to the multiple SAH and the presence of pseudoaneurysm. It should be alert to the risk factors and take active treatment as soon as the occurrence of rupture in clinic work, for this, most patients can get a good prognosis.
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Objective To investigate the efficacy, technical tip, safety and complication prevention of combining Neuroform stents and Guglielmi detachable coils for treating acute ruptured giant intracranial aneurysms. Methods Among 10 cases who were diagnosed with giant intracranial aneurysms,Neuroform stents were released for supporting the neck of aneurysms, then micro-catheters were inserted into aneurysms through lumina of stents and coils were implanted. Results All the operations were completed successfully. There was no complication in these cases. The aneurysms were packed totally in 9 cases and partly in 1 case.Eight postoperative cases were followed up by 6 to 17 months. Neither bleeding nor thrombus was found, and all the patients recovered well. Conclusion Combining Neuroform stents and Guglielmi detachable coils for treating acute ruptured giant intracranial aneurysms is a safe and effective method.
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Objective To evaluate the clinical efficacy of detachable balloons,detachable coils and intracranial covered stents in management of intracranial giant aneurysms.Methods From April 1998 to March 2006,20 patients with a giant or very large aneurysm were treated by parent artery occlusion(PAO), coils embolization and covered stent,in which 9 aneurysms were treated by PAO,8 by coils embolization and 3 by covered stent at initial management.Two recurrent aneurysms treated by coils embolization were performed by covered stent.Follow-up 9-83 months,mean 41.1?25.3 months.Immediate postprocedural angiographic outcomes were categorized as complete occlusion(100%),subtotal occlusion(95%-99%),and incomplete occlusion(＜95%)of the aneurysms;and follow-up angiographic outcomes were categorized as stable, thrombosis,and recanalization.Clinical outcomes were graded according to a modified Glasgow Outcome Scale (GOS).Results Endovascular treatment was technically feasible in all aneurysms without procedural-related complications.Immediate postprocedural angiograms showed complete occlusion was achieved in 11 aneurysms, subtotal occlusion in 7 and incomplete occlusion in 2.One patient with incomplete occlusion died on the seventh day with a rebleeding.The final angiographic findings in nineteen survival patients confirmed a complete occlusion in 15 aneurysms,subtotal occlusion in 3 and incomplete occlusion in 1,in which 10 parent arteries were successfully preserved.No rebleeding occurred during the follow-up period.The clinical evaluation performed at final follow-up in 19 patients revealed that the symptoms disappeared in 11 patients and improved in 8 in the modified GOS.Conclusions Treatment of giant intracranial aneurysms with coiling was associated with a low complete occlusion rate and a high recanalization rate.Treatment with endovascular parent artery occlusion remains practical,but this technique may result in damage to the parent artery and cause cerebral ischemic events.The use of an intracranial covered stent proved to be a relatively simple and safe procedure and maintained the pateney of the parent artery.
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OBJECTIVE: The purpose of this study is to analyze aneurysm morphology and define limitations and feasibility in endovascular Gugliemi detachable coil(GDC) embolization for anterior communicating artery (ACoA) aneurysms. METHODS: From January 2000 through October 2003, 123patients were treated with endovascular coil embolization for ACoA aneurysms. There were 75women and 48men, with a mean age of 63years. All ruptured aneurysms were treated within 15days of rupture. Aneurysm morphology was classified according to neck size and projection of aneurysm dome as follows - A: neck of aneurysm or =4mm) aneurysms are highly related to recanalization of aneurysms. CONCLUSION: Endovascular coil embolization of ACoA aneurysms shows good outcome in our study. Nevertheless, there is a limitation in the endovascular approach to ACoA, even though advanced modern techniques evolve rapidly. Compensatory surgical approach with the endovascular approach is required for successful treatment of ACoA aneurysms.
Subject(s)
Aneurysm , Aneurysm, Ruptured , Arteries , Classification , Embolization, Therapeutic , Endovascular Procedures , Follow-Up Studies , Intracranial Aneurysm , Neck , RuptureABSTRACT
OBJECTIVE: The authors present the results of treatment and clinical outcome of intracranial aneurysm treated by Guglielmi detachable coil(GDC) embolization according to the location, size of the aneurysms and pre-operative state of patients. METHODS: We collected 222 patients who had 254 intracranial aneurysms and underwent endovascular treatment with GDC, which were treated at our institute during the 7-year period from 1995 to 2002. One hundred and forty-nine patients were females and 73 were males. Patient age ranged from 10 to 90 years(average: 54.1 years). One hundred and thirty-eight aneurysms were presented with ruptured aneurysm, 116 with unruptured aneurysm. Sixty aneurysms were located in the posterior circulation and 194 in the anterior circulation. Among the 138 ruptured aneurysms, fifteen patients were classified as Hunt-Hess Grade I, 64 Grade II, 25 Grade III, 20 Grade IV, and 14 Grade V. RESULTS: Among total of 254 aneurysms, we were achieved 90 to 100% obliteration of the aneurysm in 228 cases(89.8%) but failed in 6(2.4%) and partial obliteration(below 90%) in 20(7.9%). Overall mortality rate was 1.6%(4 cases) including 2 poor preoperative neurological status(Hunt-Hess Grade IV-V), 1 Hunt-Hess Grade III case with post-embolic rebleeding and one failed-embolic rebleeding. CONCLUSION: Embolization of intracranial aneurysms with GDC is safe, effective and reliable, and short-term clinical results of the endovascular treatment of cerebral aneurysm indicate that this procedure is a useful alternative approach in selected patients. Further follow-up review is necessary to establish durability in the long term outcomes, indication of GDC embolization and protection of rebleeding.
Subject(s)
Female , Humans , Male , Aneurysm , Aneurysm, Ruptured , Follow-Up Studies , Intracranial Aneurysm , MortalityABSTRACT
Fenestration of anterior communicating artery is one of relatively common anomalies. It is not always possible to check all of the anomalies in the anterior communicating artery by conventional angiogram. In case of coil embolization on aneurysm located in anterior communicating artery, the fenestration may cause unexpected complications. The evidential example taken here shows a 41-year-old patient with an anterior communicating artery aneurysm, on whom GDC embolization failed due to coil migration and ligation of aneurysm was given in a surgical treatment. The operative findings led to the discovery of the unexpected fenestration of anterior communicating artery and two separate aneurysms arising at each side of the fenestrated anterior communicating artery. A great concern should be given in coil embolization of aneurysms arising at the anterior communicating arteries.
Subject(s)
Adult , Humans , Aneurysm , Arteries , Embolization, Therapeutic , Intracranial Aneurysm , LigationABSTRACT
We report a case of borderzone infarction which was developed after the coil embolization of unruptured internal carotid-posterior communicating artery aneurysm. Post-procedural angiography and brain computerized tomographic scan did not reveal any abnormality. However, brain magnetic resonance image (MRI) showed a wedge-shaped borderzone cerebral infarction between left middle cerebral artery and left anterior cerebral artery territory. It was suspected to be a manifestation of hypoperfusion in the internal carotid artery territory, caused by hemodynamic instability during the procedure. In order to prevent this unexpected serious complication, using the continuous hemodynamic monitoring during aneurysmal coil embolization, such as transcranial doppler ultrasonography, should be considered.
Subject(s)
Aneurysm , Angiography , Anterior Cerebral Artery , Arteries , Brain , Carotid Artery, Internal , Cerebral Infarction , Embolization, Therapeutic , Hemodynamics , Infarction , Intracranial Aneurysm , Middle Cerebral Artery , Ultrasonography, Doppler, TranscranialABSTRACT
This article surveys current technical advancement in neuroendovascular therapy. The technical advancement happens not only in the field of products of microcatheter and guide wire but in the field of diagnosis. In the local intraarterial fibrinolysis, diffusion weighted MR imaging allows us more precise patient selection. In the atherosclerotic lesions, stent is clinically available. Some types of stent can be used in intracranial arteries. In the acutely ruptured aneurysm, intraanerysmal embolization using Guglielmi detachable coil followed by intratechal tissue-type plasminogen activator reduced occurring rate of vasospasm. In the wide neck aneurysm, neck plasty technique brings us better results. Neuroendovascular therapy is still evolving supported by such technical advancement.
Subject(s)
Aneurysm , Aneurysm, Ruptured , Arteries , Diagnosis , Diffusion , Diffusion Magnetic Resonance Imaging , Fibrinolysis , Magnetic Resonance Imaging , Neck , Patient Selection , Stents , Tissue Plasminogen ActivatorABSTRACT
GDC embolization has been performed selectively since 1991 in patients with intracranial aneurysms and made remarkable technical and clinical advances in recent years. But until now, this procedure lacks an adequate long-term follow-up study. Also, clear mechanism and evidence of electrothrombosis and endothelialization of aneurysm neck, the incidence of vasospasm after GDC embolization are still controversial. Here we critically reviewed the published literatures pertaining to the GDC embolization in order to gain a comprehensive understanding and knowledge of forementioned controversies. Also from November 1997 to April 1999, we treated 12 patients of intracranial aneurysms with GDC embolization. In conclusion, although certain shortcomings and controversies are still remain, the GDC embolization can be an alternative, supportive and attractive therapeutic modality in the treatment of intracranial aneurysms. Not only to improve outcome of intracranial aneurysms but also fulfill the patient's requirement, we need cooperations and cross-training with the interventional neuroradiology and rigorous academic evaluation on anatomy of cerebral vasculature and pathophysiology of cerebrovascular disorders.
Subject(s)
Humans , Aneurysm , Cerebrovascular Disorders , Embolization, Therapeutic , Follow-Up Studies , Incidence , Intracranial Aneurysm , NeckABSTRACT
OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Subject(s)
Female , Humans , Young Adult , Abducens Nerve Diseases , Exophthalmos , Fistula , Orbit , Punctures , VeinsABSTRACT
The purpose of the study was to evaluate short-term clinical results in 44 patients who had cerebral aneurysms and underwent endovascular treatment with Guglielmi detachable coil(GDC), and to establish selection criteria of the patients for this treatment. From March 1996 to November 1997, we treated 258 patients either by surgery or endovascular treatment, or by combination of both. Forty-four patients of them were assigned to endovascular GDC embolization as an initial treatment rather than surgery because of an anticipated technical difficulty for surgery due to anatomy of the aneurysm on cerebral angiography(25 patients), patient's poor physical or neurological condition(18 patients), or referring neurosurgeon's preference(one patient). Twenty patients were presented with ruptured aneurysm, 13 with unruptured aneurysm, 6 with mass effect, and 5 with initial incomplete clipping. Twenty-six patients had anterior circulation aneurysm and 18 had posterior circulation aneurysm. Among total of 44 patients, we were able to achieve 70 to 100% obliteration of the aneurysm in 32 patients (72.7%) but failed in 12(27.3%). Causes of failure were 5 wide neck, 4 vessel tortuosity, 2 difficult geometry, and a perforation of the distal basilar aneurysm. Seven of the failed patients were treated by subsequent clipping. Complications caused by the intra-aneurysmal endovascular treatment were a fatal perforation of the aneurysm with guide wire and an occlusion of the parent artery from over-packing of the coil, and distal migration of the coil in 2 patients, all of which could be retrieved. At an average 6-month follow-up, only one of six death was caused by the endovascular treatment. Short-term clinical results of the endovascular treatment of cerebral aneurysms indicate that this procedure is a useful alternative approach especially in selected patients with high risk aneurysm.
Subject(s)
Humans , Aneurysm , Aneurysm, Ruptured , Arteries , Follow-Up Studies , Intracranial Aneurysm , Neck , Parents , Patient SelectionABSTRACT
For the treatment of carotid-cavernous fistula, detachable balloon occlusion(DBO) is the method of choice. When it fails, or when the fistula is incompletely occluded, alternative treatment methods include direct surgery and internal carotid artery occlusion at the proximal and distal portion of the fistula. Before ligation or occlusion of the internal carotid artery, however, coil embolization should be considered, as this preserves patent internal carotid artery. The authors used DBO in a 22-year-old male patient with carotid-cavernous fistula which developed after head injury. During the procedures the fistula was partially obstructed by one detachable balloon. In spite of several attempted occlusions with a second balloon, this could not be introduced into the small remnant fistula hole. The second stage of intervention involved embolization with a Guglielmi detachable coil(GDC) ; this was successfully introduced into the partially obstructed fistula, which was thus completely occluded, and the patient's clinical symptoms improved. In this case, GDC emboization was an effective tool for the treatment of carotid-cavernous fistula incompletely occluded by a detachable balloon.
Subject(s)
Humans , Male , Young Adult , Carotid Artery, Internal , Craniocerebral Trauma , Embolization, Therapeutic , Fistula , LigationABSTRACT
For the treatment of carotid-cavernous fistula, detachable balloon occlusion(DBO) is the method of choice. When it fails, or when the fistula is incompletely occluded, alternative treatment methods include direct surgery and internal carotid artery occlusion at the proximal and distal portion of the fistula. Before ligation or occlusion of the internal carotid artery, however, coil embolization should be considered, as this preserves patent internal carotid artery. The authors used DBO in a 22-year-old male patient with carotid-cavernous fistula which developed after head injury. During the procedures the fistula was partially obstructed by one detachable balloon. In spite of several attempted occlusions with a second balloon, this could not be introduced into the small remnant fistula hole. The second stage of intervention involved embolization with a Guglielmi detachable coil(GDC) ; this was successfully introduced into the partially obstructed fistula, which was thus completely occluded, and the patient's clinical symptoms improved. In this case, GDC emboization was an effective tool for the treatment of carotid-cavernous fistula incompletely occluded by a detachable balloon.
Subject(s)
Humans , Male , Young Adult , Carotid Artery, Internal , Craniocerebral Trauma , Embolization, Therapeutic , Fistula , LigationABSTRACT
90%) and 1 incompletely (
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Objective To analyze the causes, prevention and treatment of repture druing procedure for intracranial aneurysm embolization with GDC.Methods All the seven patients were embolized. Six patients were ruptured during the procedure and continuously embolized until the bleeding was halted. Another one was identified by post procedure CT. Results Four patients recovered unevent fully with one only suffering from mild deficit. Another 2 patients died of hyper intracranial pressure within one week. Conclusions Rupture during procedure of intracranial aneurysm embolization with GDC may be related to manipulation, properties of the parent artery and arneurysm. Continuous embolization with GDC will provide favorable prognosis for the patients.