ABSTRACT
OBJECTIVE: We developed an animal model to evaluate vascular trauma induced by endovascular devices that are proposed for the treatment of cerebrovascular diseases. METHODS: The model was constructed in six domestic swine by elongating the common carotid artery using interpositional grafts. Balloon catheters (n = 3), stents (n = 2), and a snare were tested 9 to 13 days after surgery. Device performance was evaluated by angiography, macroscopic photography, and histopathological examination. RESULTS: Animals tolerated the surgical procedure well, and artificial siphons were thought to provide realistic conditions for device testing. Balloon catheters induced minimal trauma, whereas coronary stents caused severe spasm or thrombosis and extensive macroscopic changes. CONCLUSION: Construction of an in vivo siphon model is feasible and potentially useful for testing neurovascular devices.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Carotid Arteries/surgery , Materials Testing , Models, Animal , Neurosurgical Procedures/instrumentation , Anastomosis, Surgical/methods , Angioplasty/instrumentation , Animals , Female , Male , Polyethylene Terephthalates , Stents , SwineABSTRACT
BACKGROUND AND PURPOSE: Our aim in this study was to assess the incidence and determining factors of angiographic recurrences after endovascular treatment of aneurysms. METHODS: A retrospective analysis of all patients with selective endosaccular coil occlusion of intracranial aneurysms prospectively collected from 1992 to 2002 was performed. There were 501 aneurysms in 466 patients (mean+/-SD age, 54.20+/-12.54 years; 74% female). Aneurysms were acutely ruptured (54.1%) or unruptured (45.9%). Mean+/-SD aneurysm size was 9.67+/-5.91 mm with a 4.31+/-1.97-mm neck. The most frequent sites were basilar bifurcation (27.7%) and carotid ophthalmic (18.0%) aneurysms. Recurrences were subjectively divided into minor and major (ideally necessitating re-treatment). The most significant predictors of angiographic recurrence were determined by logistic regression. These results were confirmed by chi2, t tests, or ANOVAs followed, when appropriate, by Tukey's contrasts. RESULTS: Short-term (< or =1 year) follow-up angiograms were available in 353 aneurysms (70.5%) and long-term (>1 year) follow-up angiograms, in 277 (55%), for a total of 383 (76.5%) followed up. Recurrences were found in 33.6% of treated aneurysms that were followed up and that appeared at a mean+/-SD time of 12.31+/-11.33 months after treatment. Major recurrences presented in 20.7% and appeared at a mean of 16.49+/-15.93 months. Three patients (0.8%) bled during a mean clinical follow-up period of 31.32+/-24.96 months. Variables determined to be significant predictors (P<0.05) of a recurrence included aneurysm size > or =10 mm, treatment during the acute phase of rupture, incomplete initial occlusions, and duration of follow-up. CONCLUSIONS: Long-term monitoring of patients treated by endosaccular coiling is mandatory.
Subject(s)
Embolization, Therapeutic , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/therapy , Vascular Surgical Procedures , Cerebral Angiography , Embolization, Therapeutic/adverse effects , Female , Follow-Up Studies , Humans , Logistic Models , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Factors , Time , Treatment Failure , Vascular Surgical Procedures/adverse effectsABSTRACT
BACKGROUND AND PURPOSE: Beta radiation can prevent recanalization after embolization. Our goal was to assess the feasibility of endovascular treatment of intracranial aneurysms using coils of a predetermined activity of 32P per centimeter. METHODS: We studied the total length of coils deployed into 357 intracranial aneurysms. Aneurysmal volumes were estimated using 3 mathematical models. We simulated that coils were implanted with 0.26 microCi/cm of 32P, calculated resulting volumetric activities, and compared them with "effective" levels derived from experimental data and "safe" levels prescribed for the clinical use of 32P in cystic craniopharyngiomas. RESULTS: Effective activities would have been reached in 92% to 98% of lesions had the coils been radioactive at the time of treatment. CONCLUSIONS: Radioactive coil embolization of aneurysms is feasible in most patients.
Subject(s)
Embolization, Therapeutic/methods , Intracranial Aneurysm/radiotherapy , Intracranial Aneurysm/therapy , Prostheses and Implants , Adult , Aged , Beta Particles , Combined Modality Therapy , Feasibility Studies , Female , Humans , Intracranial Aneurysm/pathology , Male , Middle Aged , Models, Theoretical , Phosphorus Radioisotopes , Retrospective StudiesABSTRACT
The majority of spinal magnetic resonance (MR) imaging has been performed with spin-echo sequences and spoiled gradient-echo sequences. Advances in gradient MR imaging performance now permit imaging with coherent steady-state sequences. In this study, the authors compare a three-dimensional true fast imaging with steady-state precession sequence with a three-dimensional spoiled gradient-recalled-echo sequence for MR evaluation of the cervical spine in the transverse plane. Initial experience indicates that the steady-state sequence is superior to spoiled gradient-recalled-echo sequences for MR evaluation of cervical spine anatomy and abnormalities.
Subject(s)
Imaging, Three-Dimensional , Magnetic Resonance Imaging , Myelography/methods , Spinal Cord Diseases/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pilot Projects , Spinal Cord Diseases/pathology , Time FactorsABSTRACT
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.
