Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy.

BACKGROUND AND PURPOSE: The durability of aneurysm coil embolization is thought to depend on packing density. The expansile property of hydrogel coating on coils increases volumetric packing per coil length. We describe our experience using hydrogel-coated coils (HydroCoils) compared with inert platinum coils in intracranial aneurysm embolization. METHODS: Fifty aneurysms embolized primarily using HydroCoils from 2003 to 2004 were compared with 57 volume- and shape-matched aneurysms treated with standard platinum coils from 2000 to 2003. Outcome measures included volumetric percentage occlusion (VPO), length and number of coils used, procedure time, fluoroscopy time, contrast volume, coil cost, length of hospital stay, and durability of therapy. RESULTS: Seventeen/26/5 small/medium/large aneurysms treated with HydroCoils were matched with 29/24/4 small/medium/large aneurysms treated with inert platinum. HydroCoil embolization yielded significantly greater VPO (84.8% versus 29.8%; P<0.001), decreased average total coil length used per aneurysm (33.2 versus 44.3 cm), reduced fluoroscopy time (53.2 versus 65.2 minutes; P=0.016), but increased contrast volume used (174.8 versus 112.9 cc; P<0.001). There were no differences in length of hospital stay. Procedure-related morbidity and mortality rates in the HydroCoil cohort were 4% and 0%, respectively. Follow-up angiography at mean 12.3 months revealed lower aneurysm recurrence rates (17% versus 24%; number-needed-to-treat [NNT] 14.3). Initial costs associated with HydroCoil embolization were higher ($5835 versus $4017; P=0.004) but countered by lower retreatment rates (10% versus 17%; NNT 14.3). CONCLUSIONS: HydroCoil embolization achieves greater aneurysm packing density with decreased coil length. Initial durability data favor HydroCoils, with lower recurrence and retreatment rates.

Endovascular management of intracerebral and subarachnoid hemorrhage.

Significant advances in neuroendovascular devices and techniques are changing the approach to the management of acute hemorrhagic stroke. Greater numbers of aneurysms can now be treated using a wide array of platinum coils. Intracranial stents and balloon remodeling have made possible the treatment of wide-necked aneurysms. Microcatheters have been developed with better tractability to traverse tortuous vessels and access vascular lesions. With more than an estimated 100,000 patients with aneurysms treated worldwide, coil embolization has an excellent safety profile and level of outcome, with similar or better results compared with surgical clipping in select patient populations. Arteriovenous malformations and fistulae may also benefit from endovascular treatment by embolization using n-butyl cyanoacrylate or coils. In this article, we describe the endovascular role for the most common causes of intracerebral and subarachnoid hemorrhages, with special attention toward ruptured aneurysms and vascular malformations.

Glossal angiomyoma: imaging findings and endovascular treatment.

BACKGROUND: An angiomyoma is an uncommon, benign tumor characterized by numerous vascular channels intermixed with bundles of smooth muscle cells. Oral manifestations are quite rare. We describe for the first time the CT, MRI, and angiographic imaging features and successful preoperative endovascular embolization of an angiomyoma of the tongue. The pathologic findings before and after embolization are also described. METHODS AND RESULTS: A 25-year-old man was seen with a rapidly enlarging tongue mass. Imaging studies revealed the extent and hypervascular nature of this tumor. The diagnosis of angiomyoma was confirmed by histologic examination. Preoperative embolization proved to be helpful in the surgical management of this lesion. CONCLUSIONS: Angiomyoma should be considered in the differential diagnosis of any well-circumscribed, hypervascular, soft tissue tumor in the mouth. In addition, endovascular embolization may be a useful adjunct that facilitates resection.

Radiation dose to the operator during vertebroplasty: prospective comparison of the use of 1-cc syringes versus an injection device.

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty procedures require relatively long durations of fluoroscopic guidance, which might lead to substantial radiation dose to operators. Specialized injection devices have been proposed to limit operator exposure. Our purpose was to compare the radiation dose to the operator's hands during vertebroplasty when using 1-cc syringes versus that when using an injection device. METHODS: Radiation dosimeters were worn on the left wrist during 39 vertebroplasty injection procedures in 25 patients. Cases were alternated between the use of 1-cc syringes (19 procedures) and the use of an injection device (20 procedures). For each procedure, one dosimeter was worn throughout the procedure, both during needle placement and injection, and a second dosimeter was worn during the injection phase only. Mean doses for the whole case and mean doses for the injection procedure alone were compared between groups. RESULTS: Mean whole case dose was 128 +/- 161 mrem (range, 0-660 mrem) for the 1-cc syringe group versus 98 +/- 90 mrem (range, 0-340 mrem) for the injection device group (P =.23). Mean dose during injection was 100 +/- 145 mrem (range, 0-660 mrem) for the 1-cc syringe group versus 55 +/- 43 mrem (range, 0-130 mrem) for the injection device group (P =.09). Three of 19 1-cc syringe cases yielded zero dose, compared with four of 20 injection device cases. Duration of injection was markedly different between groups, with mean injection times of 4.2 and 7.5 min for 1-cc syringe and injection device cases, respectively (P <.00002). Mean injection dose per minute of lateral fluoroscopy was 23.6 and 7.3 mrem for the 1-cc syringe and injection device groups, respectively (P =.002). CONCLUSION: The use of an injection device significantly decreased the radiation dose to the operator's extremity per unit time of injection. However, total dose per injection was equivalent between groups because of significantly longer injection duration for the injection device cohort.