Abstract
Purpose
The aim of this study was to evaluate the stability of occlusion of terminal bifurcation aneurysms after embolization with hydrogel-coated coils.
Methods
Of 35 bifurcation aneurysms, 34 were treated with hydrogel-coated coils in combination with platinum coils, and 1 was treated with hydrogel-coated coils only. Aneurysms were located at the basilar tip in 17 patients, and the internal carotid artery (ICA) bifurcation in 18 patients. The patient population consisted of 20 women and 15 men with ages ranging from 21 to 65 years. The aneurysm was found in 16 patients on presentation for subarachnoid hemorrhage, and in 19 patients the finding was incidental. Of the 35 aneurysms, 25 were small, 9 were large and 1 was giant. The giant aneurysm was located at the basilar tip and showed partial thrombosis. All except two basilar tip aneurysms were treated with balloon assistance. The remaining two basilar tip aneurysms were embolized with the assistance of an aneurysmal neck bridge device.
Results
The mean percentage occluded aneurysm volume for all devices was in the range 34–100%. Follow-up angiograms were obtained at 1 year in 6 patients, 2 years in 11 patients, and 3 years in 18 patients. Angiograms obtained immediately after embolization demonstrated a Raymond class 1 occlusion in 29 patients (82.9%) and a Raymond class 2 occlusion in 6 patients (17.1%). In four of these six patients follow-up angiograms demonstrated regrowth with resultant Raymond class 3 occlusion. In the other two patients, Raymond class 2 occlusion remained stable on follow-up angiograms. In patients who had a Raymond class 1 occlusion on the angiogram obtained immediately after embolization, no regrowth was seen on the follow-up angiograms. The overall recanalization rate was 11.4% (three large, one giant) at 6 months. Retreatment was not considered in three of these patients and they were to be followed; the other patient was retreated.
Conclusion
Our initial procedural data demonstrate that higher volumetric occlusion was achieved with hydrogel-coated coils and the long-term follow-up results showed a favorably low recanalization rates among the terminal bifurcation aneurysms.
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References
Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via an endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75:8–14
Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274
Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98(5):959–966
Raymond J, Guilbert F, Weill A, Georganos S, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403
Byrne J, Sohn MJ, Molyneux AJ (1999) Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg 90:656–663
Gruber A, Killer M, Bavinzski G, Richling B (1999) Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single center experience. Neurosurgery 45(4):793–802
CARAT Investigators (2006) Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 37(6):1437–1442
Fujiwara NH, Kallmes DF (2002) Healing response in elastase-induced rabbit aneurysms after embolization with a new platinum coil system. AJNR Am J Neuroradiol 23:1137–1144
Yoshino Y, Niimi Y, Song JK, Silane M, Berenstein A (2004) Endovascular treatment of intracranial aneurysms: comparative evaluation in a terminal bifurcation aneurysm model in dog. J Neurosurg 101:996–1003
Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) Reconstruction technique in the treatment of wide-neck intracranial aneurysms: long-term angiographic and clinical results – apropos of 56 cases. J Neuroradiol 24:30–44
Satoh K, Matsubara S, Hondoh H, Nagahira S (1997) Intracranial aneurysm embolization using interlocking detachable coils. Intervent Neuroradiol 3 [Suppl 2]:125–128
Tamatani S, Ito Y, Abe H, Koike T, Takeuchi S, Tanaka R (2002) Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms. AJNR Am J Neuroradiol 23:762–767
Bavinzski G, Richling B, Binder BR, Gruber A, Talazoglu V, Dietrich W et al (1999) Histopathological findings in experimental aneurysms embolized with conventional and thrombogenic/antithrombolytic Guglielmi coils. Minim Invasive Neurosurg 42:167–174
Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R, Moret J (2007) Intracranial aneurysms: treatment with bare platinum coils – aneurysm packing, complex coils, and angiographic recurrence. Radiology 243(2):500–508
Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Vinuela F (2000) Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93:561–568
Cloft HJ, Kallmes DF (2004) Aneurysm packing with Hydrocoil embolic system versus platinum coils: initial clinical experience. AJNR Am J Neuroradiol 25:60–62
Kallmes DF, Fujiwara NH (2002) New expandable hydrogel-platinum coil hybrid device for aneurysm embolization. AJNR Am J Neuroradiol 23:1580–1588
Cloft HJ (2006) HydroCoil for Endovascular Aneurysm Occlusion Study (HEAL): periprocedural results. AJNR Am J Neuroradiol 27(2):289–292
Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482
Fanning NF, Berentei Z, Brennan PR (2007) Hydrocoil as an adjuvant to bare platinum coil treatment of 100 cerebral aneurysms. Neuroradiology 49:139–148
Berenstein A, Song JK, Niimi Y, Namba K, Heran NS, Brisman JL (2006) Treatment of cerebral aneurysms with Hydrogel-coated platinum coils: early single center experience. AJNR Am J Neuroradiol 27:1834–1840
Ding YH, Dai D, Lewis DA, Cloft HJ, Kallmes DF (2005) Angiographic and histologic analysis of experimental aneurysms embolized with platinum coils, Matrix, and Hydrocoils. AJNR Am J Neuroradiol 26:1757–1763
Kwan ESK, Heilman CB, Shucart WA, Kluzcnik RP (1991) Enlargement of basilar artery aneurysms following balloon occlusion – “water-hammer effect”. J Neurosurg 75:963–968
Lozier AP, Connolly ES, Lavine SD, Solomon RA (2002) Guglielmi detachable coil embolization of posterior circulation aneurysms: a systematic review of the literature. Stroke 33:2509–2518
Henkes H, Fischer S, Mariushi W, Weber W, Liebig T, Miloslavski E et al (2005) Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms. J Neurosurg 103:990–999
Meyers PM, Lavine SD, Fitzsimmons BF, Commichau C, Parra A, Mayer SA et al (2004) Chemical meningitis after cerebral aneurysm treatment using two second-generation aneurysm coils: report of two cases. Neurosurgery 55(5):1222–1227
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Geyik, S., Yavuz, K., Cekirge, S. et al. Endovascular treatment of basilar and ICA termination aneurysms: effects of the use of HydroCoils on treatment stability in a subgroup of patients prone to a higher recurrence rate. Neuroradiology 49, 1015–1021 (2007). https://doi.org/10.1007/s00234-007-0290-5
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DOI: https://doi.org/10.1007/s00234-007-0290-5