History of the genesis of detachable coils

A review

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The genesis of detachable coils and the background of this genesis are described in this article. To frame the beginning developmental stages of the discovery of detachable coils, the previous extravascular-intravascular and endovascular techniques are presented, as well as the development of the various delivery systems. The experimental studies, initial clinical application, and crucial moment of the conception of detachable coils are also reported.

Abbreviations used in this paper: AVM = arteriovenous malformation; GDC = Guglielmi detachable coil; ICA = internal carotid artery; POD = paraoperational device.

Article Information

Address correspondence to: Guido Guglielmi, M.D., Piazza Mazzini 27 00195, Rome, Italy. email: guidogdc@yahoo.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Plain skull radiograph obtained after 9 m of silver-enameled wire had been inserted into an aneurysm of the ICA by puncturing the aneurysmal wall. This procedure was performed in 1941 by Werner and colleagues. The image shows an impressive resemblance to what can be achieved today using detachable coils (an aneurysm filled with a metallic wire).

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    Right carotid artery angiogram with contrast material showing an experimental aneurysm produced in a rabbit in 1981 after endovascular electrothrombosis. It is possible to notice a minimal degree of thrombosis in the superior aspect of the aneurysm (arrow). A free fragment of the stainless steel wire used for electrothrombosis is visible within the thrombus, indicating detachment of the wire.

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    Image of the animal in Fig. 2, with no injection of contrast. In this image the detachment of the distal portion of the wire is very visible, above the tip of the intraaneurysmal catheter. The arrow indicates the distal tip of the electrode that was separated from the proximal wire (due to the passage of electrical current). This phenomenon was later used for the detachment of the GDCs.

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    Historic diagrammatic representation, drawn in 1990 for a meeting presentation, shows the phenomenon of electrolysis that is used for the detachment of the coils.

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    Photograph of a detachable coil. This particular coil was constructed in 1989 and was one of the first ever built.

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    Historic diagrammatic representations drawn in 1989 show the first two (upper) and remaining two (lower) steps of the detachable coil technique.

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    Historic photograph showing the first label on the package of a detachable coil. It was prepared in 1989, when the detachable coils were still called GEMs. The name was then changed to GDCs.

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    Historic photograph of the first (handmade) current generator used to detach the coils in 1989.

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    Preoperative (upper) and postoperative (lower) angiograms from a procedure performed in 1992. Upper: A small, small-necked, incidental ICA aneurysm is shown. The Tracker microcatheter is already in the aneurysm. Lower: Complete occlusion of the aneurysm using 4 detachable coils is demonstrated.

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