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.

Abstract

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.

The word genesis comes from Greek “Γένεσις” which means “birth, origin.” The history of the genesis of detachable coils is the history of an invention that led to an alternative endovascular treatment of brain aneurysms. The genesis of detachable coils encompasses many years, from 1970 to 1990. The initial idea sparked the merging of the “three arts” that were to become the basis of the invention of detachable coils; those three arts were electronics, neurosurgery, and interventional neuroradiology. The initial research for these coils drew upon decades of earlier scientific research and discoveries. This previous work is described in this article because it provides the background for understanding the genesis of detachable coils.

Background

Extravascular Approach

In the early stages of the conception of detachable coils, the only reliable, controllable, and successful therapeutic approach to brain aneurysms was surgical clipping. After the first clipping of a brain aneurysm in 1937, Dandy wrote: “…an aneurysm at the circle of Willis is not entirely hopeless…” Since then, due to a continuous technical and cultural evolution, surgical clipping has become the most rational procedure for treating brain aneurysms. The precise planning of all surgical steps in surgical clipping leaves nothing to chance. Surgical clipping of an aneurysm is an entirely extravascular procedure because the endovascular space is not violated. A spectacular review and description of aneurysm clipping is found in the books that Yaşargil wrote in the mid-1980s.32,33 Nevertheless, the inherent invasiveness of surgery (craniotomy, brain retraction, arachnoid dissection, and aneurysm manipulation) led to the desire of finding less traumatic, alternative approaches that used the intravascular space as a natural compartment to reach and occlude brain aneurysms.

Extravascular-Intravascular Approach

In the attempt to find alternative approaches to aneurysm treatment, some scientists conceived and tested different techniques. At the heart of these extravascular-intravascular techniques was the notion that the aneurysm was better cured if it was surgically exposed or stereotactically reached using a probe. The wall or neck of the aneurysm is then punctured to gain access to the intravascular compartment (extravascular-intravascular approach).

In 1941, Werner et al.31 reported on the wiring and electrothermic coagulation of an ICA aneurysm. After exposing and puncturing the aneurysm with a special needle, 9 m of silver-enameled wire were introduced into the aneurysm through the needle (Fig. 1). The wire was heated to an average temperature of 80°C for a total of 40 seconds. It is unclear how these investigators heated the wire. The patient tolerated the procedure.

Fig. 1.
Fig. 1.

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).

In the 1960s, Mullan and colleagues25 developed a novel technique that consisted of stereotactic insertion of fine (0.2 mm in diameter) copper-plated steel needles through a bur hole, across the neck of brain aneurysms at 1.0-mm intervals. Electrothrombosis was initiated by passing a 1-mA positive direct electric current through each needle for 5 minutes. Postoperative angiograms were obtained every 30 minutes until satisfactory thrombosis was achieved. Using this technique, 61 patients were treated,24 and adequate occlusion of the aneurysm was achieved in 49 patients. Four intraoperative deaths occurred. Incomplete occlusion occurred in 8 patients, all of whom died 1–66 days posttreatment due to recurrent intracranial hemorrhage.

Mullan24 also piloted his method in 15 patients harboring giant intracranial aneurysms. In these cases he adopted a different technique in which he performed a craniotomy and punctured the aneurysm. He then introduced very thin, spring-like copper wire into the aneurysm. The copper ions induced the phenomenon of electrothrombosis. A total of 5 patients died, while the thrombosis was considered satisfactory in the remaining 10 patients. These techniques did not become popular because the aneurysm had to be punctured, extensive equipment was required, it was necessary to penetrate cerebral tissue to reach the aneurysm with the probe, and it was unsuitable for a wide spectrum of aneurysms. Furthermore, aneurysm clipping consolidated as the ideal treatment, with lower morbidity and mortality rates.

In the mid-1970s Alksne and Smith1 attempted to treat intracranial aneurysms by stereotactic placement of a magnetic probe against the sac of the aneurysm, followed by the injection of iron microspheres into the aneurysm by puncturing its wall with a small needle. Their aim was to create an intraaneurysmal thrombus by the attraction of iron microspheres to the extravascular magnet. However, the fragmentation of the metallic thrombus, after removal of the probe, was a significant problem. The authors reported their clinical experience with 22 consecutive cases of anterior communicating artery aneurysms treated using stereotactic iron-acrylic occlusion.1 These investigators suspended the iron powder in methyl methacrylate to prevent fragmentation. There were no deaths and no rebleeding in this patient series. Morbidity was low, and 16 of the 22 patients returned to work. The patients whose aneurysms could be treated transsphenoidally enjoyed the best outcome. This technique did not become popular and was soon abandoned due to the tremendous progress in aneurysm clipping.

The work of these pioneer investigators is important because it suggests the concept of filling the intravascular compartment of an aneurysm, even though the aneurysm was punctured from the outside. Their work had a decisive impact on the conceptual development of detachable coils. The idea of detachable coils was to perform endovascularly what they had done extravascularly-intravascularly.

Endovascular Approach

The desire to avoid craniotomy and the aspiration to use arteries as natural channels through which aneurysms could be reached led some researchers to seek a way of treating cerebral aneurysms via a purely endovascular approach.

In the mid-1970s the field of endovascular neurosurgery was stupefied by a report of Serbinenko30 who described the endovascular treatment of more than 300 patients using detachable and nondetachable inflatable balloons. It was the first report demonstrating the feasibility of endovascular endosaccular occlusion of brain aneurysms while preserving the parent artery. The next decade (until 1990) saw the establishment of neuroendovascular centers in which endosaccular balloon occlusion of cerebral aneurysms was practiced. In 1982, Romodanov and Shcheglov28 reported on the balloon occlusion of 120 aneurysms with a 73% rate of preservation of the parent vessel. Regarding the limits of balloon embolization, these authors stated that the endovascular operation was contraindicated in small aneurysms, in aneurysms with a wide neck, in the acute phase after subarachnoid hemorrhage, and in the presence of vasospasm, because the mortality rate among such patients was 22%. In 1990, Higashida et al.18 reported on a series of 84 nonsurgical aneurysms of the anterior and posterior circulation that were treated using balloon embolization. In this study, an 18% mortality rate and an 11% morbidity rate directly related to the embolization procedure were observed.

As innovative as they were, balloons did not adopt the shape of the aneurysm and, as a consequence, they produced an “angioplasty” of the aneurysmal cavity. Balloons, in other words, forced the aneurysm to adapt to the shape of the balloon. This adaptation entailed a high incidence of aneurysm rupture. In other words, balloon embolization (unlike surgical clipping) was an entirely “uncontrollable” procedure in which much was left to chance. The high rates of morbidity and mortality following balloon occlusion were not acceptable to most neurosurgeons around the world. Due to the high incidence of severe immediate complications, delayed rupture of the aneurysm, and recanalization, this technique did not become popular, failed to attain widespread utilization, and was adopted only in small clinical series. Nevertheless, the work of these pioneers had a definite impact on the genesis of detachable coils because it demonstrated that entering an aneurysm via the endovascular approach was feasible in the majority of cases.

The substantial failure of balloon embolization motivated investigators, including the author, to find a less traumatic embolic agent that could gently adopt the shape of the fragile walls of the aneurysm. In 1989, Hilal and colleagues19 reported the first use of short pushable coils for endosaccular treatment of intracranial aneurysms. With these relatively stiff coils, however, dense aneurysm packing could not be achieved. Furthermore, as these coils were nonretrievable and noncontrollable, an unwanted deposit in the parent artery was highly probable.

Endovascular Access and Delivery Systems

The history of the endovascular delivery systems (microcatheters and microguidewires) is as important as the history of the embolic-occlusive agents. The implementation of the detachable coil technique would have been impossible without an appropriate delivery system. Cerebral arteries are delicate, narrow, and tortuous. In the past, several groundbreaking researchers tried to devise microcatheters soft enough to not damage the arteries, and stiff enough to be pushed into the intracranial vasculature, overcoming the curves of the carotid siphon. The so-called “variable stiffness,” “over the wire” microcatheter (the Tracker; Target Therapeutics) emerged as the final solution (see below).

Luessenhop and Velasquez,23 in the mid-1960s, were the first to catheterize brain vessels using a Silastic tubing. These investigators used a glass chamber connected to the external carotid artery to inject the Silastic tubing into the intracranial circulation. Enthusiastic about their work, they prophetically predicted that catheterization of brain arteries would eventually lead to the treatment of aneurysms and AVMs. At that time, however, it was not possible to direct and deflect their Silastic microcatheter and negotiate arterial bifurcations. To overcome this problem, magnet-tipped microcatheters, called PODs, were developed by various scientists. A powerful external magnet created a magnetic field that directed the microcatheter tip at will. In 1966 Frei and colleagues6 were the first to describe the POD. In 1969, the first experience of magnetically guiding a microcatheter into the middle cerebral artery of a patient was reported by Driller et al.4 Cares and associates, in 1973,2 introduced the concept of mounting a detachable balloon on the POD system. Hilal et al.,20 in 1974, reported on the use of the POD system in 120 patients; it was possible to enter the basilar artery as well as the middle cerebral artery and inject embolic materials into AVMs, perform intravascular electroencephalography, and enter a basilar artery aneurysm. In spite of some success, the POD catheter did not become popular and was soon abandoned because new microcatheters appeared on the horizon.

From the mid-1970s to the mid-1980s, various scientists developed microcatheters that allowed injection of acrylics into AVMs, balloon occlusion of carotid cavernous fistulas, and balloon embolization of aneurysms.3,17,21,28,30 The major drawback of these systems was (again) the absence of a deflecting tip at arterial bifurcations to guide the catheter at the selected destinations.7

To overcome this critical problem, Engelson, in the mid-1980s, devised a new, revolutionary, variable stiffness microcatheter: the Tracker.5,22 The Tracker was a breakthrough in the armamentarium of endovascular neurosurgeons because it solved all of the previous problems of endovascular catheterization of brain arteries. By pushing this microcatheter over a steerable microguidewire the system was capable of easily negotiating arterial bifurcations. The tip of the catheter was steam-shapeable, to facilitate access in tortuous vascular anatomy. The Tracker allowed direct catheterization of brain aneurysms and was adopted as the ideal delivery system for detachable coils.

The Genesis of Detachable Coils

The genesis of detachable coils thus commenced by studying the work of previous investigators and attempting to use the endovascular approach rather than their extravascular-intravascular approach (see above). Induction of aneurysm thrombosis using an endovascular metallic wire as well as endovascular ferromagnetic thrombosis was piloted using experimentally created aneurysms.

The idea of catheterizing an aneurysm and applying an electric current to thrombose it was conceived in the early 1980s.9 At the experimental laboratory of the Institute of Neurosurgery, University of Rome, Italy, in vitro and in vivo studies were conducted. Experimental saccular aneurysms were created on the carotid artery of 10 rabbits. A 3 Fr catheter was navigated into the aneurysm via a transfemoral approach. Through the catheter, a 0.2-mm stainless steel wire electrode was introduced into the aneurysm. A 10-mA positive current was then applied to the wire for 10 minutes, eliciting electrothrombosis (see below). Minimal occlusion of the aneurysms was achieved (Fig. 2). This experimental result led to the temporary abandonment of this research. Nevertheless, a “rat tail” erosion of the intraaneurysmal stainless steel electrode was noted, due to the passage of the electric current (Fig. 3). This phenomenon, of inducing electrolysis of an endovascular intraaneurysmal stainless steel guidewire, was applied almost 10 years later for the detachment mechanism of detachable coils.

Fig. 2.
Fig. 2.

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.

Fig. 3.
Fig. 3.

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.

In the mid-1980s, a new concept was tested in vitro. Glass models of saccular aneurysms were used, using an artificial circulation of saline made of Silastic tubings. A pump was used to circulate the fluid into the Silastic tubings and in the glass aneurysm. A 1-mm cylindrical micromagnet was glued to the tip of a stainless steel wire. The magnet was introduced “endovascularly” into the aneurysm sac. Iron microspheres (< 8 μm in diameter) were then injected into the circulation. The microspheres became attracted to the magnet, increased its size, and partially occluded the glass aneurysm. No electric current was applied.

This concept was tested in vivo in 1989 at the Leo G. Rigler Research Center at the University of California at Los Angeles. Experimental aneurysms were created on the common carotid artery of swine.10 A micromagnet-tipped stainless steel wire was introduced into the aneurysm via a then new microcatheter named the Tracker. Iron microspheres were injected into the aneurysm via the intraaneurysmal microcatheter, and as a result, the magnet attracted the microspheres and “enlarged.” This enlargement was not enough to occlude the aneurysm. We then had the idea of further increasing the occlusive mass by eliciting an electrothrombotic phenomenon around the magnet. A 4-mA positive electric current was applied to the stainless steel wire, which produced an erosion of the wire next to the magnet and subsequently detached the magnet in the aneurysm by electrolysis. A reliable detachment mechanism had been discovered!

The substantial failure of the ferromagnetic technique led to the search for an alternative endovascular method. Now that the detachment mechanism had been found, the question was: what do we detach? This was the key, crucial moment of the discovery of detachable coils.

Modifying an existing stainless steel, platinum-tipped microguidewire, a 1-cm long detachable platinum tip was created. It became possible to enter an aneurysm, fill it with a platinum tip, and detach the tip with a 4-mA positive electric current. This current, in fact, dissolves the stainless steel wire next to the platinum tip by electrolysis (migration of ferrous ions from the anode to the cathode; Fig. 4). Platinum is radiopaque and biocompatible and, as a noble metal, is not affected by electrolysis. It also became clear that a tip was not enough to fill the entire aneurysm. Therefore a platinum coil was soldered to the stainless steel delivery wire. The detachable coil was born (Fig. 5)!

Fig. 4.
Fig. 4.

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

Fig. 5.
Fig. 5.

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

Using the Tracker as a delivery microcatheter, multiple coils were delivered and detached into the experimental aneurysms, until the aneurysm was completely packed16 and excluded from the circulation (Fig. 6). At first, the detachable coils were named GEMs (Guglielmi Electrolytic Microcoils; Fig. 7), but they were eventually named GDCs (Boston Scientific). A handmade electric current generator was used to elicit electrolysis and coil detachment (Fig. 8). Finally, on March 6, 1990, the first patient was treated with the new device.11,12 The results of the experimental research as well as the initial clinical application were published in the Journal of Neurosurgery.12,16

Fig 6
Fig 6

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

Fig. 7.
Fig. 7.

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.

Fig. 8.
Fig. 8.

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

The genesis of detachable coils did not end with the treatment of experimental aneurysms and with the initial clinical application. Coil characteristics such as softness, length, shape, diameter of the circular memory, diameter of the platinum wire, diameter of the coil, and diameter of the delivery wire had to be changed, evaluated, tested, and implemented. In 1990 there were only 3 types of detachable coils, but by 1995 there were over 100 types. Smaller and less traumatic Tracker delivery microcatheters and microguidewires were also devised to treat small aneurysms in the presence of vasospasm. Furthermore, the junction between the stainless steel delivery wire and the platinum coil underwent various modifications to decrease the detachment time of the coil. Markers were also added for a precise positioning (inside the aneurysm) of the platinum-stainless steel junction.13 The interaction with Ivan Sepetka, an engineer at a (then small) company named Target Therapeutics, played an important role in these last developments.13,16

Role of Electrothrombosis

In the past, some scientists tested the phenomenon of electrothrombosis.9,2426,29 A positively charged endovascular electrode attracts the negatively charged blood elements (white and red blood cells, platelets, and fibrinogen). As a consequence, an electrothrombus will form around the electrode. Theoretically, because the detachable coils are positively charged, they should elicit the phenomenon of electrothrombosis. However, effective electrothrombosis did not even come close to being achieved in the detachable coil technique. In fact, the amount of electricity that is delivered (1 mA) is not enough to generate a sufficient electrothrombotic phenomenon. The mass of the thrombus is directly proportional to the amount of electrical current and time (coulombs). Chen, Ji, and Guglielmi performed a series of in vitro experiments on heparinized blood (unpublished data, 1995) in which they confirmed that the amount of thrombus is directly proportional to the electrical current. The following weights of thrombus were formed when the given current was applied for 3 minutes, using a platinum electrode: at 1 mA, mass was 10 mg; at 2 mA, mass was 12 mg; at 3 mA, mass was 26 mg; and at 10 mA, mass was 85 mg. Past researchers have often used 3–10 mA to produce sufficient electrothrombosis in both the in vitro and in vivo settings.7,26,29 From the data in our experiments and from the data in the literature, we can state that, when applying 1 mA of current, the mass of the (electro) thrombus is almost insignificant. Despite the reassuring experimental and clinical data of the previous scientific literature, the 1-mA electrical current was not increased. Whether an increase of the electrical current would lead to improved results remains unknown.

Clinical Application

The detachable coil can be considered an “endovascular controllable occlusive soft coil.” It is mainly used for the endovascular occlusion of brain aneurysms. Multiple detachable coils are usually delivered and detached into the aneurysm to densely fill its cavity (Fig. 9). The technique can be used in the acute phase after subarachnoid hemorrhage and in the presence of vasospasm. Prior to detachment, each coil can be retrieved and repositioned at will, in and out of the aneurysm, or exchanged for one of a different size. It soon became clear that the best results could be obtained in small aneurysms with a small neck (neck size < 4 mm).13 In large and giant aneurysms the results were far from optimal due to the phenomenon of coil compaction (and subsequent reexposure of portions of the aneurysm to blood flow) in the months after the procedure. One or more sessions of retreatment have to be performed in these cases. The detachable coil can be used to treat lesions other than aneurysms, such as vertebrovertebral arteriovenous fistulas,14 direct carotid cavernous arteriovenous fistulas,11,14 peripheral brain aneurysms,15 and occlusion of small feeding arteries of brain tumors.8 It can also be used for ICA occlusion, vertebral artery occlusion, occlusion of dissecting aneurysms, vein of Galen arteriovenous fistulas, fistulas within brain AVMs, and dural arteriovenous fistulas of the cavernous sinus. The detachable coil has, at this point in time, been used in over 300,000 patients worldwide.

Fig 9
Fig 9

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.

It is the author's opinion that further research will be necessary to find a way to prevent the phenomenon of coil compaction in wide-necked and terminal aneurysms. This could be achieved by changing the composition of the metal utilized to fabricate the coils (Tantalum perhaps?) to elicit a more celeritous and stronger biological response. Until this goal is reached, using coil therapy in this subset of aneurysms can often be considered a nondefinitive treatment.

Conclusions

The advent of the detachable coil substantially changed the management of brain aneurysms. Beginning in 1990, more and more patients have been treated with the endovascular approach. It is estimated that, currently, approximately 50,000 patients per year are treated with detachable coils worldwide. In many centers this approach has become the gold standard procedure. The detachable coil paved the way for the new discipline of endovascular neurosurgery. Two important dates to remember in the history of the treatment of brain aneurysms are: March 23, 1937, the first clipping of a brain aneurysm,27 and March 6, 1990, use of the first detachable coil in a brain aneurysm.12

Disclosure

Dr. Guglielmi is the inventor of the GDC.

Acknowledgments

The author would like to thank Fernando Viñuela, M.D., Giampaolo Cantore, M.D., Ivan Sepetka, M.S., Erik Engelson, M.S., Velio Macellari, M.S., Raffaele Guerrisi, M.D., John Robert, R.A., and last (but not least) his wife Nella for their invaluable support, both personally and professionally.

Please include this information when citing this paper: published online March 13, 2009; DOI: 10.3171/2009.2.JNS081039.

References

  • 1

    Alksne JFSmith RW: Stereotaxic occlusion of 22 consecutive anterior communicating artery aneurysms. J Neurosurg 52:7907931980

  • 2

    Cares HLHale JRMontgomery DB: Laboratory experience with a magnetically guided intravascular catheter system. J Neurosurg 38:1451541973

  • 3

    Debrun GLacour PCaron JP: Inflatable and release balloon technique. Experimentation in dog—application in man. Neuroradiology 9:2672711975

  • 4

    Driller JHilal SKMichelsen WJ: Development and use of the POD catheter in the cerebral vascular system. Med Res Eng 8:11161969

  • 5

    Engelson E: Catheter for guide-wire tracking. US Patent No. 47397681986

  • 6

    Frei EHDriller JNeufeld HNBarr IBleiden LAskenzay HN: The POD and its applications. Med Res Eng 8:11181966

  • 7

    Guglielmi G: History of endovascular endosaccular occlusion of brain aneurysms: 1965–1990. Intervent Neuroradiol 13:2172242007

  • 8

    Guglielmi G: Use of the GDC crescent for embolization of tumors fed by cavernous and petrous branches of the internal carotid artery. J Neurosurg 89:8578601998

  • 9

    Guglielmi GGuerrisi RGuidetti B: L'elettrotrombosi intravasale nelle malformazioni vascolari sperimentalmente provocate. Carella: Proceedings of III Congress of the Italian Society of Neuroradiology BariAssociazione Italiana di Neuroradiologia1983. 139146

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    Guglielmi GJi CKurata ALownie SViñuela FRobert J: Experimental saccular aneurysms. II: A new model in swine. Neuroradiology 36:5475501994

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    Guglielmi GViñuela FBriganti FDuckwiler G: Carotid-cavernous fistula caused by a ruptured intracavernous aneurysm: endovascular treatment by electrothrombosis with detachable coils. Neurosurgery 31:5915971992

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    Guglielmi GViñuela FDion JDuckwiler G: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. Special article. J Neurosurg 75:8141991

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    Guglielmi GViñuela FDuckwiler GDion JLylyk PBerenstein A: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:5155241992

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    Guglielmi GViñuela FDuckwiler GDion JStocker A: Highflow, small-hole arteriovenous fistulas: treatment with electrodetachable coils. AJNR Am J Neuroradiol 16:3253281995

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    Guglielmi GViñuela FGuidetti GDazzi M: The Guglielmi detachable coil “crescent” in the endovascular treatment of peripheral brain aneurysms: technical case report. Neurosurgery 61:2 SupplE295E2962007

  • 16

    Guglielmi GViñuela FSepetka IMacellari V: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. Special article. J Neurosurg 75:171991

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    Hieshima GBGrinnell VSMehringer CM: A detachable balloon for transcatheter occlusions. Radiology 138:2272281981

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    Higashida RTHalbach VVBarnwell SLDowd CDormandy BBell J: Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR Am J Neuroradiol 11:6336401990

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    Hilal SKKhandji ASolomon RW: Obliteration of intracranial aneurysms with pre-shaped highly thrombogenic coils. Radiology 173:2502571989

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    Hilal SKMichelsen WJDriller J: Magnetically guided devices for vascular exploration and treatment. Laboratory and clinical investigations. Radiology 113:5295401974

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    Kerber C: Balloon catheter with a calibrated leak. A new system for superselective angiography and occlusive catheter therapy. Radiology 120:5475501976

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    Kikuchi YStrother CMBoyer M: New catheter for endovascular interventional procedures. Radiology 165:8708711987

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    Luessenhop AJVelasquez AC: Observations on the tolerance of the intracranial arteries to catheterization. J Neurosurg 21:85911964

  • 24

    Mullan S: Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas. J Neurosurg 41:6576701974

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    Mullan SBeckman FVailati GKarasick GDobben G: An experimental approach to the problem of cerebral aneurysms. J Neurosurg 21:8388451964

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    Piton JBillerey JConstant PRenou AMCaillé JM: Selective vascular thrombosis induced by a direct electrical current. J Neuroradiol 5:1391521978

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    Prestigiacomo CJ: Historical perspectives: the microsurgical and endovascular treatment of aneurysms. Neurosurgery 59:3 SupplS339S347

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    Romodanov APShcheglov VIIntravascular occlusion of saccular aneurysms of the cerebral arteries by means of a detachable balloon catheter. Krayenbühl H: Advances and Technical Standards in Neurosurgery BerlinSpringerVol 9:1982. 2548

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    Sawyer PNPate JW: Bio-electric phenomena as an etiologic factor in intravascular thrombosis. Am J Physiol 175:1031071953

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    Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:1251451974

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    Werner SCBlakemore AHKing BG: Aneurysm of the internal carotid artery within the skull. Wiring and electrothermic coagulation. JAMA 116:5785821941

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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.

Headings

Figures

  • View in gallery

    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).

  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

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

  • View in gallery

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

  • View in gallery

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

  • View in gallery

    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.

  • View in gallery

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

  • View in gallery

    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.

References

1

Alksne JFSmith RW: Stereotaxic occlusion of 22 consecutive anterior communicating artery aneurysms. J Neurosurg 52:7907931980

2

Cares HLHale JRMontgomery DB: Laboratory experience with a magnetically guided intravascular catheter system. J Neurosurg 38:1451541973

3

Debrun GLacour PCaron JP: Inflatable and release balloon technique. Experimentation in dog—application in man. Neuroradiology 9:2672711975

4

Driller JHilal SKMichelsen WJ: Development and use of the POD catheter in the cerebral vascular system. Med Res Eng 8:11161969

5

Engelson E: Catheter for guide-wire tracking. US Patent No. 47397681986

6

Frei EHDriller JNeufeld HNBarr IBleiden LAskenzay HN: The POD and its applications. Med Res Eng 8:11181966

7

Guglielmi G: History of endovascular endosaccular occlusion of brain aneurysms: 1965–1990. Intervent Neuroradiol 13:2172242007

8

Guglielmi G: Use of the GDC crescent for embolization of tumors fed by cavernous and petrous branches of the internal carotid artery. J Neurosurg 89:8578601998

9

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