Electrothrombosis of saccular aneurysms via endovascular approach

Part 1: Electrochemical basis, technique, and experimental results

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✓ Eleven experimental saccular aneurysms were created on the common carotid artery of swine. Between 3 and 15 days after creation of these aneurysms, they were thrombosed via an endovascular approach, using a very soft detachable platinum coil delivered through a microcatheter positioned within the aneurysm. This detachable platinum coil was soldered to a stainless steel delivery guidewire. Intra-aneurysmal thrombosis was then initiated by applying a low positive direct electric current to the delivery guidewire. Thrombosis occurred because of the attraction of negatively charged white blood cells, red blood cells, platelets, and fibrinogen to the positively charged platinum coil positioned within the aneurysm. The passage of electric current detached the platinum coil within the clotted aneurysm in 4 to 12 minutes. This detachment was elicited by electrolysis of the stainless steel wire nearest to the thrombus-covered platinum coil. Control angiograms obtained 2 to 6 months postembolization confirmed permanent aneurysm occlusion as well as patency of the parent artery in all cases. No angiographic manifestation of untoward distal embolization was noted. Due to the encouraging results of this research, this technique has been applied in selected clinical cases which are described in Part 2 of this study.

Article Information

Address reprint requests to: Guido Guglielmi, M.D., Universita' di Roma, Dipartimento di Scienze Neurologiche, Neuroangiografia Terapeutica, Viale dell'Universita' 30/a, 00185 Roma, Italy.

© AANS, except where prohibited by US copyright law.

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Figures

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    Diagrams representing the steps in electrothrombosis of saccular aneurysms via endovascular approach. Upper Left: The tip of a microcatheter is positioned into the aneurysmal neck. Upper Right: The platinum distal portion of a stainless steel delivery guidewire is introduced into the aneurysmal sac through the microcatheter. Arrow points to the junction between the platinum and stainless steel. Lower Left: Positive direct electric current is applied to the guidewire so that the positively charged platinum attracts the negatively charged white blood cells, red blood cells, platelets, and fibrinogen, thus initiating thrombus formation. Lower Right: In 4 to 12 minutes the current has dissolved, by electrolysis, the stainless steel portion proximal to the junction. The platinum portion is therefore detached within the clotted aneurysm.

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    Diagram of the detachable platinum coil. A: Diameter of the circular memory. B: The distal portion (4 to 40 cm in length) made of coiled platinum wire. C: Microsolder connecting the distal portion to the intermediate portion. D: Microsolder connecting the intermediate portion of the proximal portion. E and F: The intermediate portion (3 cm in length) made of coiled stainless steel wire. E: The uninsulated part of the intermediate portion. F: The Teflon-insulated part of the intermediate portion. G: The proximal stainless steel portion (175 cm in length). H: The tapering stainless steel core wire. I: Teflon lamination.

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    A platinum spiral with circular memory is shown (long double arrows). The Teflon-laminated intermediate portion (short double arrows) made of stainless steel and the platinum-stainless steel junction (curved arrow) are also shown. The 2-mm long uninsulated stainless steel is indicated by the long single arrow.

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    Left common carotid angiograms in a pig. Left: Pre-embolization study showing a surgically created saccular aneurysm 7 mm in diameter (arrows). Center: Angiogram taken 15 minutes after detachment of two 20-cm platinum coils into the aneurysmal sac. Intra-aneurysmal thrombosis is not yet complete. Right: Follow-up angiogram taken 3 weeks after embolization. The aneurysm is occluded and the parent artery preserved. The coils are visible within the aneurysmal sac (arrows). A 2-day postembolization angiogram (not shown) provided similar findings.

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    Right common carotid angiograms in a pig. Left: Pre-embolization study showing a surgically created saccular aneurysm 9 mm in diameter (arrows). Right: Follow-up angiogram obtained 3 months postembolization showing six detached platinum coils in the former aneurysmal sac (arrows). The aneurysm is occluded and the parent artery preserved.

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    Left: Specimen consisting of the common carotid artery and aneurysm. The former aneurysmal neck (arrow) appears covered by neo-endothelium. Right: Low-power photomicrograph of the same aneurysm in a longitudinal section obtained 2 months after coil embolization. Sections of coil are surrounded by abundant well-organized thrombus, numerous foreign-body giant cells, and chronic inflammation within the clot. The neck of the aneurysm (arrows) is entirely occluded by organized thrombus and the free luminal surface appears to be totally lined by endothelium. Also visible are Proline sutures (arrowheads) which anchor the vein to the artery wall and silk suture (curved arrow) used to form the dome of the aneurysm. Fuchsin stain.

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