Electrothrombosis of saccular aneurysms via endovascular approach

Part 2: Preliminary clinical experience

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✓ Fifteen patients with high-risk intracranial saccular aneurysms were treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage.

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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    Photograph of various detachable platinum coils for aneurysm embolization: a platinum coil, 40 cm long with an 8-mm circular memory (upper); a platinum coil, 15 cm long with a 5-mm circular memory (center); and a platinum helix, 8 cm long and 2 mm in diameter (lower). The junction between the platinum and the stainless steel components of the detachable coils is indicated by the long arrow and the uninsulated stainless steel coil 2 mm long by the curved arrow. The insulated stainless steel coil 2.8 cm long (double arrows) and the junction between the stainless steel coil and the stainless steel core wire (arrowhead) are also visible.

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    Diagram showing circuit of power supply used to produce electrothrombosis and electrolysis. LED = light-emitting diode; POT = potentiometer.

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    Case 3. Left: Vertebral angiogram, lateral view, demonstrating a small aneurysm (arrow) originating from the left posterior inferior cerebellar artery. Right: Follow-up angiogram after delivery of two detachable coils, demonstrating aneurysm obliteration. A small neck remnant (arrow) is also observed. Surgical clipping of the residual neck was performed 3 months postembolization.

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    Case 4. A. Vertebral angiogram, anteroposterior view, demonstrating a giant basilar bifurcation aneurysm. Both posterior cerebral arteries (straight arrows) and both superior cerebellar arteries (curved arrows) originate from the aneurysm base. B. Vertebral angiogram, lateral view, taken during the embolization procedure. A partially inflated balloon (arrowhead) was temporarily positioned in the mid-basilar artery in order to reduce blood flow. The tip of a Tracker 10 microcatheter (arrow) is seen in the aneurysm dome. C: Vertebral angiogram, anteroposterior view, demonstrating seven detached coils (total length 265 cm) inside the aneurysm sac. D. Arteriogram obtained 45 days postembolization showing obliteration of the aneurysm dome. The proximal sac has been preserved in order to preserve the origin of both posterior cerebral arteries and of both superior cerebellar arteries.

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    Case 6. A: Vertebral angiogram, lateral view, demonstrating a large vertebrobasilar junction aneurysm (arrows). B: Vertebral angiogram, anteroposterior view, showing this aneurysm arising from a basilar artery fenestration (arrowhead). C: Plain skull x-ray film showing the network of coils placed within the aneurysm (total coil length 1.4 m). D and E: Arteriograms obtained 6 days postembolization, lateral view (D) and anteroposterior view (E), showing 95% occlusion of the aneurysm. Residual aneurysm neck is visible (arrowhead), and the fenestrated basilar artery is now better seen (arrows).

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    Case 15. Left: Vertebral angiogram, anteroposterior view, demonstrating a small basilar bifurcation aneurysm. Right: Vertebral angiogram obtained 4 days postembolization showing complete aneurysm obliteration with two detachable platinum coils. Note that these coils assume the original shape and size of the aneurysm without deforming it.

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