Histological findings in giant aneurysms treated with Guglielmi detachable coils

Report of two cases with autopsy correlation

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✓ The authors report the pathological and histological findings in two patients with giant partially thrombosed aneurysms who were treated by means of Guglielmi detachable coils with subtotal occlusion of the aneurysms. Autopsies of these patients were performed 2 and 6 months after endovascular treatment. The histological findings revealed coils embedded in largely unorganized thrombus in the aneurysms; there was no clear reduction in size of the aneurysms over the period. There was no evidence of endothelialization of the aneurysm neck demonstrated in either case. The significance of these findings is discussed.

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Address reprint requests to: Andrew J. Molyneux, F.R.C.R., Department of Neuroradiology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, England.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Left: Anteroposterior vertebral angiogram showing the lumen of the aneurysm filling via the posterior communicating artery and extending across the midline. Center and Right: Angiograms obtained following Guglielmi detachable coil placement performed via the microcatheter, showing subtotal occlusion of the aneurysm.

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    Case 2. Left: Sagittal T1-weighted magnetic resonance image showing the aneurysm indenting the pons. Center: Frontal projection of the initial vertebral angiogram revealing the aneurysm lumen. Right: Angiogram obtained following the second procedure showing placement of eight Guglielmi detachable coils.

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    Case 2. Photograph at autopsy showing the aneurysm after dissection of the basilar artery and creation of a window in the fundus. The coils are embedded in solid and semiliquid unorganized blood clot that was easily dissected away to reveal the coils.

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    Photomicrographs in Case 2. H & E. Left: Low-power photomicrograph showing the wall of the aneurysm, which is composed of almost avascular fibrous tissue and is permeated by a moderate lymphocytic inflammatory infiltrate. The aneurysm fundus at this point is filled with unorganized thrombus. Original magnification × 25. Center: A portion of the aneurysm contents adjacent to one of the coils. The location of the coil is indicated by the scalloped cavity. The blood clot in the immediate vicinity of the coil and between the coil and the aneurysm wall shows loose fibrous connective tissue containing capillaries. Deeper within the aneurysm, unorganized thrombus is still present. Original magnification × 25. Right: Higher power illustration of the tissue adjacent to the coil. The tissue reaction consists largely of inflammatory and phagocytic cells within a loose fibrous stroma that contains large-diameter capillaries. Original magnification × 100.

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