Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils

View More View Less
  • 1 Departments of Neurosurgery and Bone and Biomaterials Research at the Institute for Histology and Embrology, University of Vienna, Vienna, Austria; and Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. The histopathological characteristics of aneurysms obtained at autopsy or surgery 3 days to 54 months after being treated with Guglielmi detachable coils (GDCs) were assessed.

Methods. Seventeen aneurysms were obtained at autopsy and one was removed at surgery. Fourteen were examined histologically with the coils in situ. Naked coils embedded in an unorganized thrombus were found in those aneurysms that had been treated with coils within 1 week earlier. An incomplete replacement of the intraluminal blood clot by fibrous tissue and a partial membranous covering at the aneurysm orifice were observed in those aneurysms that had been treated with coils between 2 and 3 weeks prior to examination. One small aneurysm treated 6 weeks before harvesting showed formation of an endothelium-lined layer of connective tissue at the orifice. Collagen-rich vascularized tissue surrounding the coils was found in an aneurysm removed at surgery 54 months after coil implantation. Interestingly, six (50%) of 12 aneurysms (two small, three large, and one giant) that had been deemed 100% occluded on initial angiography showed tiny open spaces between the coils at the neck on gross examination.

Conclusions. Endothelialization of the aneurysm orifice following placement of GDCs can occur; however, it appears to be the exception rather than the rule. In large aneurysms the process of intraaneurysm clot organization seems to be delayed and incomplete; tiny open spaces between the coils and an incomplete membranous covering in the region of the neck are frequently encountered. Further longitudinal studies are required to establish the spectrum of healing profiles that may direct our efforts in modifying the GDC system to produce a more stable long-term result.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Gerhard Bavinzski, M.D., Neurochirurgische Universitätsklinik, Allgemeines Krankenhaus der Stadt Wien, Waehringer Guertel 18–20, 1090 Vienna, Austria.
  • 1.

    Byrne JV, , Hope JK, & Hubbard N, et al: The nature of thrombosis induced by platinum and tungsten coils in saccular aneurysms. AJNR 18:2933, 1997 Byrne JV, Hope JK, Hubbard N, et al: The nature of thrombosis induced by platinum and tungsten coils in saccular aneurysms. AJNR 18:29–33, 1997

    • Search Google Scholar
    • Export Citation
  • 2.

    Fernandez Zubillaga A, , Guglielmi G, & Viñuela F, et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815820, 1994 Fernandez Zubillaga A, Guglielmi G, Viñuela F, et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815–820, 1994

    • Search Google Scholar
    • Export Citation
  • 3.

    Gaebel C, , Reul J, & Reusche E, et al: Pathology of human intracranial aneurysms after GDC-embolization and correlation with animal model data. Clin Neuropathol 15:270, 1996 Gaebel C, Reul J, Reusche E, et al: Pathology of human intracranial aneurysms after GDC-embolization and correlation with animal model data. Clin Neuropathol 15:270, 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Guglielmi G, , Viñuela F, & Sepetka I, et al: Electrothrombosis of saccular aneurysms via the endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:17, 1991 Guglielmi G, Viñuela F, Sepetka I, et al: Electrothrombosis of saccular aneurysms via the endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:1–7, 1991

    • Search Google Scholar
    • Export Citation
  • 5.

    Horowitz MB, , Purdy PD, & Burns D, et al: Scanning electron microscopic findings in a basilar tip aneurysm embolized with detachable coils. AJNR 18:688690, 1997 Horowitz MB, Purdy PD, Burns D, et al: Scanning electron microscopic findings in a basilar tip aneurysm embolized with detachable coils. AJNR 18:688–690, 1997

    • Search Google Scholar
    • Export Citation
  • 6.

    Koizumi T, , Kawano T, & Kazekawa K, et al: Histological finding in aneurysm treated with interlocking detachable coils: scanning electron microscopical study. Neurol Surg 25:10271031, 1997 Koizumi T, Kawano T, Kazekawa K, et al: Histological finding in aneurysm treated with interlocking detachable coils: scanning electron microscopical study. Neurol Surg 25:1027–1031, 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Leibovich SJ, & Ross R: The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol 78:71100, 1975 Leibovich SJ, Ross R: The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol 78:71–100, 1975

    • Search Google Scholar
    • Export Citation
  • 8.

    Malisch TW, , Guglielmi G, & Viñuela F, et al: Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87:176183, 1997 Malisch TW, Guglielmi G, Viñuela F, et al: Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87:176–183, 1997

    • Search Google Scholar
    • Export Citation
  • 9.

    Manabe H, , Fujita S, & Hatayama T, et al: Embolisation of ruptured cerebral aneurysms with interlocking detachable coils in acute stage. Acute IDC embolisation for ruptured aneurysms. Intervent Neuroradiol 3:4963, 1997 Manabe H, Fujita S, Hatayama T, et al: Embolisation of ruptured cerebral aneurysms with interlocking detachable coils in acute stage. Acute IDC embolisation for ruptured aneurysms. Intervent Neuroradiol 3:49–63, 1997

    • Search Google Scholar
    • Export Citation
  • 10.

    Manabe H, , Fujita S, & Hatayama T, et al: Rerupture of coil-embolized aneurysm during long-term observation. Case report. J Neurosurg 88:10961098, 1998 Manabe H, Fujita S, Hatayama T, et al: Rerupture of coil-embolized aneurysm during long-term observation. Case report. J Neurosurg 88:1096–1098, 1998

    • Search Google Scholar
    • Export Citation
  • 11.

    Mawad ME, , Mawad JK, & Cartwright J Jr, et al: Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR 16:713, 1995 Mawad ME, Mawad JK, Cartwright J Jr, et al: Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR 16:7–13, 1995

    • Search Google Scholar
    • Export Citation
  • 12.

    Mizoi K, , Yoshimoto T, & Takahashi A, et al: A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 39:165169, 1996 Mizoi K, Yoshimoto T, Takahashi A, et al: A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 39:165–169, 1996

    • Search Google Scholar
    • Export Citation
  • 13.

    Molyneux AJ, , Ellison DW, & Morris J et al: Histological findings in giant aneurysms treated with Guglielmi detachable coils. Report of two cases with autopsy correlation. J Neurosurg 83:129132, 1995 Molyneux AJ, Ellison DW, Morris J et al: Histological findings in giant aneurysms treated with Guglielmi detachable coils. Report of two cases with autopsy correlation. J Neurosurg 83:129–132, 1995

    • Search Google Scholar
    • Export Citation
  • 14.

    Pile-Spellman J, & Wu J: Coil embolization of aneurysms: angiographic and histologic changes. AJNR 18:4344, 1997 Pile-Spellman J, Wu J: Coil embolization of aneurysms: angiographic and histologic changes. AJNR 18:43–44, 1997

    • Search Google Scholar
    • Export Citation
  • 15.

    Plenk H Jr: The microscopic evaluation of hard tissue implants, in Williams DF (ed): Techniques of Biocompatibility Testing. Boca Raton, FL: CRC Press, 1986, Vol 1, pp 3581 Plenk H Jr: The microscopic evaluation of hard tissue implants, in Williams DF (ed): Techniques of Biocompatibility Testing. Boca Raton, FL: CRC Press, 1986, Vol 1, pp 35–81

    • Search Google Scholar
    • Export Citation
  • 16.

    Reul J, , Spetzger U, & Weis J, et al: Endovascular occlusion of experimental aneurysms with detachable coils: influence of packing density and perioperative anticoagulation. Neurosurgery 41:11601168, 1997 Reul J, Spetzger U, Weis J, et al: Endovascular occlusion of experimental aneurysms with detachable coils: influence of packing density and perioperative anticoagulation. Neurosurgery 41:1160–1168, 1997

    • Search Google Scholar
    • Export Citation
  • 17.

    Reul J, , Spetzger U, & Weis J, et al: The nature of early intraluminal thrombosis in terminal aneurysms occluded with Guglielmi detachable coils. Intervent Neuroradiol 4:3948, 1998 Reul J, Spetzger U, Weis J, et al: The nature of early intraluminal thrombosis in terminal aneurysms occluded with Guglielmi detachable coils. Intervent Neuroradiol 4:39–48, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Reul J, , Weis J, & Spetzger U: Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils. AJNR 18:3542, 1997 Reul J, Weis J, Spetzger U: Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils. AJNR 18:35–42, 1997

    • Search Google Scholar
    • Export Citation
  • 19.

    Richling B, , Bavinzski G, & Gross C, et al: Early clinical outcome of patients with ruptured cerebral aneurysms treated by endovascular (GDC) or microsurgical techniques. A single center experience. Intervent Neuroradiol 1:1927, 1995 Richling B, Bavinzski G, Gross C, et al: Early clinical outcome of patients with ruptured cerebral aneurysms treated by endovascular (GDC) or microsurgical techniques. A single center experience. Intervent Neuroradiol 1:19–27, 1995

    • Search Google Scholar
    • Export Citation
  • 20.

    Richling B, , Gruber A, & Bavinzski G, et al: GDC-System embolization for brain aneurysms—location and follow-up. Acta Neurochir 134:177183, 1995 Richling B, Gruber A, Bavinzski G, et al: GDC-System embolization for brain aneurysms—location and follow-up. Acta Neurochir 134:177–183, 1995

    • Search Google Scholar
    • Export Citation
  • 21.

    Szikora I, , Wakhloo AK, & Guterman LR, et al: Initial experience with collagen-filled Guglielmi detachable coils for endovascular treatment of experimental aneurysms. AJNR 18:667672, 1997 Szikora I, Wakhloo AK, Guterman LR, et al: Initial experience with collagen-filled Guglielmi detachable coils for endovascular treatment of experimental aneurysms. AJNR 18:667–672, 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Tamatani S, , Ozawa T, & Minakawa T, et al: Histological interaction of cultured endothelial cells and endovascular embolic materials coated with extracellular matrix. J Neurosurg 86:109112, 1997 Tamatani S, Ozawa T, Minakawa T, et al: Histological interaction of cultured endothelial cells and endovascular embolic materials coated with extracellular matrix. J Neurosurg 86:109–112, 1997

    • Search Google Scholar
    • Export Citation
  • 23.

    Tenjin H, , Fushiki S, & Nakahara Y, et al: Effect of Guglielmi detachable coils on experimental carotid artery aneurysms in primates. Stroke 26:20752080, 1995 Tenjin H, Fushiki S, Nakahara Y, et al: Effect of Guglielmi detachable coils on experimental carotid artery aneurysms in primates. Stroke 26:2075–2080, 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    Viñuela F, , Duckwiler G, & Mawad M, et al: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475482, 1997 Viñuela F, Duckwiler G, Mawad M, et al: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482, 1997

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 620 272 18
Full Text Views 218 17 0
PDF Downloads 126 16 0
EPUB Downloads 0 0 0