Neurointervention.  2013 Sep;8(2):105-109. 10.5469/neuroint.2013.8.2.105.

Complex Coil Assisted Single Coil Embolization for Small Intracranial Aneurysm

• Yang MS
• Yang TH
• Ou CH
• Chan SW
• Chen TI
• Yang CJ
• Chiang CM
• Huang WC

• KMID: 1784027
• DOI: http://doi.org/10.5469/neuroint.2013.8.2.105

Abstract

The purpose of the technical note is to introduce the complex coil assisted coil embolization method in the treatment of intracranial small aneurysm, in order to enhance the safety of the procedure. The first microcatheter was navigated into the aneurysm sac and the ultrasoft coil was used as the embolization coil. If the embolizations coil could not stay within the aneurysm sac smoothly, such as coil herniation into parent artery during the delivery process. The second microcatheter would be navigated to the aneurysm level in the parent artery. Another complex coil was delivered within the parent artery via the second microcatheter to provide the neck bridge effect in order to enhance the stability of embolization coil. Besides, the protection coil will not disturb the parent artery flow. While the embolization coil was put into the aneurysm sac smoothly under the help of complex protective coil, the protective coil was then withdrawn gently. We use the most magnified view, dual-plane approach simultaneously to observe the stability of embolization coil. The embolization coil would be detached without any evidence of coil motion or vibration. The new method could provide the physiological protective method, without leaving any protective device such as stent within the parent artery.

Keyword

Complex coil; Aneurysm, Ruptured/therapy; Embolization, Therapeutic/methods Intracranial aneurysm

MeSH Terms

Aneurysm
Arteries
Humans
Intracranial Aneurysm
Neck
Parents
Protective Devices
Stents
Vibration

Figure

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  Fig. 1 A. the 43 years old female suffered from explosive headache. Digital subtraction angiography of right carotid artery revealed carotid cave aneurysm.B. The first microcatheter was navigated to the aneurysm sac and initiates the coiling process, but easy coil herniation was noted. The second microcatheter was advanced to right ICA at the aneurysm level.C. The Complex coil (MicroVention, Aliso Viejo, CA, USA), 5 mm×12 cm, was delivered as the protective coil within the parent artery at the aneurysm level, to act the neck bridge effect.D. The embolization coil was put into the aneurysm sac successfully with the help of protective coil, act as the neck bridge.E. The protective coil was withdrawn gently and observes the stability of embolization coil.F. Post embolization DSA revealed complete obliteration of the aneurysm sac.

Reference

1. Nguyen TN, Raymond J, Guilbert F, Roy D, Bérubé MD, Mahmoud M, et al. Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg. 2008; 108:1088–1092. PMID: 18518708.

2. Cloft HJ, Kallmes DF. Cerebral Aneurysm Performation Complicating Therapy with Guglielmi Detachable Coils: A Meta-Analysis. AJNR Am J Neuroradiol. 2002; 23:1706–1720. PMID: 12427628.

3. Goddard JK, Moran CJ, Cross DT III. Absent Relationship between the Coil-Embolization Ratio in Small Aneurysms Treated with a single Detachable Coil and Outcomes. AJNR Am J Neuroradiol. 2005; 26:1916–1920. PMID: 16155134.

4. Yang MS, Wong HF, Yang TH. Alternative option in the treatment of very small ruptured intracranial aneurysms. Surg Neurol. 2009; 72(Suppl 2):S41–S46. PMID: 19944825.

5. Moret J, Cognard C, Weill A. The "remodeling technique" in the treatment of wide neck intracranial aneurysms: Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol. 1997; 3:21–35. PMID: 20678369.

6. Nelson PK, Levy DI. Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: medium-termangiographic and clinical follow-up in 22 patients. AJNR Am J Neuroradiol. 2001; 22:19–26. PMID: 11158882.

7. Soeda A, Sakai N, Sakai H, Iihara K, Yamada N, Imakita S, et al. Thromboembolic events associated with Guglielmidetachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2003; 24:127–132. PMID: 12533341.

8. Sorteberg A, Sorteberg W, Aagaard Beverly DL. Hemodynamic versus Hydrodynamic Effects of Guglielmi Detachable Coils on Intra-Aneurysmal Pressure and Flow at Varying Pulse Rate and Systemic Pressure. AJNR Am J Neuroradiol. 2004; 25:1049–1057. PMID: 15205147.

9. Gobin YP, Counord JL, Flaud P. In vitro study of haemodynamics in a giant saccular aneurysm model: influence of flow dynamics in the parent vessel and effects of coil embolisation. Neuroradiology. 1994; 36:530–536. PMID: 7845578.