Abstract No. 255 - The triple coaxial system in gdc embolization with the voltage detach technique

Abstract

Purpose A new microcatheter with a 1.9-Fr non-tapered tip has recently become available and this new microcatheter can be inserted into a 2.7-Fr. microcatheter. It is called the triple co-axial system, and it has been reported that this system contributes to super selective catheterization in transcatheter arterial chemoembolisation for hepatocellular carcinoma. Recently, we attempted coil embolization by the triple co-axial system using 0.010-inch Guglielmi detachable coils (GDC). However, usually a two-marker microcatheter is required to detach GDC, but this 1.9-Fr. no-taper microcatheter has only one marker. To solve this problem, we attempted to find the detach point by watching the change of voltage. We name it voltage detach technique. The aim of this study was to describe this new technique, and evaluate its technical feasibility and clinical efficacy. Materials and Methods Nineteen patients, 14 males and 5 females, with a median age of 62 years (range, 37-89 years) underwent this procedure. The reason for undergoing GDC embolization was gastrointestinal bleeding in 5, traumatic bleeding in 3, recanalization of pulmonary arteriovenous malformation in 3, and other disease in 8. The medical records and imaging of the procedures were reviewed, and technical success rate, clinical success rate, and complications were evaluated. The technical success was defined as successful delivery and detachment of GDC, and clinical success as immediate post-embolic complete cessation of blood flow confirmed by digital subtraction angiography. Results Totally, 138 GDC were used, and 19 arteries were embolized. The technical success rate was 93% (129/138). In 6 of 9 failed cases, the stack of GDC inside of the microcatheter occurred, and in 3 of 9 failed cases, incorrect connection of GDC cable occurred. The clinical success rate was 95% (18/19). One failed case died during the procedure because of blood loss. There were no major complications related to this procedure. Conclusion Triple co-axial system in GDC embolization with voltage detach technique appeared to be safe and effective.