Coiling Procedure Research Articles

Treating a Challenging Giant Aneurysm of Middle Cerebral Artery (MCA) with a Staged Procedure of Endovascular Coiling and Flow Diverter (FD): Case Report

Background: Giant intracranial aneurysms pose significant challenges in treatment due to a high risk of postoperative complications, including delayed rupture, cerebral edema, and aggravation of mass effect. Endovascular approaches, such as adjunctive coiling and flow diverter (FD) procedures, have become increasingly recommended for wide-necked, large, and giant aneurysms. Case Description: In this report, we present a challenging case of a staged coiling and FD procedure in a giant unruptured middle cerebral artery (MCA) aneurysm. The patient, a 26-year-old adult female, was admitted to our hospital with a history of convulsions. Digital Subtraction Angiography (DSA) revealed a massive aneurysm measuring 40 mm × 27 mm in the M1 segment of the MCA. To mitigate the risk of mass effect aggravation, we performed a two-staged procedure with a seven-day interval between the interventions. The first step involved partial endovascular coiling to shrink the aneurysm, followed by successful flow diversion. The patient did not experience further convulsions or neurologic deficits, and the follow-up angiogram showed no residual flow to the aneurysm. Conclusion: We report one of the very first cases of adjunctive coiling and FD in ‘unruptured’ giant aneurysms. Our neurovascular intervention provides valuable insights into the approach and treatment of unruptured giant aneurysms in cerebral arteries. By employing a staged procedure, effective flow diversion can be achieved even in giant unruptured aneurysms. Although further research is necessary to confirm its superiority and address critical issues, our findings may contribute to the future management of giant aneurysms and inspire avenues for research in the neurosurgical community. Bang. J Neurosurgery 2023; 12(2): 129-136

Risk Factor Analysis of Complications and Mortality Following Coil Procedures in Patients with Intracranial Unruptured Aneurysms Using a Nationwide Health Insurance Database.

(1) Background: Unruptured intracranial aneurysm (UIA) occurs in 1-2% of the population and is being increasingly detected. Patients with UIA are treated with close observation, endovascular coiling or surgical clipping. The proportion of endovascular coiling has been rising. However, complications such as cerebral infarction (CI), intracranial hemorrhage (ICRH), and death remain crucial issues after coil treatment. (2) Methods: We analyzed the incidence and risk factors of complications after the use of coil in patients with UIA based on the patients' characteristics. We utilized the Health Insurance Review and Assessment (HIRA) database. Patients treated with coils for UIA between 1 January 2015 and 1 December 2021 were retrospectively analyzed. (3) Results: Of the total 35,140 patients, 1062 developed ICRH, of whom 87 died, with a mortality rate of 8.2%. Meanwhile, 749 patients developed CI, of whom 29 died, with a mortality rate of 3.9%. The overall mortality rate was 1.8%. In a univariate analysis of the risk factors, older age, males, a higher Charlson Comorbidity Index (CCI) score, and diabetes increase the risk of CI. Meanwhile, males with higher CCI scores and hemiplegia or paraplegia show increased ICRH risk. Older age, males and metastatic solid tumors relate to increased mortality risk. (4) Conclusions: This study is significant in that the complications based on the patient's underlying medical condition were analyzed.

Endovascular treatment with coil embolization of saccular celiac artery aneurysm: a case report

Objective: Aneurysms of the celiac artery and its visceral branches are more often an incidental finding and can lead to serious complications. Many difficulties arise in matters of their treatment due to the rarity of occurrence. Case presentation: This report describes the rare case of saccular celiac artery aneurysm in patient with severe cardiac comorbidities including history of cardiac surgeries. Celiac artery aneurysm was treated using the endovascular coiling procedure. We had coil dislocation during procedure, and 2nd attempt of coil embolization of aneurysm was successful. The dislocation into femoral artery was treated successfully. Immediate and 1st month follow-up data showed no evidence of recanalization and aneurysm enlargement and computed tomography angiography chowed correct position of coil. Conclusion: Coil embolization is a safe and effective method for the treatment of celiac artery aneurysm in patients with severe comorbid conditions. One should be also prepared for possible technical difficulties that were overcome successfully and thus making minimal invasive approach in such patients effective.

혈관내 스텐트를 이용하여 경정맥구 게실에 의한 박동성 이명을 치료한 증례보고

Pulsatile tinnitus is a rare otologic symptom that presents a diagnostic and management dilemma for experienced otolaryngologists. Treatment options range from conservative management to surgery, but patients may not be able to tolerate symptoms with the former and the latter procedure may be associated with significant morbidity We describe the case of using a stent-assisted coil approach to treating a patient with jugular bulb diverticulum (JBD) and severe pulsatile tinnitus. We describe a 41-year-old woman who presented with disabling pulsatile tinnitus due to right JBD. Both surgical or endovascular approaches were possible, but we decided to treat the diverticulum with coil emboli-zation and stenting of the jugular bulb. Following the procedure, tinnitus presence and severity were self-reported or assessed using the tinnitus handicap inventory (THI) and tinnitus magnitude index (TMI). The total score of both THI and TMI improved in 6 months after surgery, and there was no complication. Therefore, we report this experience, which was resolved through successful endovas-cular coiling and stent procedure for severe pulsatile tinnitus with no complication.

Safety and Considerations of the Anaesthetic Management during Bronchoscopic Lung Volume Reduction Treatments

Background: Different bronchoscopic lung volume reduction approaches are available for a select group of patients with advanced COPD. General anaesthesia is the recommended method of sedation during these procedures. However, this patient population is at an increased risk of anaesthetic complications, and the best approach to general anaesthesia and mechanical ventilation is unknown. Objectives: The aims of this study were to describe the anaesthetic management techniques used during bronchoscopic lung volume reduction procedures and to investigate the number of anaesthesia-related events. Methods: Data were retrospectively collected from all endobronchial valve and lung volume reduction coil procedures performed between January 2018 and March 2020 in our hospital. Primary outcomes measures were anaesthetic technique including airway management; ventilation mode and settings; and the incidence of anaesthesia-related events, classified as catastrophic, severe, significant, or moderate. Results: 202 procedures were included. One procedure was performed under procedural sedation, 198 (98%) under general anaesthesia with endotracheal intubation, and 3 (1.5%) under general anaesthesia with laryngeal mask airway. Volume-controlled ventilation was used in 64% of the procedures and pressure-controlled in 36%. Patients were ventilated with a median respiration rate of 9.9 (IQR: 9.6–10.6) breaths per minute, mean tidal volume of 5.8 ± 1.4 mL/kg, and median inspiratory to expiratory (I:E) ratio of 1:2.8 (IQR: 1:2.1–1:3.2). No catastrophic anaesthesia-related events were observed. Hypotension was the most observed anaesthesia-related event. Conclusions: Despite the presence of advanced COPD, general anaesthesia and mechanical ventilation are well tolerated by patients undergoing endobronchial valve or lung volume reduction coil treatment. This is presumably strongly linked to the strict selection criteria. Other important considerations are using a low respiratory rate, low tidal volume, and high I:E ratio.

Coil migration during pressure-cooker technique for cerebral AVM

Introduction: In recent decades, the endovascular treatment of cerebral arteriovenous malformations (AVMs) has advanced. However, it still carries risks of unanticipated complications. Coil migration is a reported complication of aneurysmal coiling procedures. Herein, we report a case of early intraprocedural coil migration during pressure cooker technique embolization of right thalamic AVM, discussing the management and potential explanations. The literature showed no report of coil migration after the pressure cooker technique in the form of coil-augmented Onyx injection technique (CAIT). Case description: An otherwise healthy 26-year-old female suddenly developed a severe headache with no loss of consciousness. Computed tomography (CT) scan of the head illustrated intraventricular haemorrhage. Magnetic resonance imaging (MRI) showed the bag of worms' sign in the right thalamic area. The size and location of the AVM prompted the decision for multistage endovascular embolization using onyx. In the anterior circulation, the right A5 arterial feeder has a high flow which indicates the pressure cooker technique embolization in the form of CAIT. In the procedure, early detachment and migration of the coil occurred in the medial prefrontal branch through the anterior cerebral artery. No intervention to retrieve the coil was carried out because the detachment piece is small and lodged distally. Onyx was injected directly without the coil because of the risk of radiation to the patient. Otherwise, the intraprocedural and postprocedural courses went uneventful. Conclusion: This is the first report of coil migration during the pressure cooker technique with CAIT for the right thalamic AVM.

Endovascular coiling procedure for saccular multilobulated anterior communicating artery aneurysm associated with contralateral A1 segment aplasia

The anterior communicating artery complex anatomy is very important in treating anterior cerebral circulation aneurysms surgically. About a quarter of all intracranial aneurysms are anterior communicating artery (AcomA) aneurysms. Aneurysm formation may be influenced by anatomic risk factors, with a co-occurring incidence of anterior cerebral artery trunks (A1) asymmetry. Patients with AcomA aneurysm are often presented with anterior cerebral artery A1 segment aplasia/hypoplasia. In this study, we will report a case of A1 hypoplasia in a 42-year-old female with a history of headache 3 days prior to admission which worsened overtime. Traditionally, coiling of A1 hypoplasia was not needed, however due to the neurological deficit, coiling was performed. This case report addresses the comparison between patient's pre-operative and post-operative results from angiography and coiling.

How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint

BackgroundPipeline embolization device (PED) deployment combined with coil therapy for large complex intracranial aneurysms is effective and considered superior to PED deployment alone. However, the optimal strategy for use of...

A retrospective evaluation of the pulmonary function tests and quality of life assessment surveys of emphysema patients subject to coil treatment.

Bronchoscopic volume reduction treatments are among the important alternatives for selected emphysema patients with a dyspneic course despite optimal medical treatment. Our aim was to carry out a retrospective scan of the data for COPD patients subject to coil treatment at our center for assessing whether coil procedure has an impact on the respiratory symptom and pulmonary function tests in COPD patients. The data of 41 patients with severe emphysema and treated with coils between 2017-2020 were evaluated retrospectively. Cardiopulmonary rehabilitation programs were completed for all patients prior to the procedure and they were assessed with pulmonary function test (PFT), diffusing capacity for carbonmonoxide test (DLCO), body plethysmography, 6-minute walk test, ventilation/perfusion scintigraphy, St. George's Respiratory Questionnaire (SGRQ). Data acquired prior to the procedure and 3rd month control data after the procedure were recorded and SGRQ was applied via face-to-face interviews during the controls by doctors working on Pulmonary Diseases as was the case before the procedure. SGRQ questionnaires of 32 patients were evaluated. Statistically significant changes were observed after the procedure in symptom, activity, impact score and total score which were calculated prior to the procedure. Pre and post procedure FEV1, FVC, FEV1/FVC, PEF, FEF25/75 parameters were used for the comparison made via SFT. Statistically significant changes were observed in FEV1, FVC, FEF25/75 when the pre and post-procedure SFT parameters of the 32 patients included in the study were compared. A statistically significant improvement was observed in the PFT parameters and quality of life questionnaires following the coil procedure which is a bronchoscopic volume reduction procedure.

Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey.

ABSTRACTBACKGROUND: Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm.OBJECTIVES: Compare our experience with valve and coil BLVR devices.DESIGN: Retrospective.SETTING: Single tertiary care centre.PATIENTS AND METHODS: Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded.MAIN OUTCOME MEASURES: Change in PFTs and completion of the 6MWT.SAMPLE SIZE: 60 Turkish men with a diagnosis of chronic pulmonary lung disease.RESULTS: Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups.CONCLUSION: Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema.LIMITATIONS: Relatively small sample, retrospective design, single-centre retrospective study.CONFLICT OF INTEREST: None.

Bronchoscopic lung volume reduction using coil therapy: complications and management.

Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment option for patients with homogeneous and heterogeneous end-stage emphysema and a forced expiratory volume in 1 second (FEV1) of 15-45%. This treatment decreases hyperinflation and improves lung function, the quality of life, and exercise capacity. It is very important to prepare patients for treatment, premedications, anesthesia applications, intubation, post-procedure follow-up and treatments. Further, it has been observed that various complications can develop during and after the procedure. Generally, the observed and reported complications are chronic obstructive pulmonary disease (COPD) exacerbation, chest pain, mild bleeding, pneumonia, pneumothorax, and respiratory failure. Rarely, aspergillus cavitation (coil-related aspergilloma), bronchopleural fistula and penetration into the pleural space, bronchiectasis, coil-associated inflammatory response and opacities, and hiccups are observed. Common complications are usually mild or moderate, while the rare ones can be life-threatening (except hiccup), so early diagnosis and treatment are necessary. However, patients treated with BLVR have lower mortality rates than untreated patients with similar morbidity. Based on the findings of this review, we can estimate that premedication one day before and just before the procedure may reduce potential complications. Some medical centers apply and recommend 30-day macrolide treatment after the procedure. New generation supraglottic devices may be preferred to avoid complications due to endotracheal intubation. Moreover, further research is needed to identify risk factors, prevent potential complications, and a common consensus is required for routine preventive treatment.

S2196 Splenic Artery Pseudoaneurysm Hemorrhage

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a common disorder within the medical field. UGIB accounts for up to 75% of all acute GIBs and can have multiple etiologies, with the most common being peptic ulcer disease. One etiology not often seen is acute hemorrhage from a splenic artery pseudoaneurysm (SAP). Usually, SAPs are rare anatomic variances seen in trauma or pancreatitis. Unlike splenic artery aneurysms (SAA), SAPs are typically found in symptomatic patients at the time of a UGIB. Our case highlights a patient who presented with a massive GIB from a fundic ulcer secondary to a penetrating (SAP). CASE DESCRIPTION/METHODS: An 81 year-old-male who presented via transfer secondary to concerns of UGIB. Esophagogastroduodenoscopy (EGD) prior to transfer revealed no active bleeding, but significant clot burden within the stomach. The EGD was aborted when the patient converted to AF with rapid ventricular rate. Rate control was achieved with beta-blocker therapy and subsequently transferred to our facility, receiving 2 units of packed red blood cells (PRBC) prior to transfer. EGD at our facility revealed multiple, cratered, fundic ulcers without bleeding stigmata or clot burden, requiring no initial therapy. Overnight, the patient would have multiple episodes of hematemesis requiring multiple PRBC transfusions . Repeat EGD revealed significant clot burden and stigmata of bleeding. Attempts were made to evaluate the ulcer underneath the clot burden, however, this resulted in active bleeding. Hemostasis was not achieved with epinephrine injection. General surgery was contacted and unable to offer assistance. Interventional radiology was contacted and performed angiography with coiling of the upper division of the splenic artery involving two large left supra abdominal splenic arterial branches believed to be short gastric-arterial pseudoaneurysms. Hemodynamic stability was achieved but the patient remained intubated. The decision was made to transfer to a tertiary center for higher level management. DISCUSSION: While the majority of SAAs are asymptomatic, SAPs are often found in symptomatic patients. The majority of SAP hemorrhage usually arise from pancreatitis or trauma. In our case, it is believed that his previous fundic ulcers likely resulted in penetration into the SAP causing a massive UGIB. Because our case had neither trauma nor pancreatitis, it exemplifies a rare presentation UGIB caused by splenic artery pseudoaneurysms.Figure 1.: Fundic ulcer.Figure 2.: Pseudoaneurysm present before coil procedure by IR.Figure 3.: Post coil procedure by IR.

A shotgun wedding

A 69-year-old woman developed a carotid-cavernous fistula (CCF) after firing a shotgun. Initially, the patient had mild visual symptoms, but later on developed prominent features of CCF including chemosis, proptosis, ophthalmoparesis and conjunctival injection . The fistula was embolized via an intravascular coiling procedure. We are unaware of another patient who developed a CCF due to blunt force from shotgun use.

Patient Characteristics, Patterns, and Repair of Aneurysms in Human Immunodeficiency Virus–Positive Patients

Human immunodeficiency virus (HIV) is a multisystem disease and is associated with vascular complications including aneurysm formation. HIV-associated aneurysms are well documented and may present in unusual locations with concerning features. However, the literature regarding aneurysms in HIV-positive patients is limited to case series with limited data regarding aneurysm patterns. Furthermore, several small series have documented poor outcomes with surgical repair. Thus, our aim was to investigate the characteristics, patterns, and repair of aneurysms in HIV-positive patients in a multicenter study. All patients with a diagnosis of aneurysms and HIV were retrospectively identified from 2013 to 2018 across 2 institutions. Comorbidities, HIV-related characteristics, aneurysm characteristics, and repair were reviewed. There were a total of 104 HIV-positive patients with 129 aneurysms. The mean age at the time of diagnosis was 57.7±10.3years, 80.8% of patients were male, and 32.0% had a history of acquired immunodeficiency syndrome. The average time from HIV diagnosis to aneurysm diagnosis was 14.1±10.1years. There were 53 (41.1%) ascending aortic, 25 (19.4%) abdominal aortic, 14 (10.9%) cerebral artery aneurysms, 13 (10.1%) descending thoracic, 9 (7.0%) iliac, 6 (4.7%) femoropopliteal, 4 (3.1%) visceral, 3 (2.9%) axillosubclavian, 1 (0.8%) carotid, and 1 (0.8%) coronary artery aneurysms. There were 23 (22.1%) patients with aneurysms in multiple vascular beds, 10 (9.6%) saccular aneurysms, and 1 (0.8%) inflammatory aneurysm. There were 7 ruptures (cerebral, descending thoracic, and iliac), 3 type A dissections (ascending aorta), and 1 thrombosis (popliteal). There were 26 (25.0%) patients who underwent surgical repair. This included 8 endovascular aneurysm repairs for abdominal aortic aneurysms, 6 endovascular coiling, clipping, and stent procedures for cerebral aneurysms, 4 open ascending aorta repairs, 2 bypasses for popliteal artery aneurysms, 2 endovascular stents for axillosubclavian artery aneurysms, 1 open descending aortic aneurysm repair, 1 endovascular aneurysm repair for an iliac aneurysm, 1 endovascular coiling for a renal artery aneurysm, and 1 open repair of a femoral artery aneurysm. Perioperative complications were common at 46.2%, although mortality was low at 3.8%. Although aneurysms were widespread, most HIV-positive patients had large vessel aneurysms in this study. There was a high prevalence of saccular and multiple aneurysms, and repair was associated with low rates of mortality despite high rates of complications. Additional studies are necessary to characterize this rare entity.

Early Goal-directed Therapy During Endovascular Coiling Procedures Following Aneurysmal Subarachnoid Hemorrhage: A Pilot Prospective Randomized Controlled Study.

Maintenance of euvolemia and cerebral perfusion are recommended for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). We conducted a pilot randomized controlled study to assess the feasibility and efficacy of goal-directed therapy (GDT) to correct fluid and hemodynamic derangements during endovascular coiling in patients with aSAH. This study was conducted between November 2015 and February 2019 at a single tertiary center in Canada. Adult patients with aSAH within 5 days of aneurysm rupture were randomly assigned to receive either GDT or standard therapy during endovascular coiling. The incidence of dehydration at presentation and the efficacy of GDT were evaluated. Forty patients were allocated to receive GDT (n=21) or standard therapy (n=19). Sixty percent of all patients were found to have dehydration before the coiling procedure commenced. Compared with standard therapy, GDT reduced the duration of intraoperative hypovolemia (mean difference 37.6 [95% confidence interval, 6.2-37.4] min, P=0.006) and low cardiac index (mean difference 30.7 [95% confidence interval, 9.5-56.9] min, P=0.035). There were no differences between the 2 treatment groups with respect to the incidence of vasospasm, stroke, death, and other complications up to postoperative day 90. A high proportion of aSAH patients presented at the coiling procedure with dehydration and a low cardiac output state; these derangements were more likely to be corrected if the GDT algorithm was used. Compared with standard therapy, use of the GDT algorithm resulted in earlier recognition and more consistent treatment of dehydration and hemodynamic derangement during endovascular coiling.

Evaluation of Safety and Successfulness of the Coil Embolization of Intracranial Aneurysms

Abstract Intracranial aneurisms are ongoing problem for neurosurgeons and especially for interventional neuroradiologists due to its morbidity and mortality. The method of choice for treatment of the unruptured and ruptured intracranial aneurysms is endovascular coiling on account of its minimal invasiveness and high effectiveness. The aim of our study was to evaluate the safety and successfulness of endovascular coiling procedure in unruptured and ruptured intracranial aneurysms. Our study was designed as case series and consisted of patients older than 18 years, who underwent endovascular coiling of unruptured and ruptured intracranial aneurysms and follow-up examination 6 months after the interventional procedure. The procedures were performed from December 2010 to December 2016, by experienced interventional neuroradilogists (more than 400 performed embolizations each) at the Department for Interventional Neuroradiology, Clinical Center Kragujevac, Serbia. There were 681 patients (average age 47.5 ± 11.2 years) treated with endovascular coiling, out of them 324 (234 females, 90 males) had unruptured intracranial aneurysm and 357 (138 females, 219 males) had ruptured intracranial aneurysm. In our series, total complication rate was 11.71 %. Analysis of the results after first endovascular procedure has shown that complete aneurysm occlusion was accomplished in 546 patients (80.3%), near-complete in 81 patients (11.8%), and incomplete in 54 patients (7.9 %). Our results were satisfying regarding the procedure’s success, safety, outcomes and study material. However, further technical development of the materials and constant training of the interventional radiologists, are a necessity in order to improve treatment outcomes and patients’ benefit.

Role of Magnesium Sulfate in Preventing Vasospasm and Maintaining Hemodynamic Stability in Patients Undergoing Endovascular Coiling for Brain Aneurysm

Introduction: Themaintenance of hemodynamic stability in brain aneurysm surgery has paramount clinical significance in order to prevent vasospasm in the patients with aneurysmal subarachnoid hemorrhage. Regarding this, the present study was conducted to assess the role of magnesium sulfate in preventing vasospasm and maintaining hemodynamic stability during endovascular coiling procedure for brain aneurysm. Materials and Methods: This double-blind clinical trial was conducted on 60 patients who were candidates for undergoing endovascular coiling for brain aneurysm. The patients were subjected to angiography through femoral artery catheterization. Then, they were randomly assigned into two treatment groups of case receiving magnesium sulfate and control administered normal saline. The vasospasm and hemodynamic status were measured and recorded during and following the surgery. Results: According to the results, no significant difference was observed between the two groups in terms of heart rate (p=0.98) and mean arterial pressure =p) 0.89( one hour post-surgery. Furthermore, there was no statistical difference between the two groups regarding the use of nimodipine ( p=0.11). Nevertheless, the frequency of vasospasm was significantly lower in the patients receiving magnesium sulfate, during surgery (p=0.037) and after surgery (p=0.02), compared to those administered normal saline. Conclusion: As the findings indicated, magnesium sulfate could lower the incidence of vasospasm during and following the endovascular coiling procedure for brain aneurysm. Moreover, it resulted in no adverse effects on the hemodynamic status of the patients.

Contrast Media-Induced Nephropathy in Patients with Unruptured Cerebral Aneurysm After Coiling Endovascular Treatment

The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have been limited. Thus, we evaluated the incidence and risk factors for CIN in patients who had undergone cerebral aneurysmal coiling procedures. We retrospectively reviewed the electric medical records of 380 patients who had undergone cerebral aneurysmal coiling treatment under general anesthesia. CIN was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or a relative increase (≥25%) in the baseline serum creatinine value at 48-72 hours after exposure to a contrast agent. Elective cerebral aneurysmal coiling procedures were performed in 230 patients. Of the 230 patients, CIN developed in 13 (5.6%). The presence of diabetes mellitus (30.8% vs. 9.7%; P= 0.040) and patient age >75 years (30.8% vs. 6.5%; P= 0.012) were risk factors for CIN. Our study has demonstrated that the incidence of CIN in patients undergoing elective cerebral aneurysmal coiling procedures is ∼6.0%. We also identified underlying diabetes mellitus and advanced age (≥75 years) as potential risk factors.

Adoption Patterns of Bronchoscopic Lung Volume Reduction Procedures in Germany and Predicted Procedure Volumes for Other European Countries

Background: Bronchoscopic lung volume reduction (BLVR) using valves and coils has been approved for use since 2003 and 2010, respectively. Objective(s): To study adoption patterns of BLVR in an early-adopting country, and to estimate potential treatment volumes in other European countries. Methods: Therapy- and age-specific volumes for endobronchial valve and coil procedures were obtained from German federal statistics for 2007–2016. Therapy-specific and total BLVR procedure volumes and growth were computed, and patterns in treatment age and device utilization analyzed. Patient volumes for other European countries were predicted using mean German patient volumes of the last 3 data years and age-specific population and emphysema incidences. Results: Over the study period, annual BLVR procedure volumes grew from 91 to 2,053 (+2,256%), reaching a peak of 2,556 procedures in 2013. Coil procedures constituted 36% of the total volume in 2016. Treatment age was stable over time, with highest procedure counts in age group 60–64 years for valves and 65–69 years for coils. A limited increase in device use per procedure was observed. For ­Germany, 1,655 newly treated BLVR patients were estimated per year, approximating about 5% of the annual newly diagnosed severe emphysema cases. Predicted volume estimates for other European countries ranged from 1 for Liechtenstein to 1,226 for France. Conclusions: Analysis of ­German procedure data show pronounced BLVR therapy uptake in the early years of adoption, with the more recently introduced coil therapy used in about one-third of patients. Estimated patient volumes to date constitute only a small fraction of the severe emphysema population.

Lung volume reduction with endobronchial coils for patients with emphysema.

The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. The treatment is aimed at a large group of patients where lung volume reduction surgery and bronchoscopic lung volume reduction using endobronchial valves are no option, or alternatively, can be offered as a bridge to lung transplantation. The nitinol coil exhibits a shape memory effect and is biologically inert. The lung volume reduction coil procedure is performed in two separate treatment sessions, targeting one lobe per session, with the contralateral lobe being treated 4 to 8 weeks after the first session. In one treatment session, around 10 to 14 coils, thereby treating an entire lobe, are being placed. Selecting optimally treated, symptomatic chronic obstructive pulmonary disease (COPD) patients with emphysema and severe hyperinflation, while avoiding significant airway disease such as asthma, chronic bronchitis and bronchiectasis, is key to achieve treatment success. Three randomized clinical trials investigating lung volume reduction coil treatment have been published until now, reporting the results of 452 treated patients up to 12 months after coil treatment. Lung volume reduction coil treatment results in significant improvement of pulmonary function outcomes and quality of life in patients with severe hyperinflation. The most common complications of lung volume reduction coil treatment are: COPD exacerbations, pneumonia, Coil Associated Opacity and an increased risk of pneumothorax. The purpose of this article is to describe the coil technique and review the available literature regarding effect, safety and future perspectives of lung volume reduction with coils for emphysema patients.