Coiling Procedure Research Articles

Nurses' Role in Intracranial Aneurysm Coiling Procedure

Nurses' Role in Intracranial Aneurysm Coiling Procedure

Treatment Pathways, Resource Use, and Costs of Endovascular Coiling Versus Surgical Clipping After aSAH

The International Subarachnoid Aneurysm Trial (ISAT) reported that endovascular coiling yields better clinical outcomes than surgical clipping at 1 year. The high cost of the consumables associated with the endovascular coiling procedure (particularly the coils) led health care purchasers to conclude that coiling was a more costly procedure overall. To examine this assumption and provide evidence for future policy, accurate and comprehensive data are required on the overall resource usage and cost of each strategy. We provide detailed results of patient treatment pathways, resource utilization, and costs up to 24 months postrandomization for endovascular and neurosurgical treatment of aSAH. We report data on costs related to initial and subsequent procedures (ward days, ITU, equipment, staff, consumables, etc), adverse events, complications, and follow up. The data are based on a subsample of all patients randomized in ISAT, containing all patients across 22 UK centers (n=1644). There was a nonsignificant difference - pound 1740 (- pound 3582 to pound 32) in the total 12-month cost of treatment in favor of endovascular treatment. Endovascular patients had higher costs than neurosurgical patients for the initial procedure, for the number and length of stay of subsequent procedures, and for follow-up angiograms. These were more than offset by lower costs related to length of stay for the initial procedure. In the following 12- to 24-month period, costs for subsequent procedures, angiograms, complications, and adverse events were greater for the endovascular patients, reducing the difference in total per patient cost to - pound 1228 (- pound 3199 to pound 786) over the first 24 months of follow-up. No significant difference in costs between the endovascular and neurosurgery groups existed at 12- or 24-month follow up.

The production of the superconducting conductor for the TFCI

The superconducting cable-in-conduit conductor (CICC) for the TF Coil Insert (TFCI) consists of the cable (1152 superconducting Nb/sub 3/Sn strands of 0.81 mm diameter) jacketed by welded titanium conduit. All superconducting strands are covered by Cr layer of near 2.5 /spl mu/m thickness and cabled in five stages. The sub-cables and the full cable are wrapped by the thin SS tape. The manufacturing procedure was carried out for a jacketing of cable by the tubes of titanium (2.0 mm thickness). This paper presents the description of the conductor manufacturing process. cabling, welding of conduit, insertion of cable, compaction, winding of coil and QA procedure. The coil of TFCI was made of the superconducting conductor successfully.

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatomic and clinical outcomes are discussed. Seventy-five basilar tip aneurysms were treated with the GDC system at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28-82 yr). Forty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 patients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small with a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were large, and 10 (13.3%) were giant aneurysms. Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic difficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneurysms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlusion. One incompletely embolized giant aneurysm ruptured during the follow-up period. In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depends on the shape of the aneurysm, not its location. The results of this study indicate that endovascular GDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of patient age, clinical presentation, clinical status, or timing of treatment.

Transcatheter closure of patent ductus arteriosus with the use of Rashkind occluders and/or Gianturco coils: Long-term follow-up in 123 patients and special reference to comparison, residual shunts, complications, and technique

Background This report describes the long-term follow-up of transcatheter closure of patent ductus arteriosus (PDA) with 2 different modalities in 123 patients of diverse ages. Methods and Results Between October 1990 and August 1997, 123 patients underwent transcatheter PDA (1.9 to 7.5 mm) closure at a mean age of 6.8 ± 8.9 years (range 0.06 to 52) and mean weight of 20.9 ± 17.6 kg (range 2.7 to 83). In the initial procedure, the Rashkind device was used in 60, the Gianturco coil(s) in 60, and the Rashkind device with a coil in 3 patients. Six-month closure rate for the Rashkind group was 77% versus 90% for the coil group. The second procedure was carried out for residual shunt in 19 (14 in the Rashkind group and 5 in the coil group) and a third procedure in 1 patient from the Rashkind group. A balloon wedge catheter was used in 50 of 78 coil procedures to prevent coil embolization. One device and 11 coils (8 without balloon aid) embolized to the pulmonary arteries. The device and all coils except 2 were retrieved successfully. Overall, 122 (99%) patients showed complete PDA closure. The mean uneventful follow-up period was 44.11 ± 23.77 months (range 8.7 to 90.28). Conclusions Transcatheter closure of PDA is feasible in infants as well as in patients >50 years of age without significant complications. The coils are easy to implant, less expensive, and multiple coils may be used in moderately large (>3.5 mm) ducts more effectively than with the Rashkind device. The use of a balloon wedge catheter prevents immediate coil embolization. Multiple procedures are feasible and safe to achieve complete closure. (Am Heart J 1999;138:1176-83.)

Hemolysis following coil embolization of a patent ductus arteriosus

We describe the development of hemolysis from moderate residual shunting across a patent ductus arteriosus following coil embolization. The fall in hemoglobin levels from 11.6 to 6.0 gm/dl necessitated a second coil procedure which resulted in complete closure of the residual shunting and resolution of hemolysis. Therefore, appearance of anemia following coil embolization of patent ductus arteriosus should be monitored closely; however, repeat coil embolization with elimination of residual shunt will lead to prompt recovery of normal hemoglobin levels.

Follow-up of coil occlusion of patent ductus arteriosus

Objective. We sought to determine the prevalence and fate of residual ductal shunting following coil occlusion of patent ductus arteriosus.Background. Although transcatheter coil occlusion of patent ductus arteriosus has gained popularity, few follow-up data have been reported.Methods. A review of 75 patients who underwent coil occlusion was performed. Residual shunting was investigated by Doppler echocardiography in follow-up. Angiograms were reviewed to obtain minimal ductal diameter and ductal angiographic type.Results. Residual shunts were found in 31 patients (41%) on the day of the procedure, and of these, spontaneous closure was noted in 17 (55%) at 2 weeks to 20 months of follow-up. Of the 75 patients studied, 5 (7%) required a second coil procedure, and 10 (13%) remained with persistent residual shunts at most recent follow-up. Actuarial analysis estimated a 6 ± 5% prevalence of residual shunts 20 months after a single coil procedure and 3 ± 3% after all coil procedures. Minimal ductal diameter was associated with immediate complete ductal occlusion by a single coil. These patients had significantly smaller (p = 0.003) minimal ductal diameters (1.2 ± 0.7 mm) than those who required two coils during their initial procedure to achieve immediate occlusion (1.9 ± 0.7 mm), those who required a second coil procedure (2.0 ± 0.9 mm), those who had spontaneous closure of residual shunts (1.9 ± 0.7 mm) and those with persistent residual shunts (2.0 ± 0.9 mm). No association was identified between ductal angiographic type and outcome of coil occlusion. No late adverse clinical events of coil occlusion or evidence of recanalization was found.Conclusions. Small residual shunts are common after coil embolization of patent ductus arteriosus, but most close spontaneously. Actuarial analysis estimates complete closure in 94% at 20 months, and reintervention was required in only 7% of patients.

Determination of lead in blood by tungsten coil electrothermal atomic absorption spectrometry

A method for the determination of lead in blood using a tungsten coil atomizer is described. A 100 μl volume of the whole blood sample is transferred to a sampler cup containing 100 μl of water plus 300 μl of 0.25% v/v Triton X-100. After lysis of blood cells, 500 μl of 10% w/v trichloroacetic acid is added for protein precipitation and 10 μl of the supernatant solution is automatically delivered into the tungsten coil. The furnace heating program is implemented in 41 s. It is shown by the paired t-test that there is no significant difference at the 5% probability level between results obtained by the proposed method and by using a transversely heated graphite atomizer with a longitudinal Zeeman background correction. Accuracy is also assessed by employing reference materials. The proposed tungsten coil procedure presents a characteristic mass of 15 pg Pb and a detection limit of 1.9 μg Pb dl −1.

783-2 Follow-up After Coil Occlusion of Patent Ductus Arteriosus

To define the prevalence and fate of residual shunts after Gianturco coil occlusion of patent ductus arteriosus (PDA), 50 pts were followed prospectively after PDA coil occlusion at CS Mott Children's Hospital between 10/92 and 8/94. Evidence of residual shunt was sought on immediate post-coil aortic angiograms and on color-flow Doppler echocardiograms performed in follow-up. Survival analysis of residual PDA shunting was analyzed by the Kaplan-Meier method, and the effect of minimum PDA angiographic size on residual shunting was determined by ANOVA. The 50 pts, median age 4.4 years (range 0.4-62), have been followed for ≤ 20 months (mean ± SD: 8 ± 6). PDA minimum diameter was 1.6 ± 0.8 mm (range 0.5–3.3). Complete PDA occlusion was noted immediately in 29 pts (58%); tiny residual shunts closed spontaneously 1–20 months after coil occlusion in 12 pts (24%). Tiny residual shunts persisted have undergone a second coil occlusion with immediate complete closure. Survival analysis (graph) estimates 20 month prevalence of residual shunts at 7 ± 6% after 1 coil procedure and 4 ± 4% after all coil procedures. PDA diameter significantly influenced residual shunting, being 1.3 ± 0.7 mm in pts with immediate closure, 1.9 ± 0.8 mm with spontaneous shunt closure in follow-up, and 2.0 ± 0.9 mm with persistent residual shunt or second coil placement (p = 0.02). 1) Survival analysis estimates 93% complete PDA closure after a single coil occlusion procedure; 2) Residual shunts are associated with larger PDA diameter, and most close spontaneously; and 3) When necessary, a second coil occlusion has been uniformly successful.