Conventional Coil Embolization Research Articles

Remodeling Technique for Endovascular Treatment of Ruptured Intracranial Aneurysms Had a Higher Rate of Adequate Postoperative Occlusion than Did Conventional Coil Embolization with Comparable Safety

To compare the safety and efficacy of the remodeling technique with that of conventional coil embolization in a large multicenter series involving the endovascular treatment of ruptured intracranial aneurysms, the CLARITY study (Clinical and Anatomic Results in the Treatment of Ruptured Intracranial Aneurysms). The institutional review board approved the CLARITY study, and written informed consent was obtained from all patients. A total of 768 patients (age range, 19-80 years; mean age ± standard deviation, 51.0 years ± 11.1) with 768 ruptured aneurysms were treated with either conventional coil embolization (608 patients, 79.2%) or the remodeling technique (160 patients, 20.8%). Patient and aneurysm characteristics, the rate of adverse events related to the treatment or initial intracranial hemorrhage, and patient outcome were compared between treatment groups by using the χ(2), Fisher exact, or Student t test. The overall rate of treatment-related complications, with or without clinical manifestations, was 17.4% (106 of 608 patients) with coil embolization and 16.9% (27 of 160 patients) with remodeling (P = .999). The difference in the rates of thromboembolic events, intraoperative rupture, and early repeat bleeding between the treatment groups was not statistically significant. The cumulative morbidity and mortality rate related to the treatment in the remodeling group (3.8%, six of 160 patients) was similar to that in the coil embolization group (5.1%, 31 of 608 patients) (P = .678). Likewise, the global cumulative morbidity and mortality rates related to both the treatment and the initial hemorrhage did not differ significantly between groups (16.2% [26 of 160 patients] with remodeling and 19.6% [119 of 608 patients] with coil embolization, P = .366). The rate of adequate aneurysm occlusion, however, was significantly higher in the remodeling group (94.9%, 150 of 158 aneurysms) than in the coil embolization group (88.7%, 534 of 602 aneurysms) (P = .017). In our large series of patients treated for ruptured aneurysms, the remodeling technique-despite being performed in aneurysms with unfavorable characteristics-was as safe as conventional coil embolization and more efficacious in terms of the rate of adequate postoperative occlusion. These results indicate that the remodeling technique can be routinely used in the treatment of ruptured aneurysms.

Abstract No. 207: Internal Iliac Artery Embolization Prior to EVAR: Comparison of the AMPLATZER® Vascular Plug to Conventional Coils

Internal iliac artery (IIA) embolization is routinely performed prior to endovascular repair of aortoiliac and isolated common iliac artery (CIA) aneurysms. The purpose of this study was to compare main trunk IIA embolization using the AMPLATZER® Vascular Plug (AVP) to conventional coil embolization with regards to cost, procedure time, number of angiographic runs, and late development of an endoleak. We retrospectively reviewed 34 cases between September 2004 and July 2008 of main trunk IIA embolization prior to endovascular stent graft repair of either aortoiliac (21) or isolated CIA aneurysms (8), or revision of preexisting endovascular stent grafts (5). In 14 patients embolization was performed with the AVP, and in the remaining 20 patients, embolization was performed with conventional coils. In each case, the total number of plugs/coils and their cost were determined. Procedure time and number of angiographic runs, both from initial IIA catheterization to vessel occlusion, were reviewed. There was no significant difference in average IIA diameter between the two groups. IIA occlusion was obtained with a single AVP in 12 of the 14 patients, and with two AVPs in the remaing two. An average of 7.8 (+/- 3.7) coils were used in the 20 patients undergoing coil embolization. Average cost of embolization with the AVP was $443.39, significantly lower than the $621.12 average cost of coil embolization (P value 0.035). Average time from initial IIA catheterization to vessel occlusion was also significantly decreased when the AVP was used over coils (23.7 vs 34.7 minutes, P value 0.035). No statistically significant difference in number of angiographic runs was noted. Follow-up CT angiograms were available in 12/14 patients who underwent AVP embolization, and in 17/20 patients who underwent coil embolization (mean followup 10.7 months), none of which demonstrated the presence of endoleak related to the IIA or distal iliac limb. In patients undergoing endovascular stent graft repair of aortoiliac or CIA aneurysms, successful IIA embolization can be performed both at a lower cost and with shorter procedure time with the AVP as compared to conventional coils.

Balloon-Assisted Coil Embolization

Object. The aim of this study was to assess the incidence, indications, complications, and angiography results associated with balloon-assisted coil embolization (BACE) of intracranial aneurysms and to compare these factors with those for conventional coil embolization (CE). Methods. Between 1995 and 2005, 827 intracranial aneurysms in 757 consecutive patients were packed with coils. Balloon-assisted coil embolization was used in 8.6% (71 of 827) of the coil insertion procedures and was more frequently used in large aneurysms, un-ruptured lesions, and those located on the vertebrobasilar system and carotid artery. Procedure-related complications leading to death or dependency were significantly higher in BACEs (14.1%) compared with those in CEs (3%). Packing densities and the results of 6-month follow-up angiography studies did not differ significantly between the two types of treatments. There was a strong trend for a higher retreatment rate in the aneurysms treated with BACE. Conclusions. Balloon-assisted coil embolization of intracranial aneurysms is associated with a high complication rate and should only be used if conventional CE of these lesions is impossible or has failed and if anticipated surgical risks are too high. The BACE procedure does not improve the occlusion rates of the aneurysms on follow-up evaluation.

Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results

The aim of this study was to assess the incidence, indications, complications, and angiography results associated with balloon-assisted coil embolization (BACE) of intracranial aneurysms and to compare these factors with those for conventional coil embolization (CE). Between 1995 and 2005, 827 intracranial aneurysms in 757 consecutive patients were packed with coils. Balloon-assisted coil embolization was used in 8.6% (71 of 827) of the coil insertion procedures and was more frequently used in large aneurysms, unruptured lesions, and those located on the vertebrobasilar system and carotid artery. Procedure-related complications leading to death or dependency were significantly higher in BACEs (14.1%) compared with those in CEs (3%). Packing densities and the results of 6-month follow-up angiography studies did not differ significantly between the two types of treatments. There was a strong trend for a higher retreatment rate in the aneurysms treated with BACE. Balloon-assisted coil embolization of intracranial aneurysms is associated with a high complication rate and should only be used if conventional CE of these lesions is impossible or has failed and if anticipated surgical risks are too high. The BACE procedure does not improve the occlusion rates of the aneurysms on follow-up evaluation.

Balloon-assisted coil embolization of intracranial aneurysms

In an extensive clinical series, Sluzewski and colleagues evaluated the risks associated with balloon-assisted coil embolization (BACE) of intracranial aneurysms. Specifically, these experienced authors analyzed the results in 71 cases in which BACE was performed and compared the data with those from a group of 756 aneurysms in which coil embolization (CE) alone was used. Hence, during the interval between 1995 and 2005, the authors treated 827 intracranial aneurysms by using endovascular techniques. They observed that BACE was more frequently utilized in larger aneurysms with broad necks, unruptured lesions, and lesions in the posterior circulation. Predictably, balloon-assisted techniques had a higher procedural complication rate of 14.1% compared with the 3% rate in the conventional CE interventions. Follow-up evaluations of these 71 aneurysms were somewhat limited: only 52 lesions had 6-month angiography follow-up data. At that time, 71% of the lesions were completely occluded and 29% still had residual filling. Of the 15 incompletely obliterated aneurysms, 10 were subjected to additional intervention, including two surgical clip applications. Long-term follow up of these incompletely treated aneurysms was limited, but the authors report that at a meeting 28 months posttreatment none in this group demonstrated repeated hemorrhage.

Amplatzer Vascular Plug to occlude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair

The purpose of this report is to evaluate the use of conventional coils and the Amplatzer Vascular Plug, a type of nitinol-based self-expanding device, to occlude the internal iliac artery in patients undergoing aortoiliac or common iliac aneurysm endograft repair, or both. Between August and December 2004, in preparation for endograft repairs of aortoiliac or common iliac artery aneurysms, or both, at a community hospital system, five patients underwent the occlusion of the internal iliac artery with an Amplatzer Vascular Plug to prevent endoleak. During the preceding 12 months, the conventional coil embolization of the internal iliac artery was used for the same purpose in 10 patients. In five patients undergoing the Amplatzer Vascular Plug occlusion of the internal iliac artery, precise deployment at the origin of the artery was achieved. Complete and precise occlusion was confirmed angiographically, and only one device was used for each internal iliac artery. Two patients reported mild buttock claudication 2 weeks after occlusion, which resolved completely by 6 and 8 weeks, respectively. A type II endoleak from the inferior mesenteric artery developed in one patient. In the previous 10 patients, 11 internal iliac arteries were treated with conventional coils. Subsequent repeat coil embolization was required for three patients. The procedural complications in this second group included one case of coil embolization into the superficial femoral artery and one into the common iliac artery; both errant coils were retrieved successfully by endovascular techniques. An average of 7 +/- 3.4 (mode of 5) coils were used for each internal iliac artery. Three cases of buttock claudication occurred after the unilateral internal iliac artery occlusion in this group and did not resolve. No evidence of ischemic bowel, buttock necrosis, or sexual dysfunction was observed in either group. The estimated average cost to occlude one internal iliac artery was 375 dollars for Amplatzer Vascular Plugs and 3,500 dollars for conventional coils. The Amplatzer Vascular Plug allows for a cost-effective method to occlude the internal iliac artery in patients undergoing endograft repairs of aortoiliac aneurysms. The use of a single device with a precise placement at the origin of the artery minimizes cost and avoids ischemic complications.

Stent-supported Coil Embolization: The Treatment of Fusiform and Wide-neck Aneurysms and Pseudoaneurysms

OBJECTIVE We describe a consecutive series of patients treated with endovascular stent-supported coil embolization for symptomatic or enlarging wide-neck and fusiform aneurysms and pseudoaneurysms of the carotid and vertebrobasilar arteries. METHODS Seven stent-supported coil embolization procedures were performed for seven aneurysms in seven consecutive patients. There were five pseudoaneurysms, one dissecting aneurysm, and one berry aneurysm. Four aneurysms were located in the carotid artery, and three were located in the vertebrobasilar system. Three aneurysms were intracranial. Four patients were symptomatic, and three had angiographic evidence of increasing aneurysm size. RESULTS Technical success was achieved in six (86%) of seven patients. Entanglement of a coil with the stent struts necessitated partial coil delivery into the parent artery in one patient, but there were no neurological or other adverse sequelae. The 30-day rate of periprocedural stroke or mortality was 0%. At a mean clinical follow-up of 14.5 months, neurological status was at baseline or better in all patients. To date, all treated patients remain clinically asymptomatic with oral administration of aspirin only. CONCLUSION Stent-supported coil embolization represents an emerging therapeutic alternative to surgery for the treatment of symptomatic or enlarging wide-neck and fusiform aneurysms and pseudoaneurysms of the cervical and vertebrobasilar arteries, which are not amenable to conventional unsupported coil embolization. Experience with greater numbers of patients and long-term follow-up are required to further validate this technique.