Detachable Coils Research Articles

Case of endovascular treatment of a patient with fusiform aneurysm de novo m2-branch of the middle brain artery

A clinical case with the choice of an individual strategy and tactics of endovascular treatment of a patient with fusiform aneurysm de novo of a branch of the middle cerebral artery is considered. Diagnosis and treatment was carried out in Scientific-practical Center of endovascular neuroradiology of the National Academy of Medical Sciences of Ukraine. Patient B., born in 1996, was admitted to the center in the acute period of hemorrhage from the fusiform aneurysm of the M2-branch of the middle cerebral artery, which, in turn, was excluded from circulation deconstructive, without neurological deficit in the postoperative period. Three months after the first endovascular treatment the patient was re-admitted to the center with the clinical manifestations of spontaneous subarachnoid hemorrhage. According to multispiral computed tomography and selective cerebral angiography, a fusiform aneurysm de novo of M2-branch of the middle cerebral artery was found, which, in turn, was excluded from circulation deconstructive in two stages. The first attempt at endovascular treatment failed to achieve total fusiform aneurysm de novo occlusion using detachable coils, due to the high risk of intraoperative complications. Ten days after the first stage the patient was taken again. Non-standard technique using balloon-assisted adhesive composition made it possible to achieve complete deconstructive occlusion of fusiform aneurysm de novo from the blood stream and to avoid complications in the form of neurological deficit. The postoperative period proceeded without features. In satisfactory condition the patient discharged under the supervision of a neurologist at the place of residence. The patient underwent 4 control examinations in the form of selective cerebral angiography. Collateral blood flow to the branches of the middle cerebral artery is preserved.

Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization.

Intracranial aneurysms treated with endovascular coil embolization may recur. We investigated the factors affecting aneurysmal recurrence after embolization and effects of endovascular retreatment within 1 year. In 3 years, 1,335 patients with 1,385 intracranial aneurysms were treated with coil embolization. Factors affecting aneurysm recurrence and the effects of endovascular retreatment were analyzed. Angiography immediately following embolization showed total occlusion in 1,030 aneurysms (74.4%), neck remnant in 207 (14.9%), and partial occlusion in 148 (10.7%), with a total peri-procedure complication rate of 4.2%. Overall, 145 patients with 151 aneurysms recurred within 1 year and the other 1,234 aneurysms remained occluded (89.1%). A significant (p < 0.05) difference existed in aneurysm size, rupture status, use of stent and immediate occlusion outcome between the two groups, with significantly (p < 0.05) lower recurrence rates in aneurysms with smaller sizes, no rupture and stent-assistance coiling. Neck remnant, partial occlusion, coiling without stent assistance, large and giant aneurysms were significant (p < 0.05) risk factors for aneurysm recurrence during the first year. The rate of recurrence was 4.7% (11/232) in aneurysms with total occlusion and 35.9% (23/64) in aneurysms with neck remnant and partial occlusion. Of the 34 recurrent aneurysms, 6 were re-embolized with detachable coils alone, 12 with stent-assisted coiling, 8 with balloon-assisted embolization, and the remaining 8 aneurysms with covered stents, resulting in total occlusion in 28 aneurysms and neck remnant in 6. Recurrence of previously-coiled cerebral aneurysms is significantly affected by aneurysm size, use of stent and degree of immediate occlusion. Endovascular retreatment with balloon-or stent-assisted techniques or with covered stents can be safe and effective for recurrent cerebral aneurysms.

Intraosseous Arteriovenous Malformations in the Extremities Managed with Coils and Absolute Ethanol Treatment

The extremity intraosseous arteriovenous malformations (AVMs) are rare high flow vascular lesions for which the treatment remains challenging. The aim of the study wasto assess treatment methods, interim results, and complications of coils and absolute ethanol in managing extremity intraosseous AVMs via direct puncture approach. From 2009 to 2017, 12 patients (mean age, 27.5years; range, 3-54years) with extremity intraosseous AVMs underwent staged coils and absolute ethanol treatment via the direct puncture approach. All patients were symptomatic before the procedure as per the Schobinger staging system. The mechanical detachable coils and undetachable coils were used first followed by the injection of absolute ethanol used as a sclerosant agent via a direct puncture approach. Follow-up evaluation (6 to 72months; mean, 23.5months), including imaging and symptoms and signs, was performed in all patients. Twenty-seven absolute alcohol procedures were performed for patients with intravascular sclerosis (range: 1-3, mean: 2) with one procedure required per patient (n=2), 2 per patient (n=5), or 3 per patient (n=5). The average stretched length of the total coils per patient was 843.33cm. The amount of absolute ethanol used ranged from 10mL to 45mL (mean, 25.69mL) in a single session. Nine of twelve patients (75%) exhibited complete responses, and 3 patients (25%) exhibited partial responses. One patient experienced minor complication of transient motor nerve injury and completely recovered half a month later. No major complications occurred. The study provides strong evidence, suggesting that direct puncture and coils with absolute ethanol approach is an effective and safe treatment in patients with extremity intraosseous AVMs, yielding minor complications and good results.

Do we still need coils for the endovascular treatment of intracranial aneurysms?

Controlled-detachable coils (Guglielmi detachable coils) were introduced in 1991 as part of the armamentarium of tools available for aneurysm endovascular treatment. The value of these coils compared with clipping has...

Embolization using hydrogel-coated coils for pulmonary arteriovenous malformations

PurposeTo prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs). Materials and methodsThe outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8±15.2 [SD] years; age range 14–78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization. ResultsThe mean feeding artery and venous sac sizes were 4.0mm and 8.5mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3±2.1 (SD) (range, 1–8) and 4.4±3.9 (SD) (range, 1–17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae. ConclusionVSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.

P1001Safety and effectiveness of transcatheter leak occlusion with detachable coils following left atrial appendage closure

Abstract Introduction Incomplete left atrial appendage (LAA) closure resulting in residual, significant leak is common after LAA exclusion procedures, potentially hindering an effective thromboembolic (TE) prevention. Detachable coils have found a wide range of applications for transcatheter vascular occlusion/embolization procedures. Purpose We report for the first time the feasibility and efficacy of transcatheter leak closure with detachable coils in patients with incomplete LAA closure. Methods Thirtyconsecutive high TE-riskpatients with a clinically-relevant residual leak (mean age: 72±9 years; 73.3% males; CHA2DS2-VASc: 4.3±1.5; HAS-BLED: 3.4±1.1)underwent percutaneous closure of the LAA patency via detachable coils (Interlock-35 Fibered IDC Occlusion System, Boston Scientific Inc.; Concerto Helix Detachable Coil System, ev3 Endovascular Inc; Azur Embolization System, Terumo Interventional Systems). Trans-oesophageal echocardiography (TEE) was performed at 45±15 days post-procedure to assess for residual LAA patency. Results LAA closure had been previously attempted with a Watchman device in 25 patients, an Amulet in 2 and a LARIAT in 3. At pre-procedural TEE, a moderate/severe leak was documented in 28 (93.3%) patients, a mild one in 2 (6.7%) patients. Procedure andfluoroscopy times were 73±40min and 21±15min, respectively; the mean volume of iodinated contrast medium was 80±48mL. Overall, 114 coils were released into patents' LAA (median: 3 coils/patient; IQR: 2–4). Coil deployment was successful in 98.2% of cases (112/114). The overall complication-free rate was 93.3% (28/30). There were no instances of vascular injury, TE events, device dislodgment. There was 1 major adverse device-related event in an 87-yo male, who developed pericardial tamponade requiring a pericardial window. A small pericardial effusion without hemodynamic compromise was noted in a 78-yo woman and treated conservatively. Follow-up TEE in all patients revealed complete LAA sealing or a minimal-mild leak in 28 cases (93.3%; 22 with no residual leak, 6 with a minimal-mild residual one), and a moderate residual leak in 2 patients (6.7%). Conclusions Transcatheter LAA leak occlusion via detachable coils is a safe, effective and promising approach in high TE-risk patients with incomplete LAA closure.

Neurointerventional Training for Neurosurgeons: Past, Present, and Future

AbstractEndovascular therapy as any other specialty has continuously been developed since 1904, but acceptability among neurosurgeons remains low despite being other subspecialties and techniques, like endoscope and for that matter microscope also, being adopted very rapidly. From injecting particles for vascular lesions to balloons for fistulas and arteriovenous malformations and embolizing agents to detachable coils for aneurysm coiling, it has come a long way. Old generations of neurosurgeons used to perform carotid puncture for diagnosing mass lesions, but once CT/MRI came in to the picture, this procedure was stopped and handed over to radiologists. A debate continues among neurosurgeons about the feasibility of aneurysm coiling since international subarachnoid aneurysm trial (ISAT) and doubts about the long-term efficacy of this novel treatment cost a subspecialty. With the recent addition of endovascular treatment of stroke and long-term efficacy of endovascular treatment of aneurysm, there is a lot of debate among clinicians and nonclinicians about who will be the true heir of this sub specialty.

Endovascular management of the carotid blowout syndrome: a single-center experience.

It is aimed to present endovascular treatment of carotid blowout syndrome (CBS) in patients with head and neck cancer. A retrospective review was performed on patients with carotid blowout syndrome between 2012 and 2018 in our hospital. A total of ten patients with prior history of head and neck cancer surgery and radiation therapy were investigated with clinical, postoperative and follow-up findings as well as technical outcome. Digital subtraction angiography of the carotid arteries was performed in all the cases for the diagnosis of the source of bleeding. Detachable coils and covered stents were used in endovascular treatment of carotid blowout syndrome. After the procedures, all patients were admitted to the intensive care unit for the follow-up of both hemodynamic and neurologic conditions. Thirteen diagnostic and endovascular treatment sessions were performed in 10 patients. Seven patients had major surgery for head and neck cancer and all patients were treated with chemoradiotherapy. Head and neck cancers in seven of the ten patients were persistent and pharyngocutaneous fistula developed in five patients. Two patients had impending CBS and eight patients had acute CBS. A total number of 19 vascular lesions in 10 patients were detected and 4 patients had multiple lesions. In three patients, additional endovascular treatment of stent-graft deployment had required due to recurrent hemorrhage after a mean time of 5.33days (range 1-11days). As a conclusion, covered stent application with or without coil embolization is a safe and efficient technique in treatment of CBS secondary to head and neck cancers.

All-In-One Induction Heating Using Dual Magnetic Couplings

This paper proposes and implements an all-in-one induction heating system, which can accommodate both pan-shaped and wok-shaped utensils. Traditionally, the pan is heated by a planar induction cooktop while the wok is heated by a curved induction cooktop. In this paper, both magnetic inductive coupling and magnetic resonant coupling are utilized to achieve excellent heating performance of the wok based on a planar primary coil. The key is to flexibly employ a detachable frustum coil for heating the wok. Specifically, the theoretical models of the proposed induction heating system with and without using the frustum coil are derived to analyze the proposed system. Computational simulation results of the magnetic and thermal fields of the proposed system are provided to elaborate the heating performance of the wok. A 1500 W prototype is designed and built. The calculated, simulated and experimental results are all in good agreement, which validate the feasibility of the proposed induction heating system well.

Embolotherapy for High-Flow Arteriovenous Malformations in the Hands Using Absolute Ethanol with Coil-Assisted Dominant Outflow Vein Occlusion

PurposeThe purpose of this study was to evaluate the management, outcomes, and technical and clinical safety of coil-assisted dominant outflow vein (DOV) occlusion for the ethanol embolization of high-flow arteriovenous malformations (AVMs) in the hands. Materials and MethodsBetween March 2013 and October 2016, 12 consecutive patients with AVMs with DOVs underwent ethanol embolization combined with detachable and pushable coil-assisted DOV occlusion. All patients completed the course of clinical follow-up (range: 14–57 months; mean: 36.7 months), and imaging follow-up (range: 8–25 months; mean: 16.6 months) results from the final treatment session were available for 8 patients. The therapeutic effects, degree of devascularization, and complications at the time of follow-up arteriography were evaluated as the clinical outcomes. ResultsThe patients underwent 23 ethanol embolization procedures (range: 1–3; mean, 1.9) with 24 detachable coils and 223 pushable coils. The average stretched length of the total coils per patient was 320.17 cm. Seven of 12 patients (58.3%) exhibited complete responses, and 5 patients (41.7%) exhibited partial responses. Minor complications, including blistering and focal swelling, occurred in all 12 patients (100%) but showed spontaneous and complete recovery. No major complications occurred. ConclusionsEthanol embolization has the potential to control high-flow hand AVMs by using coil-assisted DOV occlusion with an acceptable risk of minor and major complications.

Endovascular management of pediatric neurovascular malformations – A single?center experience from South India

Background: Neurovascular malformations (NVMs) in pediatric population are highly challenging to manage and treatment options include open surgery, endovascular therapy, and radiosurgery or combined. Recently, there has been a gradual shift from conventional surgical approach toward endovascular therapies with increasing availability of technical expertise and gadgetry. Objective: We aimed to study the clinical profile and immediate outcome of children with NVMs, who underwent endovascular therapy. Materials and Methods: This retrospective observational study was conducted in a tertiary care center in South India between February 2017 and August 2018. We included children admitted in pediatric intensive care unit (PICU) with NVM and needed neuroradiological intervention. Children with thromboembolism or other NVMs who did not require intervention were excluded from the study. Data on clinical profile, endovascular procedure done, supportive therapy given, and immediate outcome were collected and analyzed. Results: Of 1615 children admitted in PICU, 13 had NVM (0.8%), of which five had arteriovenous malformation (AVM), three had vein of Galen arteriovenous malformation (VGAM), one had VGAM with dural AVM, one had acquired carotid-cavernous fistula, two had berry aneurysm, and one had mycotic aneurysm. VGAM presented as hydrocephalus, whereas AVM and aneurysm as intracranial hemorrhage. Endovascular embolization was done using platinum detachable coils, onyx, N-butyl cyanoacrylate glue, and coil assist stents. One child needed decompressive craniectomy and another child needed extraventricular drainage. Four children needed pre-procedure ventilation and seven children needed prolonged post-procedure ventilation. Mortality was 15%; and among the survivors, 72% had an uneventful recovery. One child had seizures and two had hemiparesis at discharge. Conclusion: Endovascular management is an effective intervention for pediatric NVM. Multidisciplinary team approach and good pediatric intensive care are important for successful outcome. Further studies with long-term follow-up are needed to assess the durability of endovascular therapy.

The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification

The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.

Shape Memory Polyurethane with Porous Architectures for Potential Applications in Intracranial Aneurysm Treatment

Conventional endovascular embolization of intracranial (or brain) aneurysms using helical detachable platinum coils can be time-consuming and occasionally requires retreatment due to incomplete coil packing. These shortcomings create a need for new biomedical devices and methods of achieving brain aneurysm occlusion. This paper presents a biocompatible and highly porous shape memory polymer (SMP) material with potential applications in the development of novel endovascular devices for treating complex intracranial aneurysms. The novel highly porous polyurethane SMP is synthesized as an open cell foam material with a glass transition temperature (Tg) of 39 °C using a sugar particle leaching method. Once heated above the Tg, the compressed SMP foam is able to quickly return to its original shape. An electrical resistance heating method is also employed to demonstrate a potential triggering design for the shape recovery process in future medical applications. The mechanical properties of the developed SMP foam are characterized at temperatures up to 10 °C above the respective Tg. The results from this work demonstrate that the porous SMP material developed in this study and the electrical resistance heating trigger mechanism provide a solid foundation for future design of biomedical devices to enhance the long-term therapeutic outcomes of endovascular intracranial aneurysm treatments.

Transvenous Embolisation of Dural Arteriovenous Fistulas with Combination of Guglielmi Detachable Coils and Onyx: Preliminary Experience and Evaluation of the Clinical Outcomes

Transvenous Embolisation of Dural Arteriovenous Fistulas with Combination of Guglielmi Detachable Coils and Onyx: Preliminary Experience and Evaluation of the Clinical Outcomes

03:18 PM Abstract No. 133 Go Direct!: ultrasound-guided puncture of uterine arteriovenous fistulas for obliteration with ethylene vinyl alcohol copolymer in women with life-threatening hemorrhage

To determine the safety and efficacy of ultrasound (US)-guided direct puncture for ethylene vinyl alcohol copolymer (EVOH) embolization in the treatment of uterine arteriovenous fistulas (UAVFs). A retrospective review of consecutive female patients treated for UAVFs from July 2015 to August 2018 was performed. Patient histories, laboratory values, imaging studies, and follow up clinic notes were reviewed. A total of 4 patients were included; median age was 28 years (range: 24-33). All patients had history of uterine instrumentation and presented with life-threatening vaginal bleeding with an UAVF visible on US or MRI. Two (50%) had previously undergone proximal uterine artery embolization (UAE) but had recurrent bleeding. US-guided direct UAVF puncture was performed by transabdominal (n=2) or transvaginal (n=2) approach with injection of EVOH in all patients (a detachable coil scaffold was deployed in the first case but was not necessary in subsequent cases). After the fistulous connection had been successfully closed, Gelfoam UAE was performed to stasis. Technical success was defined by resolution of UAVF on intraprocedural angiography/US and follow up MRI. Clinical success was defined as resolution of the bleeding without recurrence or need for other therapies. Technical success was 100%. Angiography after obliteration of the fistulous connection with EVOH showed elimination of rapid filling of outflow veins in all cases and allowed for safe Gelfoam UAE. Follow up MRI showed EVOH filling the previously seen dilated vascular channels in all cases. Clinical success was 100% with resolution of bleeding in all patients; average follow up duration 395 days (range: 32 – 1,123 days). All patients tolerated the procedure well without immediate or delayed complication at 1 year. A 24-year old patient was 19 weeks pregnant at the time of data collection. US-guided direct puncture for EVOH delivery prior to Gelfoam UAE is a safe and effective option for management of UAVFs, avoiding hysterectomy and preserving the option of fertility in young women.

Embolization of high-output idiopathic renal arteriovenous fistula primarily using an atrial septal defect occluder via venous access: a case report

BackgroundThe case report is to evaluate the efficacy and safety of embolization of a high-output idiopathic renal arteriovenous fistula (IRAVF) with an atrial septal defect occluder (ASDO) via venous access.Case presentationA 57-year-old male diagnosed with high-output IRAVF received embolization with an ASDO via renal venous access and compact occlusion with 3 vascular plugs and a detachable elastic coil. The IRAVF was successfully occluded. After a follow-up of 2 months, renal arterial computed tomography angiography (CTA) showed the precise location of the ASDO. No complications were observed after 2 years’ follow-up.ConclusionsBased on present results, embolization of a high-output IRAVF with an ASDO via venous access might be an efficient and safe method.

Endovascular embolisation treatment in a rare acute abdomen spontaneous rectus sheath haematoma.

In this study, we aimed to review spontaneous rectus sheath hematoma (RSH) and the results of endovascular therapy in patients presenting with a rare acute abdomen. We evaluated the patients with RSH because of acute abdominal pain and applied endovascular embolization treatment who were admitted to our hospital emergency department retrospectively between December 2016 and December 2018. Rectus muscle sheath bleeding is an extremely rare and urgent emergency intervention. In the etiology, chronic severe cough crises and trauma may be the cause of haemorrhage in the elderly patient group; spontaneous bleedings may be seen with the increase in the use of anticoagulants. In this study, a total of six patients, 53-95 years old (mean 75.5) endovascular embolization treatment was administered on who were admitted to our hospital with the diagnosis of RSH and long-term anticoagulant use. In our series, physical examination findings, laboratory values, computed tomography (CT), CT angiography and digital subtraction angiography (DSA) findings were presented. The findings showed an active extravasation from the superficial circumflex iliac artery in two patients and the inferior epigastric artery in three patients. We had no bleeding focus in only one patient. An ultrasound-guided 5 Fr arterial sheath was placed on the side of the hematoma in the procedure. Then, the inferior epigastric artery and deep circumflex arteries were selectively catheterized using the Vertebral Diagnostic Catheter (5 Fr or 4 Fr). Superselective catheterization, with the help of microcatheter from the existing diagnostic catheter, was used to embolize the arteries and branches with active extravasation using a detachable coil. In the control angiographies performed after embolization, pathological staining disappeared, and complete embolization was achieved. There were no complications associated with the endovascular procedures. No active extravasation was detected in angiography examination, and inpatient follow-up, blood transfusion, antibiotics and analgesic support were performed in only one patient. However, it was ex as a result of reasons related to advance heart failure. RSH is a life-threatening condition that may cause acute abdominal pain, and endovascular embolization is a safe and effective treatment option that can be applied quickly in this patient group.

Endovascular coiling versus surgical clipping for aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials.

Background:Aneurysmal subarachnoid hemorrhage is a relatively rare cause of stroke, carrying a bad prognosis of mortality and disability. The current standard procedure, neurosurgical clipping, has failed to achieve satisfactory outcomes. Therefore, endovascular detachable coils have been tested as an alternative. This meta-analysis was aimed to compare the outcomes of surgical clipping and endovascular coiling in aneurysmal subarachnoid hemorrhage.Materials and Methods:Relevant randomized trials up to June 2018 were identified from Medline, Central, and Web of Science. Data for poor outcomes (Modified Rankin Scale [mRS] scores 3 to 6) at 2–3 months, 1 year, and 3–5 years were extracted and analyzed as odds ratios (ORs) with 95% confidence intervals (CIs), using RevMan software.Results:Five studies (2780: 1393 and 1387 patients in the coiling and clipping arms, respectively) were included in the current analysis. The overall effect estimate favored endovascular coiling over surgical clipping in terms of reducing poor outcomes (death or dependency, mRS > 2) at 1 year (OR = 0.67, 95% CI: 0.57–0.79) and 3–5 years (OR = 0.8, 95% CI: 0.67–0.96). Moreover, coiling was associated with a significantly lower rate of cerebral ischemia (OR = 0.37, 95% CI: 0.16–0.86). Postprocedural mortality (OR = 0.79, 95% CI: 0.6–1.05) and rebleeding (OR = 1.15, 95% CI: 0.75–1.78) rates were comparable between the two groups. However, technical failure was significantly more common with coiling interventions than with clipping surgeries (OR = 2.84, 95% CI: 1.86–4.34).Conclusion:Our analysis suggests that coiling can be a better alternative to clipping in terms of surgical outcomes. Further improvements in the coiling technique and training may improve the outcomes of this procedure.

Endovascular treatment of the patient with vascular type of Ehlers–Danlos syndrome with bilateral dissection stenoses and aneurysms in V3- andV4- segments of vertebral arteries

A case of treatment of a patient with type 4 of Ehlers–Danlos syndrome and bilateral dissection stenoses and aneurysms in V3and V4-segments of vertebral arteries is described. Also another vascular anomaly was verified: the aberrant right subclavian artery (arteria lusoria). Сerebral angiography with dynamic rotation of the neck revealed a bow hunter's syndrom, which consists in the restriction of blood flow in the right vertebral artery when the head is turned to the left. Stage-by-stage endovascular reconstruction of both vertebral arteries was performed. Firstly, LVIS stent was implanted in the left vertebral artery on the level of the dissection lesion. Then, the aneurysm of the left vertebral artery was embolized by detachable coils. Balloon angioplasty was performed in the stented segment with the compliance balloon-catheter Scepter. On the series of angiograms: the aneurysm is totally excluded, the stenosis of the artery is eliminated. After 1 month, the second stage of endovascular treatment in the same volume in the right vertebral artery was performed. At attempts of a hemostasis with the vascular closure device Аngioseal were unsuccessful in both operations. Hemostasis was successfully performed by manual compression of the puncture site. A mutation in the gene COL3A1, responsible for the synthesis of procollagen III type, was confirmed by Ehlers–Danlos syndrome of type 4 (vascular type) at the subsequent genotyping of the patient. The patient's neurological symptoms regressed to a great extent.&#x0D; Endovascular methods can be effective in the treatment of vertebral arteries dissection lesions in patients with vascular type of Ehlers–Danlos syndrome.

Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results

Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness...