Extracranial aneurysm and arteriovenous fistula: embolization with the Guglielmi detachable coil

Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study

A wide variety of coils are available for vascular embolization. This study aimed to evaluate the safety and efficacy of a new Prestige coil. We carried out retrospective analysis of a multicenter's registry data collected between February 2022 and November 2022. The choice of embolization agent used to treat peripheral vascular anomalies was left to the investigator's discretion. Patients for whom at least one Prestige coil was used were included in Series 1. All other patients were included in Series 2. Efficacy and safety were evaluated. Patients were followed up for one month. In total, 220 patients were included, 110 in each series. Patients included 149 men (67.7%) and 71 women (32.3%), with a median age of 62.5 years (IQR: 35.8-73). Patient ages were similar in the two series. Complete occlusion of the targeted vessel was reported in 96.4% (n = 106/110) of patients in Series 1 and in 99.7% (n = 109/110) in Series 2. Four patients experienced non-serious adverse events (1.8%, n = 4/220): one experienced back pain and one vomiting in Series 1; one patient had off-target embolization and one a puncture site hematoma in Series 2. Sixteen patients (7.2%, n = 16/220) were lost to follow up. Improvement in the patient's general state at one month was reported in 79.0% (n = 83/105) of patients in Series 1 and in 74.7% (n = 74/99) in Series 2. Ten deaths occurred, five in Series 1 (4.8%, n = 5/105) and five in Series 2 (5.1%, n = 5/99). These deaths all concerned critically ill patients embolized for emergent arterial bleeding. In conclusion, the 1-month follow-up showed that Prestige coils, alone or in combination, are efficient and safe.

Feasibility and Safety of n-Butyl Cyanoacrylate-Lipiodol-Iopamidol as an Alternative Liquid Embolic Material

PURPOSE

To evaluate the feasibility and safety of n-butyl cyanoacrylate (NBCA)-Lipiodol-Iopamidol (NLI) as a liquid embolic material.

MATERIALS AND METHODS

In vitro, the ratio of NLI components was adjusted and the configuration of the mixtures was assessed visually in saline. In vivo, 14 wide-necked aneurysms were created on the common carotid and external iliac arteries of four female swine. Under balloon occlusion, 12 aneurysms were embolized with NLI prepared at a NBCA-Lipidol-Iopamidol ratio of 2:3:1 (NLI231), and two were embolized with NBCA-Lipiodol (NL) prepared at a NBCA-Lipiodol ratio of 1:2 (NL12) as a trial group. We performed angiography to evaluate the effectiveness of embolization and adhesion of the embolic material to the balloons or microcatheters.

RESULTS

In vitro, NLI231 (33% NBCA) was considered to be the optimal ratio for aneurysm embolization based on its configuration and stability. In vivo, embolization using NLI231 was successful and no adhesion between the embolic material and the balloons or microcatheters was observed in all 12 aneurysms. Embolization with NL12 was impossible in the other two aneurysms due to leakage and adhesion of NL.

CONCLUSION

The configuration of NLI changed at each ratio. NLI231 is a feasible and safe liquid embolic material for balloon-assisted embolization of wide-necked aneurysms in swine.

Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography

BACKGROUND

There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA.

MATERIAL AND METHODS

Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The postembolization MDCT follow-up findings were analyzed retrospectively.

RESULTS

The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and postprocedural hypertension developed in two patients during the follow-up period.

CONCLUSION

The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension.

Experiência preliminar com o uso da técnica de "remodelagem de colo" para tratamento endovascular de aneurismas complexos da artéria renal

OBJETIVO: Relatar os resultados preliminares da aplicação da técnica de "remodelagem do colo" no tratamento dos aneurismas de colo largo da artéria renal. MATERIAIS E MÉTODOS: Cinco pacientes (três mulheres e dois homens, com idade média de 62 anos, intervalo de 49-72 anos) com aneurismas da artéria renal variando de 10 a 25 mm de diâmetro, de colo largo, foram tratados com técnicas de embolização assistidas por "remodelagem do colo" com balão durante o período de três anos. O microbalão era posicionado diante do colo do aneurisma e insuflado, temporariamente, durante a colocação das micromolas destacáveis no interior do aneurisma. RESULTADOS: O posicionamento do balão e a colocação das micromolas foram realizados com êxito em todos os casos. Oclusão completa do aneurisma, sem protrusão de micromolas ou obstrução do vaso parental, foi alcançada em todos os pacientes. CONCLUSÃO: Nossa experiência preliminar indica que a aplicação da técnica de "remodelagem do colo" no tratamento dos aneurismas de colo largo da artéria renal é tecnicamente viável e eficaz para o tratamento endovascular de aneurismas complexos da artéria renal, sem o sacrifício de qualquer ramo arterial.

Bioptome-assisted Coil Closure of Large Pulmonary Arteriovenous Malformations

Large pulmonary arteriovenous malformations (AVMs) with feeding vessels larger than 5 mm cause significant right-to-left shunt resulting in cyanosis and need to be occluded as soon as they are diagnosed. Occlusion of such AVMs by simultaneous delivery of multiple coils was attempted in five patients and was successful in completely occluding the AVM in four of them. One patient had transient chest pain during the procedure, presumably as a result of coronary air embolism. A bioptome was used to hold the multiple coils together for optimal deployment and controlled release of the coils.

New strategies in the percutaneous management of coronary artery fistulae: A case report

Coronary artery fistulae are rare anomalies often treated percutaneously. New techniques aiding in the percutaneous closure of a giant coronary artery, not previously described, are presented in a case report. These techniques include the use of intravascular ultrasound imaging and the use of electrolytically detachable platinum coils.

Endovascular closure of a large renal arteriovenous fistula

A case is described of a large renal arteriovenous fistula causing long-term cardiovascular complications. Successful percutaneous embolization was achieved using temporary occlusion balloons, Guglielmi detachable coils, regular nondetachable spring coils, and cyanacrylate. The advanced therapeutic tools we used can improve the prognosis of patients with large and complicated arteriovenous fistulas and prevent surgery.

Vein of Galen technique for occluding the aneurysmal sac of pulmonary arteriovenous malformations

In seven of 255 consecutive patients (2.7%) who underwent pulmonary arteriovenous malformation (PAVM) embolization at our center between July 1, 1996, and July 1, 2000, the feeding artery was considered too short for safe occlusion with use of standard stainless-steel coils or detachable balloons. These patients were successfully treated with use of a modified vein of Galen technique similar to the one used for managing intracranial vein of Galen aneurysms. In this article, the authors report their experience with this technique in safely occluding the aneurysmal sacs of PAVMs in patients with short (<2 cm) feeding pulmonary arteries.

2D Fast Spoiled Gradient Echo (2D-FSPGR) Gd-DTPA Enhanced Dynamic MR Angiography in Cerebral Aneurysms after Treatment with Platinum Detachable Coils

SUMMARY

The purpose of this study is to evaluate the perfusional state of cerebral aneurysms treated by platinum detachable coils using three different techniques of MR angiography (MRA), and to compare the results of each MRA technique. Thirty examinations were investigated in twelve patients. They were three men and nine women, and their average age was 67y.o. They were all treated by platinum detachable coils for cerebral aneurysms. We obtained three different types of MRA on the same day; 2D-FSPGR Gd-DTPA enhanced dynamic MRA, 3D-TOF MRA with and without Gd-DTPA enhancement. On 2D-FSPGR enhanced dynamic MRA, we used the first pass arterial phase for judgement that did not overlap the venous phase. In each study, we evaluated parent artery flow, branch artery flow, residual flow in coils, and residual neck. Digital subtraction angiography (DSA) was used as gold standard. On 3D-TOF MRA examinations without enhancement, parent artery flow was correctly identified with an accuracy of 96.7% with DSA confirmation. Branch artery flow was identified with an accuracy of 91.3%. Flow in the coils was correctly identified with an accuracy of 86.7%. Residual neck was correctly evaluated with an accuracy of 83.3%. On 3D-TOF MRA with enhancement, parent artery flow was correctly identified with an accuracy of 96.7%. Branch artery fLow was identified with an accuracy of 91.3%. Flow in the coils was correctly identified with an accuracy of 93.3%. Residual neck was correctLy identified with an accuracy of 86.7%. On 2D-FSPGR enhanced dynamic MRA, parent artery flow was correctLy identified with an accuracy of 100%. Branch artery flow was identified with an accuracy of 94.2%. Flow in the coils was correctly identified with an accuracy of 96.7%. Residual neck was correctly evaluated with an accuracy of 100%. Parent artery flow, branch artery flow, residual flow in coils, and residual necks were seen more accurately with 2D-FSPGR Gd-DTPA enhanced dynamic MRA than 3D-TOF MRA with and without enhancement. With T1 shortening effect of Gd-DTPA and first pass arterial phase of 2D-FSPGR enhanced dynamic MRA techniques, we could evaluate more accurately the perfusional status of platinum-coil-treated cerebral aneurysms and arteries adjacent to the aneurysms than with non enhanced or enhanced 3D-TOF MRA.

SCVIR annual meeting film panel session: diagnosis and discussion of case 2: Left hepatic arterioportal fistula

A 65-year-old man with cryptogenic cirrhosis initially underwent transjugular intrahepatic portosystemic shunt (TIPS) creation for variceal bleeding. For the following 16 months, variceal bleeding and intractable ascites persisted despite TIPS revision with variceal embolization. A surgical distal splenorenal shunt was then created, but, although there was initial improvement, intractable ascites recurred. At presentation at a different hospital, the patient gave a history of dyspnea on exertion and orthopnea. Physical examination demonstrated a distended abdomen, consistent with severe ascites, a large right pleural effusion, and bilateral peripheral edema.

Embolotherapy in the bronchial and pulmonary circulations

This two-part article first discusses the role of bronchial artery transcatheter embolotherapy in the management of patients with hemoptysis. Following this discussion, the authors review pulmonary arteriovenous malformations, their embolization, follow-up protocols, and outcome criteria as currently practiced at the authors' Vascular Malformation Center.

Percutaneous embolization of a high-flow pancreatic transplant arteriovenous fistula

Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.