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L N Hopkins - One of the best experts on this subject based on the ideXlab platform.
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intracranial stent placement to trap an extruded Coil during endovascular aneurysm treatment technical note
Neurosurgery, 2000Co-Authors: Richard D Fessler, Adnan I. Qureshi, Andrew J Ringer, Lee R Guterman, L N HopkinsAbstract:OBJECTIVE:The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi Detachable Coil (GDC) during treatment of an internal carotid artery (ICA) ca
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delayed aneurysm regrowth and recanalization after Guglielmi Detachable Coil treatment case report
Journal of Neurosurgery, 1998Co-Authors: Robert A Mericle, Lee R Guterman, Ajay K Wakhloo, Demetrius K Lopes, G Lanzino, L N HopkinsAbstract:Guglielmi Detachable Coil (GDC) treatment for complicated cerebral aneurysms is an attractive option that has become widely accepted in recent years. This technique is usually considered only if the patient harbors an aneurysm that is not a good candidate for surgical clipping. However, the definition of "surgical candidate" varies among institutions, and many patients worldwide are being treated with GDCs as primary therapy. Although most centers currently perform follow-up angiography at 6 months to 1 year, others do not routinely perform it after an initially good result. The authors present a case that indicates longer follow up may be necessary and illustrates some of the pitfalls of GDC treatment. This 56-year-old man presented to the emergency room with a Hunt and Hess Grade II subarachnoid hemorrhage and was found to have a wide-necked basilar apex aneurysm. Because of associated medical comorbidities, it was decided to treat the aneurysm with endovascular techniques. The patient did well on follow-up angiography at 1 year postprocedure. However, at approximately 2 years follow up, the aneurysm was demonstrated to have dramatically recanalized and regrown, requiring open surgical intervention. Endovascular Coiling was insufficient to treat this aneurysm and complicated definitive surgical management because a large Coil mass had been placed in the operative field. It can be inferred from this case that angiographic follow up of these types of lesions may be beneficial up to 2 years after GDC treatment.
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retrieval of a Guglielmi Detachable Coil after unraveling and fracture case report and experimental results
Neurosurgery, 1994Co-Authors: Scott C Standard, Lee R Guterman, T D Chavis, Ajay K Wakhloo, Arvind Ahuja, L N HopkinsAbstract:Unraveling and fracture of electrolytically Detachable Coils (Guglielmi Detachable Coils) may occur during treatment of intracerebral aneurysms. Retrieval of the detached Coil is difficult using existing snare technology, and the intraluminal Coil may cause parent vessel thrombosis or distal embolization. We report a case of unraveling and fracture of a Guglielmi Detachable Coil that was successfully retrieved using a dual guidewire technique. The technique was evaluated in an in vitro model using 10 Coils of varying sizes and diameters, and allowed successful Coil retrieval in all trials.
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Retrieval of a Guglielmi Detachable Coil after unraveling and fracture: case report and experimental results.
Neurosurgery, 1994Co-Authors: Scott C Standard, Lee R Guterman, T D Chavis, Ajay K Wakhloo, Arvind Ahuja, L N HopkinsAbstract:ABSTRACTUNRAVELING AND FRACTURE of electrolytically Detachable Coils (Guglielmi Detachable Coils) may occur during treatment of intracerebral aneurysms. Retrieval of the detached Coil is difficult using existing snare technology, and the intraluminal Coil may cause parent vessel thrombosis or distal
R T Higashida - One of the best experts on this subject based on the ideXlab platform.
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Guglielmi Detachable Coil Extraction: Suction Generated by Pusher-Wire Withdrawal after Coil Detachment within an Intracranial Aneurysm
AJNR. American journal of neuroradiology, 2003Co-Authors: Van V. Halbach, C F Dowd, Louis P. Caragine, R T HigashidaAbstract:We present a case of Guglielmi Detachable Coil extraction into a microcatheter after Coil detachment during embolization of a superior hypophyseal artery aneurysm; extraction was a result of the suction generated during pusher-wire withdrawal. Experimental simulations using many Coil and microcatheter combinations were used to identify factors that contribute to the likelihood of this phenomenon.
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Treatment of an intracranial aneurysm using a new three-dimensional-shape Guglielmi Detachable Coil: technical case report.
Neurosurgery, 1999Co-Authors: A M Malek, R T Higashida, C C Phatouros, C F Dowd, Van V. HalbachAbstract:OBJECTIVE AND IMPORTANCE: Coil embolization of wide-necked aneurysms is currently difficult, when using a conventional endovascular approach without resorting to complex adjunctive techniques. CLINICAL PRESENTATION: A 41-year-old woman with a history of systemic lupus erythematosus and hypertension refractory to treatment presented with an unruptured right ophthalmic segment aneurysm of the internal carotid artery having an unfavorable neck-to-fundus ratio. INTERVENTION: A new type of Guglielmi Detachable Coil (Target Therapeutics, Fremont, CA), consisting of a series of omega loops, spontaneously forms a three-dimensional cage after deployment and was used to successfully treat the aneurysm, which was angiographically stable at the 3-month follow-up. CONCLUSION: The new Guglielmi Detachable Coil may be useful in the embolization of aneurysms having an unfavorable geometry, which would otherwise not be amenable to endovascular treatment without adjunctive techniques.
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Treatment of an intracranial aneurysm using a new three-dimensional-shape Guglielmi Detachable Coil: technical case report.
Neurosurgery, 1999Co-Authors: A M Malek, R T Higashida, C C Phatouros, C F Dowd, V V HalbachAbstract:Coil embolization of wide-necked aneurysms is currently difficult, when using a conventional endovascular approach without resorting to complex adjunctive techniques. A 41-year-old woman with a history of systemic lupus erythematosus and hypertension refractory to treatment presented with an unruptured right ophthalmic segment aneurysm of the internal carotid artery having an unfavorable neck-to-fundus ratio. A new type of Guglielmi Detachable Coil (Target Therapeutics, Fremont, CA), consisting of a series of omega loops, spontaneously forms a three-dimensional cage after deployment and was used to successfully treat the aneurysm, which was angiographically stable at the 3-month follow-up. The new Guglielmi Detachable Coil may be useful in the embolization of aneurysms having an unfavorable geometry, which would otherwise not be amenable to endovascular treatment without adjunctive techniques.
Fernando Viñuela - One of the best experts on this subject based on the ideXlab platform.
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Guglielmi Detachable Coil embolization of acute intracranial aneurysm perioperative anatomical and clinical outcome in 403 patients
Journal of Neurosurgery, 2008Co-Authors: Fernando Viñuela, Gary Duckwiler, Michel E MawadAbstract:From December 1990 to July 1995, the investigators participated in a prospective clinical study to evaluate the safety of the Guglielmi Detachable Coil (GDC) system for the treatment of aneurysms. This report summarizes the perioperative results from eight initial interventional neuroradiology centers in the United States. The report focuses on 403 patients who presented with acute subarachnoid hemorrhage from a ruptured intracranial aneurysm. These patients were treated within 15 days of the primary intracranial hemorrhage and were followed until they were discharged from the hospital or died. Seventy percent of the patients were female and 30% were male. The patients' mean age was 58 years old. Aneurysm size was categorized as small (60.8%), large (34.7%), and giant (4.5%); and neck size was categorized as small (53.6%), wide (36.2%), fusiform (6%), and undetermined (4.2%). Fifty-seven percent of the aneurysms were located in the posterior circulation and 43% in the anterior circulation. Eighty-two patients were classified as Hunt and Hess Grade I (20.3%), 105 Grade II (26.1%), 121 Grade III (30%), 69 Grade IV (17.1%), and 26 Grade V (6.5%). All patients in this study were excluded from surgical treatment either because of anticipated surgical difficulty (69.2%), attempted and failed surgery (12.7%), the patient's poor neurological (12.2%) or medical (4.7%) status, and/or refusal of surgery (1.2%). The GDC embolization was performed within 48 hours of primary hemorrhage in 147 patients (36.5%), within 3 to 6 days in 156 patients (38.7%), 7 to 10 days in 71 patients (17.6%), and 11 to 15 days in 29 patients (7.2%). Complete aneurysm occlusion was observed in 70.8% of small aneurysms with a small neck, 35% of large aneurysms, and 50% of giant aneurysms. A small neck remnant was observed in 21.4% of small aneurysms with a small neck, 57.1% of large aneurysms, and 50% of giant aneurysms. Technical complications included aneurysm perforation (2.7%), unintentional parent artery occlusion (3%), and untoward cerebral embolization (2.48%). There was a 8.9% immediate morbidity rate related to the GDC technique. Seven deaths were related to technical complications (1.74%) and 18 (4.47%) to the severity of the primary hemorrhage. The findings of this study demonstrate the safety of the GDC system for the treatment of ruptured intracranial aneurysms in anterior and posterior circulations. The authors believe additional randomized studies will further identify the role of this technique in the management of acutely ruptured incranial aneurysms.
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the Guglielmi Detachable Coil crescent in the endovascular treatment of peripheral brain aneurysms technical case report
Neurosurgery, 2007Co-Authors: Guido Guglielmi, Fernando Viñuela, Giulio Guidetti, Mauro DazziAbstract:OBJECTIVE: Peripheral brain aneurysms arise from the distal segments of cerebral arteries. They can be treated by surgery or by an endovascular approach. We present our experience of endovascular treatment of peripheral brain aneurysms with a novel endovascular device, the Guglielmi Detachable Coil (GDC) "crescent." METHODS: The GDC "crescent" is a 5-mm long, curved Coil steerable beyond the tip of a microcatheter and Detachable at a distance. The GDC "crescent" was used in three cases of intracranial peripheral aneurysms to occlude their parent vessel. RESULTS: Three peripheral brain aneurysms in three patients were successfully treated with parent vessel occlusion using the prototype GDC "crescent" Coils, thereby excluding the aneurysms from the brain circulation. No complications were encountered. CONCLUSION: From this limited experience, the GDC "crescent" seems particularly suitable for the controlled endovascular occlusion of the often-narrow parent artery of distal brain aneurysms.
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Guglielmi Detachable Coil embolization of cerebral aneurysms: 11 years' experience
Journal of neurosurgery, 2003Co-Authors: Yuichi Murayama, Gary Duckwiler, Yih Lin Nien, Y. Pierre Gobin, Reza Jahan, John G. Frazee, Neil A. Martin, Fernando ViñuelaAbstract:Object. The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes. Methods. Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms. Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50....
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cellular responses of bioabsorbable polymeric material and Guglielmi Detachable Coil in experimental aneurysms
Stroke, 2002Co-Authors: Yuichi Murayama, Fernando Viñuela, Satoshi Tateshima, Nestor R Gonzalez, Joon K Song, Haleh Mahdavieh, Luisa IruelaarispeAbstract:Background and Purpose— Acceleration of healing mechanisms is a promising approach to improve current limitations of endovascular aneurysm therapy with the use of platinum Coils. We evaluated a new endovascular therapeutic, bioabsorbable polymeric material (BPM), which may promote cellular reaction in the aneurysms. Methods— Four different concentrations of lactide/glycolic acid copolymer [poly(d-l-lactic-co-glycolic acid)] (PLGA), 85/15, 75/25, 65/35, and 50/50, were used as BPMs. Sixteen experimental aneurysms were created in 8 swine. Eight-millimeter-long spiral-shaped BPMs were surgically implanted in the aneurysms without tight packing (n=3 for each BPM). Guglielmi Detachable Coils (GDCs) were used as control (n=4). The animals were killed 14 days after embolization, and angiographic, histological, and immunohistochemical analyses were performed. Results— Despite loose packing of aneurysms with BPMs, faster BPMs such as 50/50 or 65/35 PLGA demonstrated more mature collagen formation and fibrosis in t...
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Embolization of incidental cerebral aneurysms by using the Guglielmi Detachable Coil system
Journal of neurosurgery, 1999Co-Authors: Yuichi Murayama, Gary Duckwiler, Fernando Viñuela, Y. Pierre Gobin, Guido GuglielmiAbstract:Object. Guglielmi Detachable Coil (GDC) technology is a valuable therapeutic alternative to the surgical treatment of ruptured or incidental intracranial aneurysms. The authors describe their technical and clinical experience in the use of the GDC technique in patients who underwent endovascular occlusion for the treatment of incidentally found intracranial aneurysms. Methods. One hundred fifteen patients with 120 incidentally found intracranial aneurysms underwent embolization by means of the GDC endovascular technique. Ninety-one patients were females and 24 were males. Patient age ranged from 13 to 80 years. In 64 patients the incidental aneurysms were discovered when unrelated nonneurological conditions signaled the need for angiography or magnetic resonance angiography (Group 1). Twenty patients who presented with incidental aneurysms that were discovered during treatment for an acutely ruptured aneurysm underwent treatment of both types of aneurysm during the acute phase of subarachnoid hemorrhage (...
Lee R Guterman - One of the best experts on this subject based on the ideXlab platform.
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intracranial stent placement to trap an extruded Coil during endovascular aneurysm treatment technical note
Neurosurgery, 2000Co-Authors: Richard D Fessler, Adnan I. Qureshi, Andrew J Ringer, Lee R Guterman, L N HopkinsAbstract:OBJECTIVE:The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi Detachable Coil (GDC) during treatment of an internal carotid artery (ICA) ca
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delayed aneurysm regrowth and recanalization after Guglielmi Detachable Coil treatment case report
Journal of Neurosurgery, 1998Co-Authors: Robert A Mericle, Lee R Guterman, Ajay K Wakhloo, Demetrius K Lopes, G Lanzino, L N HopkinsAbstract:Guglielmi Detachable Coil (GDC) treatment for complicated cerebral aneurysms is an attractive option that has become widely accepted in recent years. This technique is usually considered only if the patient harbors an aneurysm that is not a good candidate for surgical clipping. However, the definition of "surgical candidate" varies among institutions, and many patients worldwide are being treated with GDCs as primary therapy. Although most centers currently perform follow-up angiography at 6 months to 1 year, others do not routinely perform it after an initially good result. The authors present a case that indicates longer follow up may be necessary and illustrates some of the pitfalls of GDC treatment. This 56-year-old man presented to the emergency room with a Hunt and Hess Grade II subarachnoid hemorrhage and was found to have a wide-necked basilar apex aneurysm. Because of associated medical comorbidities, it was decided to treat the aneurysm with endovascular techniques. The patient did well on follow-up angiography at 1 year postprocedure. However, at approximately 2 years follow up, the aneurysm was demonstrated to have dramatically recanalized and regrown, requiring open surgical intervention. Endovascular Coiling was insufficient to treat this aneurysm and complicated definitive surgical management because a large Coil mass had been placed in the operative field. It can be inferred from this case that angiographic follow up of these types of lesions may be beneficial up to 2 years after GDC treatment.
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retrieval of a Guglielmi Detachable Coil after unraveling and fracture case report and experimental results
Neurosurgery, 1994Co-Authors: Scott C Standard, Lee R Guterman, T D Chavis, Ajay K Wakhloo, Arvind Ahuja, L N HopkinsAbstract:Unraveling and fracture of electrolytically Detachable Coils (Guglielmi Detachable Coils) may occur during treatment of intracerebral aneurysms. Retrieval of the detached Coil is difficult using existing snare technology, and the intraluminal Coil may cause parent vessel thrombosis or distal embolization. We report a case of unraveling and fracture of a Guglielmi Detachable Coil that was successfully retrieved using a dual guidewire technique. The technique was evaluated in an in vitro model using 10 Coils of varying sizes and diameters, and allowed successful Coil retrieval in all trials.
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Retrieval of a Guglielmi Detachable Coil after unraveling and fracture: case report and experimental results.
Neurosurgery, 1994Co-Authors: Scott C Standard, Lee R Guterman, T D Chavis, Ajay K Wakhloo, Arvind Ahuja, L N HopkinsAbstract:ABSTRACTUNRAVELING AND FRACTURE of electrolytically Detachable Coils (Guglielmi Detachable Coils) may occur during treatment of intracerebral aneurysms. Retrieval of the detached Coil is difficult using existing snare technology, and the intraluminal Coil may cause parent vessel thrombosis or distal
Jacques E. Dion - One of the best experts on this subject based on the ideXlab platform.
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J.E.: Use of threedimensional Guglielmi Detachable Coils in the treatment of wide-necked cerebral aneurysms
2014Co-Authors: Harry J Cloft, Jonas H. Goldstein, Gregory J. Joseph, Frank C. Tong, Jacques E. DionAbstract:Summary: A three-dimensional Guglielmi Detachable Coil (3D-GDC) has been developed that is designed specifically to bridge the neck of an aneurysm with Coil loops, thereby facilitating retention of additional Coils placed within the aneurysm. Nine wide-necked cerebral aneurysms were suc-cessfully embolized using the 3D-GDC, provided that the dome-to-neck ratio was 1.5 or greater. A principal disadvantage of embolization of ce-rebral aneurysms with Guglielmi Detachable Coils (GDCs, Target Therapeutics/Boston Scientific Corp, Natick, MA) as compared with surgical clipping is that embolization does not work well for aneurysms that have a wide neck. Complete aneurysmal throm-bosis can be achieved in 85 % of aneurysms with a neck smaller than 4 mm, but in only 15 % of aneu
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Guglielmi Detachable Coil embolization for unruptured aneurysms in nonsurgical candidates a cost effectiveness exploration
American Journal of Neuroradiology, 1998Co-Authors: David F Kallmes, Michelle H Kallmes, Harry J Cloft, Jacques E. DionAbstract:PURPOSE: We calculated the incremental cost-utility ratio for Guglielmi Detachable Coil (GDC) embolization versus no therapy for unruptured intracranial aneurysms considered inappropriate for surgical clipping procedures. METHODS: Decision tree and Markov analyses that employ cohort simulation were applied to determine the incremental cost-utility ratio of GDC embolization versus no therapy for unruptured cerebral aneurysms. Clinical values required as input data were estimated from the literature for the following variables: relative frequencies of complete aneurysmal occlusion, partial aneurysmal occlusion, and attempted Coiling (no Coils detached); morbidity and mortality of GDC embolization; frequency, morbidity, and mortality of spontaneous aneurysmal rupture in untreated and GDC-embolized aneurysms; annual rate of recanalization of GDCembolized aneurysms; quality of life when knowingly living with untreated or GDG-embolized aneurysms and of living with fixed neurologic deficit; costs of GDC embolization, spontaneous aneurysmal rupture, stroke, and rehabilitation; and discount rate. Cost-utility ratios below $50 000 per quality-adjusted life year saved were considered acceptable. Sensitivity analyses were performed for all relevant input variables. RESULTS: Baseline input values resulted in acceptable cost-utility ratios for GDC embolization of unruptured intracranial aneurysms. These ratios remained within acceptable limits across wide ranges of various input parameters. Cost-effectiveness was markedly affected by the natural course of unruptured, untreated aneurysms; rates of spontaneous rupture greater than 2% per year resulted in favorable cost-utility ratios that were relatively unaffected by variation in GDC efficacy, while rates of rupture less than 1% per year resulted in unfavorable ratios that were highly dependent on GDC efficacy. Many of the GDC efficacy indexes, such as rate of failed Coiling, early recanalization, and progressive aneurysmal thrombosis, have mild effects on the cost-utility ratios. GDC complication rate as well as life expectancy had moderate effects on the analysis. The influence of late aneurysmal recanalization was mild unless high rates of rupture for partially Coiled aneurysms were applied. Suboptimal clip placement resulting from the presence of GDC Coils within a ruptured aneurysm had no demonstrable consequence on cost-utility ratios. CONCLUSIONS: The single most influential variable determining the cost-effectiveness of GDC embolization in our analysis was the natural course of untreated aneurysms. Other important variables included GDC-related morbidity and life expectancy at the time of GDC embolization.
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The Guglielmi Detachable Coil in the treatment of arteriovenous fistulae.
Interventional neuroradiology : journal of peritherapeutic neuroradiology surgical procedures and related neurosciences, 1996Co-Authors: Avery J Evans, Mary E. Jensen, J M Mathis, Jacques E. DionAbstract:SUMMARY This report describes the use of the Guglielmi Detachable Coil (GDC) (Target Therapeutics, Fremont CA) in the treatment of cervicocerebral arteriovenous fistulae. From March, 1993 to May 1995 we used GDCs in an 1RB approved protocol as part of the endovascular treatment of 11 patients with arteriovenous fistulae of internal carotid, external carotid, or vertebral vessels. The patient population included four patients with dural arteriovenous fistulae, three patients with direct carotid cavernous fistulae, three patients with vein of Galen malformations, and one patient with a vertebral artery - vertebral vein fistula. In six of the 11 patients the AVF were completely occluded. Fistula occlusion occurred in two patients immediately, in three patients in a delayed fashion (three days to nine months) and in one patient the fistula was closed immediately, reopened spontaneously, and then reoccluded at a second procedure 17 months later. In five patients the fistula was incompletely occluded (20-95%). In all cases but one the Coils were used in conjunction with another embolic agent. In this small series of patients we found that GDCs generally could be deposited predictably at the desired site, and that they could be observed prior to detachment to help ensure that the Coil was in a secure position, decreasing the chances ofunintended passage into the venous outlet. Although they rarely proved thrombogenic enough to stop the fistula, GDCs can slow the flow in a fistula, allowing other, more thrombogenic embolic agents to be deposited with a decreased risk of distal embolisation. In conclusion, we found GDCs to be a useful tool in the treatment of AV fistulae. In combination with other embolic agents, this device can aid in the safe, effective closure of these lesions.