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Histopathologic Evaluation of Aneurysms Treated with Guglielmi Detachable Coils or Matrix Detachable Microcoils

I. Szikoraa, P. Seifertb, Z. Hanzelya, Z. Kulcsara, Z. Berenteia, M. Marosfoia, S. Czirjaka, J. Vajdaa and I. Nyarya

a National Institute of Neurosurgery, Budapest, Hungary
b Boston Scientific Neurovascular, Fremont, Calif


Figure 1
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  		Fig 1. Ruptured aneurysm of the PComA removed 2 months after treatment with GDCs (case 10, Tables 1 and 2).

A, Digital subtraction angiography (DSA) before treatment demonstrates PComA aneurysm.

B, DSA immediately following treatment demonstrates minimal neck remnant.

C, Gross pathology, demonstrating free coils covered by an incomplete fibrin layer (arrow).

D, Microscopic section (H&E stain, low-power magnification, 2x) demonstrates unorganized thrombus in the aneurysm sac (arrow) and exposed coils within the neck (open arrow).


Figure 2
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  		Fig 2. Ruptured aneurysm of the MCA removed surgically 3 years after treatment with GDCs (case 9, Tables 1 and 2).

A, DSA before treatment.

B, DSA immediately following treatment with standard GDCs, demonstrating neck remnant (broken arrow).

C, DSA 3 years after treatment demonstrates aneurysm recanalization (broken arrow).

D, Gross pathology demonstrating partially exposed coils within the neck (arrow) and coils protruding through the thin wall of the aneurysm dome.

E, Histologic section (H&E stain, low-power magnification, 2x) of the same specimen. Most of the aneurysm sac is filled with organized thrombus, but a large empty space is also seen (arrow).

F, Higher power magnification (20x) demonstrates attenuated fibrocellular tissue (arrow), an empty space (open arrow), and residual unorganized thrombus (broken arrow) within the same aneurysm.


Figure 3
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  		Fig 3. Ruptured aneurysm of the AComA, treated with Matrix coils and removed during surgery 6 months later (case 18, Tables 1 and 2).

A, DSA before treatment demonstrates ruptured AComA aneurysm (arrow) and a small incidental aneurysm at the pericallosal artery (open arrow).

B, DSA immediately after treatment demonstrating a small neck remnant (arrow).

C, DSA, 6 months later, demonstrates growing neck remnant (arrow). Two incidental aneurysms (one on the left MCA and the other on the left pericallosal artery) were clipped, and the AComA aneurysm was clipped and removed during surgery.

D, Gross pathology of the surgical specimen. The coils within the neck (arrow) are covered by a thick tissue layer. The wall of the aneurysm is very thin.

E, Microscopic section of the specimen (H&E stain, low magnification, 2x). The aneurysm cavity is filled with fibrocellular tissue without any residual blood clot or empty spaces.

F, Higher magnification (10x) H&E stain demonstrates coils embedded in fibrocellular granulation tissue with multiple neocapillaries (arrowheads).

G, Higher power view (20x) demonstrates collagen deposition (arrow), smooth muscle cells (broken arrow), and small blood vessels (arrowheads).

H, Leukocyte invasion (arrow) represents granulation tissue (20x, H&E stain).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X