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Packing efficacy of hydrocoil embolic system: in vitro study using ruptured aneurysm model

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Abstract

After endovascular coil embolization of cerebral aneurysms, coil compaction and late aneurysm recanalization have been ever observed. The HydroCoil Embolic System (HES) was developed to improve the packing efficacy of endovascular treatment of cerebral aneurysms. In this study, we evaluate the packing efficacy of HES using a silicone model of ruptured cerebral aneurysm. This silicone model was connected to a pulsatile flow pump and embolized with the initial framing coils followed by hydro coils (n = 3) or bare platinum coils (n = 3). The coils used in the two groups were identical to each other in size and length. In the hydro coil group, continuous outflow from ruptured aneurysm ceased in two out of three cases. On the other hand, in the bare platinum coil group, outflow from the ruptured point slightly decreased but did not stop in all cases. The hydro coil could result in a higher initial occlusion rate of silicone model. In addition, expanded hydrogel possibly sealed the ruptured point directly. Changes in the size of aneurysms were not detected, from which the risk of over-expansion seemed extremely low. The hydro Coil is a safe and feasible device for improving the packing efficacy in endovascular coil embolization.

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Acknowledgements

This study was supported by CATHEX Co., Ltd. (Sagamihara city, Kanagawa, Japan).

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Authors and Affiliations

  1. Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Kyoichi Watanabe, Kenji Sugiu, Koji Tokunaga, Wataru Sasahara, Shigeki Ono & Isao Date

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  1. Kyoichi Watanabe
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  2. Kenji Sugiu
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  3. Koji Tokunaga
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  4. Wataru Sasahara
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  5. Shigeki Ono
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  6. Isao Date
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Corresponding author

Correspondence to Kenji Sugiu.

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Comments

Uwe Spetzger, Karlsruhe, Germany

The authors performed a comprehensive experimental study aimed at the importance of packing density of endovascular coil occlusion of ruptured aneurysms. An established silicon side-wall aneurysm model with an aneurysm size of 10 mm and with an aneurysm neck of 6 mm was used. Aneurysm rupture was performed by puncture with a small needle, creating a rupture of less than 1 mm at the aneurysm dome. A pulsatile flow pump with purified water and a mean pressure of 130/80 mmHg was established to mimic the human circulatory conditions. The three aneurysms were occluded with bare platinum coils and hydro coils, respectively. By increase in size due to swelling of their surface, hydro coils demonstrated a higher packing density than platinum coils, which resulted in a reduction or even stop of outflow of water at the rupture site at the silicon aneurysm model. Several further investigations confirmed that a packing density of more than 40% is technically impossible; however, to reach an occlusion, a complete filling of the aneurysm is not necessary [1, 2]. This study nicely demonstrates the decisive hemodynamic effect of endovascular aneurysm occlusion. The network of the coils cause a massive reduction of the inflow into the aneurysm and markedly slow down the blood flow within the aneurysm [3]. When the coil packing density reached a value of approximately 30%, the flow velocity inside the aneurysm got close to zero and finally the intraaneurysmal blood flow stopped. Then fibrous organization of the initial thrombus led to stabilization of the tissue between the coil loops [1, 3]. A limitation of the study is that the flow pattern in side-wall aneurysm is not the usual human situation; here it would be of great interest to re-evaluate these experimental results in a bifurcation aneurysm model. However, more problematic was the experimental setup using purified water instead of blood. In addition, the problems of covered coils should be mentioned. Surface covering causes a more difficult handling of the coils, the friction inside of the catheter is higher and the coils could not be easily replaced. After contact with blood, the hydro coil could not be retrieved adequately into the micro-catheter even after a few minutes. Generally, it is difficult to extrapolate the experimental findings to human aneurysms, although the results of this study largely reflect our various clinical experiences with recanalization and coil compaction of endovascular obliteration of aneurysms. This interesting article adds an important part of the arising and complex mosaic, demonstrating the still existing problems and shortcomings of incomplete endovascular occlusion of cerebral aneurysms.

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Watanabe, K., Sugiu, K., Tokunaga, K. et al. Packing efficacy of hydrocoil embolic system: in vitro study using ruptured aneurysm model. Neurosurg Rev 30, 127–130 (2007). https://doi.org/10.1007/s10143-007-0066-8

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  • DOI: https://doi.org/10.1007/s10143-007-0066-8

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