Endovascular occlusion of experimental aneurysms with detachable coils: influence of packing density and perioperative anticoagulation.
OBJECTIVE
This study was designed to assess the intraluminal biological changes after endovascular coil occlusion of arterial aneurysms with detachable coils, to analyze the relationship between histological occlusion and mechanical packing density, and to evaluate the influence of perioperative anticoagulation on the occlusion rate.


METHODS
In rabbits, 30 microsurgically produced arterial bifurcation aneurysms were occluded with coils (18 with platinum coils, electrically detached; 12 with tungsten coils, mechanically detached). Coils were placed until no further coils fit into the aneurysmal lumen and it was no longer filled with radiographic contrast material. The individual degree of occlusion was then determined by the "packing density" on the angiograms. Complete occlusion was considered only if no neck remnant was visible on the films. Anticoagulation during and 2 days after the treatment was performed in 11 cases. After an observation period ranging from 3 to 6 months, angiographic and histological analyses were performed to obtain control data.


RESULTS
Complete occlusion was achieved in 9 cases, subtotal occlusion (i.e., > 95% occlusion, residual filling at the neck of the aneurysm) in 10 cases, and partial occlusion in 11 cases. Angiographically documented recanalization was detected in 14 aneurysms. In the remaining 16 aneurysms, the initially documented angiographic results were unchanged. A discrepancy between angiographic and pathological findings was frequently observed. Five of nine angiographically completely occluded aneurysms were recanalized. Endothelial-like tissue at the orifice of the aneurysm was able to be observed in only four of the nine initially completely occluded aneurysms.


CONCLUSIONS
The results suggest that even dense packing does not always guarantee permanent occlusion, although there was a positive relationship between packing density and occlusion rate. Anticoagulation did not have any negative effect on the results.
Reul
J
J
Department of Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochshule Aachen, Germany.
Spetzger
U
U
Weis
J
J
Sure
U
U
Gilsbach
J M
JM
Thron
A
A
D000818:Animals; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D004730:Endothelium, Vascular / Q000473:pathology / Q000648:ultrastructure; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008854:Microscopy, Electron; D008855:Microscopy, Electron, Scanning; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D011817:Rabbits