Gas generation and clot formation during electrolytic detachment of Guglielmi detachable coils: in vitro observations and animal experiment.
OBJECTIVE
Recent reports describe a high rate of thromboembolic events related to Guglielmi detachable coil (GDC) use in the treatment of cerebral aneurysms. The purpose of this study was to investigate electrolysis-related changes of blood as a potential cause of thromboembolic complications associated with GDC use.


METHODS
For in vitro observations, 15 GDCs (10 conventional coils and five insulated coils) were experimentally detached under microscopic observation. Three coils were detached in normal saline, five in human serum, and seven in heparinized human blood. For animal experiments, two coils were detached in two canine normal common carotid arteries with systemic heparinization. Immediately after detachment, the arteries were exposed, and clot formations were observed.


RESULTS
Significant amounts of gas bubbles were observed in all in vitro observations; more were seen in conventional coils, which required longer detachment times, than in insulated coils. Gas generation started with the growth of tiny bubbles into larger ones. In insulated coils, gas was generated only at the detachment zone, and no difference between saline, serum, and blood environments was observed. During detachment within heparinized blood, clot formations of 2-3-mm diameter were observed at the detachment zones of insulated coils. Animal experiments showed clot formation at the detachment zone, and bubble entrapments around the clots were also found.


CONCLUSIONS
The electrolytic detachment mechanism of the platinum coil can generate gas bubbles during the application of electric current. In association with electrothrombosis, this phenomenon may be a potential cause of thromboembolic complications during the treatment of cerebral aneurysms by use of GDCs.
Han
Moon Hee
MH
Department of Radiology, Seoul National University College of Medicine, Korea.
Kwon
O-Ki
OK
Yoon
Chang Jin
CJ
Kwon
Bae Joo
BJ
Cha
Sang Hoon
SH
Chang
Kee-Hyun
KH
D000818:Animals; D001769:Blood; D002339:Carotid Arteries / Q000473:pathology; D004285:Dogs; D004572:Electrolysis / Q000009:adverse effects*; D004618:Embolism, Air / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D066298:In Vitro Techniques; D020766:Intracranial Embolism / Q000209:etiology*; D018570:Risk Assessment; D012965:Sodium Chloride
D012965:Sodium Chloride