title: Thromboembolic events associated with Guglielmi detachable coil embolization with use of diffusion-weighted MR imaging. Part II. Detection of the microemboli proximal to cerebral aneurysm.
abstract: OBJECTIVE
  The purpose of this study was to document the incidence and radiologic appearance of thromboembolic events during Guglielmi detachable coil (GDC) embolization for asymptomatic basilar artery (BA) bifurcation and BA-superior cerebellar artery (SCA) aneurysms by using diffusion-weighted (DW) MR imaging, with special emphasis on the evidence of thromboembolic events in vascular territories proximal from the treated aneurysm, which cause cerebellar infarction, and to discuss which step of the procedure (aneurysm or catheter manipulation) may play a role for most thromboembolic events.
  
  
  METHODS
  Since 1999, 38 asymptomatic BA bifurcation and BA-SCA aneurysms were treated with GDCs at the National Cardiovascular Center. DW studies were performed for 26 patients between 2 and 5 days after GDC embolizations. All DW images were reviewed by two radiologists for depiction of abnormalities. These findings were retrospectively evaluated with clinical and technical factors of thromboembolic events.
  
  
  RESULTS
  DW images showed new hyperintense lesions in 18 patients (69%), with seven (27%) incurring neurologic deteriorations. All symptomatic patients fully recovered by discharge. Fourteen (78%) of 18 patients showed new lesions proximal to the treated aneurysm; that is, in the cerebellar hemispheres. In three cases treated with the balloon-assisted technique, new hyperintense lesions were seen.
  
  
  CONCLUSIONS
  In our experience, most thromboembolic events related to the use of the GDC embolization may be caused by catheter manipulation, especially in the case of the balloon-assisted technique. Caution should be exercised in the handling of catheters. Furthermore, a softer and smaller caliber catheter and simple GDC technique should be considered.
authors: Department of Neurosurgery, National Cardiovascular Center, Osaka, Japan.
authors: Akio
authors: A
authors: Soeda
authors: Nobuyuki
authors: N
authors: Sakai
authors: Kenichi
authors: K
authors: Murao
authors: Hideki
authors: H
authors: Sakai
authors: Koji
authors: K
authors: Ihara
authors: Naoaki
authors: N
authors: Yamada
authors: Satoshi
authors: S
authors: Imakita
authors: Izumi
authors: I
authors: Nagata
mesh_terms: D000328:Adult; D000368:Aged; D001488:Basilar Artery; D002531:Cerebellum / Q000098:blood supply; D038524:Diffusion Magnetic Resonance Imaging; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000628:therapy*; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013923:Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*