Matters to be Attended to in Intra-Aneurysmal GDC Embolization for Aneurysms with no Hemorrhage or Hemorrhage in Chronic Stage.
Sixty-two aneurysms with no hemorrhage or hemorrhage in chronic stage were treated by intraaneurysmal GDC embolization in 69 sessions. The embolizations were performed under local anesthesia, systemic heparinization, 6F introducing catheter and double-markered microcatheter. Systemic heparinization was performed during the procedure and continued 48 hours afterwards except for the first 4 sessions in which only during the procedure. Activating clotting time (ACT) was maintained 2 to 2.5 times as long as base line value. Angiographic results were complete in 30, neck remnant in 27, and body filling in 12. Symptomatic embolism distal to the aneurysm were observed in two cases out of the first 4 cases without post-embolization heparinization. In the last 65 sessions, persistent symptomatic complications were observed in 4 patients, parent artery occlusion in 1 and embolism distal to the aneurysm in 3. Asymptomatic or transient complication was observed in 7 cases (parent artery occlusion or stenosis). Complications related to systemic heparinization were observed in 5 cases. Difficulty of complete neck closure and recanalization of aneurysmal cavity mainly due to coil compaction are two main problems on GDC embolization. To avoid these two problems, it is be extremely important for GDC embolization to embolize the aneurysmal cavity as tightly as possible. On the other hand, the more tightly the aneurysmal cavity is embolized, the more frequently thromboembolic complications occur. Thus, systemic heparinization after the embolization is essential. However, one should been in mind that systemic heparinization itself carries a potential risk of hemorrhage. To overcome this dilemma, we use a special device for immediate and complete closure of the puncture site of the introducing sheath.
Ezura
M
M
Division of Intravascular Neurosurgery, Department of Neurosurgery, Kohnan Hospital; Sendai, Japan.
Takahashi
A
A
Yoshida
M
M
Takahashi
N
N
Nishimura
S
S
Yoshimoto
T
T