MicroNester coils as an adjunct to endovascular embolization.
OBJECTIVE
In June 2003, detachable balloons were removed from the US market and were supplanted with coil embolization for parent artery sacrifice in difficult or nonsurgical aneurysms and other vascular pathologies. The current series examines the use of MicroNester pushable coils (Cook Medical, Bloomington, IN) as a low-cost and effective adjunct to detachable coils in the treatment of selected neurovascular pathologies.


METHODS
A retrospective analysis of all patients undergoing neurointerventional procedures from November 2003 through May 2008 was performed to identify patients in whom MicroNester coils were used as part of treatment. Analysis of coil type and number as well as pathology was performed.


RESULTS
MicroNesters were used in 26 cases, of which 21 were for arterial sacrifice--19 for the internal carotid artery and 2 for the vertebral artery. Fourteen were performed for intracranial aneurysms, 3 for pseudoaneurysms, 2 for carotid cavernous fistulae, 1 for a carotid blowout, and 1 for an arteriovenous malformation. Five additional procedures were transvenous, for treatment of dural arterial venous fistulae. The mean number of coils for artery sacrifice was 13, with an average of 10 MicroNesters. For transvenous embolizations, the means were 30 and 6, respectively.


CONCLUSIONS
MicroNesters are not the coil of choice for most neurointerventional procedures because they are not retrievable. However, when parent artery sacrifice or transvenous occlusion of dural arteriovenous fistulas is the goal, MicroNesters are a relatively inexpensive and equally effective alternative to more expensive, detachable coils and can reduce the procedural costs by $3600 to $6000 for the current series.
Daugherty
Wilson P
WP
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. daugherty.wilson@mayo.edu
Kallmes
David F
DF
Cloft
Harry J
HJ
Lanzino
Giuseppe L
GL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002648:Child; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019736:Prostheses and Implants / Q000191:economics / Q000592:standards; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D055815:Young Adult