Interventional occlusion of congenital vascular malformations with the detachable Cook coil system

Nonsurgical closure of pathologic vascular communications can be achieved by coil embolization. Different systems used in patients with congenital heart disease (e.g., patent ductus arteriosus) allow controlled release of the devices. However, they are too stiff for coil occlusion of small or tortuous vessels.

The new detachable Cook coil system combines flexibility with a simple release control mechanism. Five children, age 8 days to 10 years, underwent heart catheterization for interventional occlusion of different vascular malformations (two coronary artery fistulas, two aortopulmonary collaterals, and one hemangioma). The diameter of the vessels varied between 1.8 mm and 3.6 mm and the length between 10 mm and 22 mm.

Up to four 0.018" soft spiral coils were placed as distally as possible in the feeding vessels. In addition, in two patients, one to three J-shaped coils were placed inside and proximal to spiral coils. Positioning of the coils was controlled easily by radio-opaque markers. Counter-clockwise rotation of the delivery wire provided fast and safe detachment without movement of the detached coils. Control angiograms showed complete occlusion of the vessels within 10 minutes after delivery of coils.

Interventional closure of vascular malformations can be successfully obtained with the detachable Cook coil system. This system offers safe and controlled placement of coils, and it works rapidly in an uncomplicated manner.