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Mechanism underlying the prevention of aneurismal rupture by coil embolization
Junji Ueno1, Takashi Matsuo, Ken Sugiyama
1Department of Neurosurgery, Funabashi Municipal Medical Center, Chiba, Japan. j-ueno@ka2.so-net.ne.jp
Object:
Endovascular treatment with Guglielmi detachable coil has been developed as a less invasive treatment for cerebral aneurysm. The aim of this study is to clarify the mechanism of the preventive effect of coil embolization.
Method:
Two aneurysm models were employed. One was a T-shaped bifurcation tube with a spherical dome made of glass, which was used for the measurement of pressure and visualization of flow pattern. The other model was a T-shaped glass tube with a spherical elastic silicone dome, which was used for the measurement of aneurismal wall displacement due to pulsation of flow.
Result:
1, Guglielmi detachable coil caused no change in intra-aneurismal fluid pressure. 2, Coil insertion obstructed and slowed intra-aneurismal flow. This flow stagnation in the aneurysm might promote thrombus formation. 3, With increase in numbers of coils anchored at the intra-aneurismal wall, the displacement of the wall was considerably depressed. This suggests that coil insertion decreases the stress on the aneurismal wall.
Conclusion:
1, Coil insertion depresses the pulsatile aneurysm wall movement, and diminishes the stress of the aneurysm wall. 2, Coil insertion obstructs intra-aneurismal flow and facilitates thrombus formation in the aneurysm. These two factors may operate synergistically to prevent aneurysm rupture.