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Post-mortem pathological examination of two patients after intraaneurysmal embolization using guglielmi detachable
T Nakahara1, S Sakamoto, O Hamasaki
1Department of Neurosurgery, Mazda Hospital, Hiroshima; Japan - tnakahar@iwa.att.ne.jp.
Insights
Histological analysis of aneurysms treated with Guglielmi detachable coils (GDC) revealed healing processes. One week post-treatment showed coils and thrombus, while one year showed organized fibrous tissue and endothelial lining.
Area of Science:
- Neurology
- Interventional Radiology
- Pathology
Background:
- Cerebral aneurysms pose significant risks.
- Guglielmi detachable coils (GDC) are a common endovascular treatment.
- Understanding the healing process post-GDC is crucial for assessing treatment efficacy.
Purpose of the Study:
- To describe the histological findings in cerebral aneurysms treated with GDC.
- To evaluate the healing progression at different time points after GDC embolization.
Main Methods:
- Autopsy examination of two patients treated with GDC for cerebral aneurysms.
- Histological analysis of aneurysm sacs at one week and one year post-embolization.
Main Results:
- One week post-GDC: coils, unorganized thrombus, and incomplete endothelial lining at the aneurysm neck.
- One year post-GDC: organized fibrous tissue, vascular granulation tissue, and a single endothelial layer at the aneurysm neck.
Conclusions:
- GDC treatment initiates a healing process characterized by thrombus organization and tissue remodeling.
- Complete endothelialization may take up to one year to establish after GDC embolization.
Summary:
We report the histological findings in two patients treated using Guglielmi detachable coils with almost complete occlusion of the aneurysms.Autopsies of these patients were performed one week and one year after GDC embolization respectively. In one aneurysm that was obtained at autopsy one week after embolization, the histological findings revealed coils and an unorganized thrombus-filled aneurysm sac; an incomplete cell-lining on the luminal side of fibrin thrombi in the region of the neck of the aneurysm was recognized. In the other aneurysm in which autopsy was performed one year after embolization, an organized fibrous tissue at the margin of the aneurysmal wall and vascular granulation tissue at the center of the aneurysm were observed. There is a single layer of endothelium covering fibrous tissue in the neck of the aneurysm. We discuss the healing process after GDC treatment.
