Acute Human Histopathology of an Intracranial Aneurysm Treated Using Guglielmi Detachable Coils: Case Report and Review of the Literature

Acute Human Histopathology of an Intracranial Aneurysm Treated Using Guglielmi Detachable Coils:... AbstractOBJECTIVE AND IMPORTANCEThis case study provided us with the opportunity to explore the histopathological effects of Guglielmi detachable coil (GDC) therapy on the aneurysm orifice and parent vessel-aneurysm neck interface. This type of study is important to the understanding of the mechanisms of obliteration of aneurysms by GDCs.CLINICAL PRESENTATIONThe patient presented with a Hunt and Hess Grade III subarachnoid hemorrhage that occurred secondary to the rupture of a small anterior communicating artery aneurysm.INTERVENTIONThe aneurysm was successfully coiled without complication, but the patient died 36 hours later. We examined the gross and microscopic pathological findings of this GDC-treated anterior communicating artery aneurysm 36 hours after coiling. A discrete membrane composed of fib rin had formed completely across the aneurysm orifice, excluding the aneurysm sac from the circulation. This membrane was contiguous with the parent vessel.CONCLUSIONThis case represents one o f the first examples in humans of the formation of a membrane over the aneurysm orifice after GDC therapy. The formation o f this membrane, shown to be composed of fibrin, was found at 36 hours after coiling, which is the earliest time frame at which membrane formation has been noted in either humans or animal Models. This fibrin membrane may function both as a scaffold for subsequent endothelialization across the aneurysm neck as well as to isolate the aneurysm from the parent circulation, permitting thrombus within the aneurysm sac to mature to an endovascular scar. The factors contributing to the formation o f this membrane and its clinical implications are discussed. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Acute Human Histopathology of an Intracranial Aneurysm Treated Using Guglielmi Detachable Coils: Case Report and Review of the Literature

Acute Human Histopathology of an Intracranial Aneurysm Treated Using Guglielmi Detachable Coils: Case Report and Review of the Literature

C A S E R E P O R T S W h e n a v a i l a b l e , a u t o p s y s t u d i e s p r o ­ Acute Human Histopathology of an v i d e i n v a l u a b l e i n f o r m a t i o n r e g a r d i n g t h e p a t h o p h y s i o l o g i c a l c h a n g e s t h a t o c ­ Intracranial Aneurysm Treated Using c u r in a n e u r y s m s s u b s e q u e n t to c o i l t h e r a p y ( 11, 17) a n d t h e r e b y p r o v i d e a n Guglielmi Detachable Coils: Case Report a d d i t i o n a l m e a s u r e o f t h e l o n g - t e r m r e ­ s u l t s o f t h i s m o d e o f t r e a t m e n t . and Review of the Literature W e r e p o r t a c a s e o f a n a n t e r i o r c o m ­ m u n i c a t i n g a r t e r y a n e u r y s m t r e a t e d b y G D C t h e r a p y in a p a t i e n t w h o d i e d 3 6 h o u r s a f t e r u n d e r g o i n g t h e c o i l p r o c e ­ Shirley I. Stiver, M .D., Ph.D., Phillip J. Porter, M.D., d u r e a n d w h o u n d e r w e n t d e t a i l e d a u ­ t o p s y e x a m i n a t i o n . T h e s i g n i f i c a n t f i n d ­ Robert A. Willinsky, M .D., M. Christopher W allace, M.D. i n g is t h a t o f a c o m p l e t e m e m b r a n e Division of Neurosurgery, Department of Surgery (SIS, PJP, M CW ), and D ivision of c o m p o s e d o f f i b r i n c o v e r i n g t h e a n e u ­ Neuroradiology, Department of R adiology (RAW ), The Toronto Hospital, Toronto, r y s m o r i f i c e . T h e f a c t o r s g o v e r n i n g t h e Ontario, Canada d e v e l o p m e n t o f t h i s e a r l y m e m b r a n e a r e c o n s i d e r e d , a n d t h e l i t e r a t u r e o n h i s ­ t o p a t h o l o g i c a l c h a n g e s a f t e r e n d o v a s c u ­ OBJECTIVE A N D IM P O R T A N C E : This case stu d y p ro v id e d us w ith the o p ­ l a r t r e a t m e n t o f a n e u r y s m s is r e v i e w e d . portunity to e x p lo re th e h is to p a th o lo g ic a l effe cts o f G u g lie lm i d e ta c h a b le coil (GDC) th e ra p y...
Loading next page...
 
/lp/ou_press/acute-human-histopathology-of-an-intracranial-aneurysm-treated-using-lwdQWrm3wE
Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199811000-00106
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE AND IMPORTANCEThis case study provided us with the opportunity to explore the histopathological effects of Guglielmi detachable coil (GDC) therapy on the aneurysm orifice and parent vessel-aneurysm neck interface. This type of study is important to the understanding of the mechanisms of obliteration of aneurysms by GDCs.CLINICAL PRESENTATIONThe patient presented with a Hunt and Hess Grade III subarachnoid hemorrhage that occurred secondary to the rupture of a small anterior communicating artery aneurysm.INTERVENTIONThe aneurysm was successfully coiled without complication, but the patient died 36 hours later. We examined the gross and microscopic pathological findings of this GDC-treated anterior communicating artery aneurysm 36 hours after coiling. A discrete membrane composed of fib rin had formed completely across the aneurysm orifice, excluding the aneurysm sac from the circulation. This membrane was contiguous with the parent vessel.CONCLUSIONThis case represents one o f the first examples in humans of the formation of a membrane over the aneurysm orifice after GDC therapy. The formation o f this membrane, shown to be composed of fibrin, was found at 36 hours after coiling, which is the earliest time frame at which membrane formation has been noted in either humans or animal Models. This fibrin membrane may function both as a scaffold for subsequent endothelialization across the aneurysm neck as well as to isolate the aneurysm from the parent circulation, permitting thrombus within the aneurysm sac to mature to an endovascular scar. The factors contributing to the formation o f this membrane and its clinical implications are discussed.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1998

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches

$49/month

Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.

$588

$360/year

billed annually
Start Free Trial

14-day Free Trial