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...
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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

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