Article Figures & Data
Figures
- Fig 1.
Axial photomicrographs show histologic findings 3 months after embolization. h indicates cyanoacrylate; c, coils; ca, carotid artery; n, neck; ra, recurrent aneurysm; vp, venous pouch; t, vascularized fibrous tissue. (HPS, original magnification ×20).
A, Lateral wall aneurysm, obtained after embolization with cyanoacrylate-coated sponge. Aneurysm remains obliterated by a thick and fibrous neointima.
B, Lateral wall aneurysm, obtained after embolization with sponge alone. Aneurysm shows large recurrence and hypertrophy of the venous pouch.
C, Bifurcation aneurysm, obtained after embolization with coils alone, shows recurrence around the mass of coils. Neointima is thin and incomplete at the neck. Coils are embedded in vascularized fibrous tissue.
D, Bifurcation aneurysm, obtained after embolization with coils and cyanoacrylate, shows no recurrence. Note aneurysm filled with cyanoacrylate.
- Fig 2.
Histologic findings 3 weeks after embolization. ca indicates carotid artery; g, sponge; r, recurrence; S, suture; L, iodized oil. (HPS; magnification ×20 [A–C], ×100 [D–F]).
A and D, Axial section of lateral wall aneurysm and carotid arteries, obtained 3 weeks after embolization with gelatin sponge. Note recurrence and thin neointima covering the uncoated sponge.
B and E, Axial section of lateral wall aneurysm and carotid arteries, obtained 3 weeks after embolization with iodized oil. Note recurrences and thin neointima covering the iodized oil-coated sponges. Higher magnification reveals that the neointima is composed of a few layers of spindle cells embedded in a collagenous matrix and covered by an endothelium in aneurysms treated with iodized oil-coated sponges.
C and F, Axial section of lateral wall aneurysms and carotid arteries, obtained 3 weeks after embolization with cyanoacrylate-coated sponges. Aneurysms treated with cyanoacrylate-coated sponges show a thicker neointima and complete obliteration of the neck.
- Fig 3.
Endovascular cyanoacrylate embolization.
A and B, Spot radiographs obtained during endovascular cyanoacrylate delivery. The cyanoacrylate deposition is limited to the aneurysm at the beginning.
C, Spot radiograph obtained after endovascular cyanoacrylate delivery. The cyanoacrylate spills through the neck at the end of the injection.
D, Carotid arteriogram shows that spilling of cyanoacrylate caused severe stenosis of the bifurcation.
- Fig 4.
Endovascular cyanoacrylate embolization using coil protection.
A and B, Radiographs obtained before (A) and after (B) carotid injection of contrast agent show how cyanoacrylate deposition can be limited by a single coil. Cyanoacrylate is seen as radiopaque material within and surrounding loops of coils. Note complete obliteration of the aneurysm without compromising the bifurcation.
Tables
- TABLE 1:
Angiographic scores and neointima thickness in lateral wall and bifurcation aneurysms treated with coils
Parameter Lateral Wall Aneurysms (n = 6) Bifurcation Aneurysms (n = 6) Initial angiographic score 0.67 ± 1.03 0.40 ± 0.89 Score at 3 wks 1.50 ± 0.55 0.75 ± 0.96 Evolution of score at 3 wks 0.83 ± 0.75 0.75 ± 0.96 Score at 3 mo 1.17 ± 0.75 3.00 ± 0.71* Evolution of score at 3 mo 0.50 ± 1.05 2.60 ± 0.55† Neointima at 3 mo (μm) 170.00 ± 42.43 29.80 ± 24.35‡ Note.—Data are the mean ± SD.
* This score was significantly worse in bifurcation than in lateral wall aneurysms (P = .004).
† This score was significantly worse in bifurcation than in lateral wall aneurysms (P = .003).
‡ This measurement was significantly thinner in bifurcation than in lateral wall aneurysms (P = .0004).
- TABLE 2:
Angiographic scores and neointima thickness in lateral wall aneurysms treated with gelatin sponges
Parameter Uncoated Sponge Iodized Oil-Coated Sponge Cyanoacrylate-Coated Sponge Initial angiographic score 1.68 ± 0.78 (21) 2.40 ± 0.55 (5) 2.19 ± 0.68 (16) Score at 3 wks 2.68 ± 1.00 (21) 2.40 ± 0.55 (5) 1.59 ± 1.33* (16) Evolution of score at 3 wks 1.00 ± 0.87 (21) 0.00 ± 1.0 (5) −0.52 ± 1.29† (16) Score at 3 mo 3.43 ± 0.79 (6) — 1.50 ± 1.64 (6) Evolution of score at 3 mo 1.86 ± 0.69 (6) — −0.67 ± 1.51† (6) Neointima at 3 wks (μm) 99.15 ± 112.35 (21) 185.75 ± 198.14 (5) 575.53 ± 328.27‡ (16) Neointima at 3 mo (μm) 124.43 ± 120.02 (6) — 429.50 ± 183.03‡ (6) Note.—Data are the mean ± SD. Numbers in parentheses are numbers of aneurysms.
* This score was significantly better in aneurysms treated with cyanoacrylate-coated sponges than in those treated with uncoated sponges (P < .05).
† This score was significantly better in aneurysms treated with cyanoacrylate-coated sponges than in those treated with uncoated sponges (P < .05).
‡ This measurement was significantly thicker in aneurysms treated with cyanoacrylate-coated sponges than in those treated with uncoated sponges (P < .05).
- TABLE 3:
Angiographic scores and neointima thickness in bifurcation aneurysms treated with coils alone or with cyanoacrylate
Parameter Coils Alone (n = 6) Cyanoacrylate and Coils (n = 6) Initial angiographic score 0.40 ± 0.89 1.00 ± 1.16 Score at 3 wks 0.75 ± 0.96 0.00 ± 0.00 Evolution of score at 3 wks 0.75 ± 0.96 −1.00 ± 1.16 Score at 3 mo 3.00 ± 0.71 0.50 ± 1.00* Evolution of score at 3 mo 2.60 ± 0.55 −0.50 ± 1.92† Neointima at 3 mo (μm) 29.80 ± 24.36 300.00 ± 50.09‡ Note.—Data are the mean ± SD.
* This score was significantly better in aneurysms treated with cyanoacrylate over a coil than in those treated with coils alone (P = .001).
† This score is significantly better in aneurysms treated with cyanoacrylate over a coil than in those treated with coils alone (P = .01).
‡ This measurement at the neck of aneurysms treated with cyanoacrylate behind a coil is significantly thicker than that in aneurysms treated with coils alone (P < .05).
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