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Delayed enhancing lesions after coil embolization of aneurysms: Clinical experience and benchtop analyses

Title
Delayed enhancing lesions after coil embolization of aneurysms: Clinical experience and benchtop analyses
Authors
Oh S.W.Shin N.Y.Lee H.-J.Kim B.M.Kim D.J.
Ewha Authors
신나영
SCOPUS Author ID
신나영scopus
Issue Date
2017
Journal Title
Journal of NeuroInterventional Surgery
ISSN
1759-8478JCR Link
Citation
vol. 9, no. 12, pp. 1243 - 1247
Keywords
CatheterCoilEmbolic
Publisher
BMJ Publishing Group
Indexed
SCIE; SCOPUS scopus
Abstract
Background Foreign body emboli during endovascular treatment (EVT) may cause delayed enhancing lesions (DELs). Objective To report our experiences of this complication in patients treated for cerebral aneurysms and to investigate the cause of the lesions by benchtop analyses. Methods Three patients with DELs on MRI after EVT were retrospectively investigated. Unusual friction had occurred in the midst of coil delivery in two patients. The imaging findings, cause of the lesions due to the devices used for the procedure, treatment, and follow-up results were assessed. Two benchtop analyses were performed. First, a microcatheter that showed similar unusual friction during coiling was retrieved and dissected at the point of friction. Second, the EVT procedure was simulated with multiple coil advancement and withdrawal maneuvers within an acutely angulated microcatheter to identify downstream foreign body material emboli. Results The DELs were identified 27-37days (mean 32.7) after the procedure. The patients presented with left arm weakness, headache, and no other symptoms. The lesions were located in the hemisphere corresponding to the treatment. The symptoms subsided after conservative therapy. The dissected microcatheter showed whitish semitransparent material adherent to the inner lumen. Similar material was sieved after multiple coil advancement and withdrawal maneuvers. Conclusions DELs may be caused by fragmentation and emboli of the inner coating wall of the microcatheter. Development of unusual friction during coil delivery may be a sign of damage of the microcatheter inner wall and the device should be discarded. © Published by the BMJ Publishing Group Limited.
DOI
10.1136/neurintsurg-2016-012833
Appears in Collections:
의학전문대학원 > 의학과 > Journal papers
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