DOI QR코드

DOI QR Code

In Vitro Observation of Air Bubbles during Delivery of Various Detachable Aneurysm Embolization Coils

  • Lee, Deok-Hee (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwang, Seon-Moon (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Ok-Kyun (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jae-Kyun (Department of Radiology, Chung-Ang University College of Medicine)
  • Published : 2012.08.01

Abstract

Objective: Device- or technique-related air embolism is a drawback of various neuro-endovascular procedures. Detachable aneurysm embolization coils can be sources of such air bubbles. We therefore assessed the formation of air bubbles during in vitro delivery of various detachable coils. Materials and Methods: A closed circuit simulating a typical endovascular coiling procedure was primed with saline solution degassed by a sonification device. Thirty commercially available detachable coils (7 Axium, 4 GDCs, 5 MicroPlex, 7 Target, and 7 Trufill coils) were tested by using the standard coil flushing and delivery techniques suggested by each manufacturer. The emergence of any air bubbles was monitored with a digital microscope and the images were captured to measure total volumes of air bubbles during coil insertion and detachment and after coil pusher removal. Results: Air bubbles were seen during insertion or removal of 23 of 30 coils (76.7%), with volumes ranging from 0 to 23.42 $mm^3$ (median: 0.16 mm3). Air bubbles were observed most frequently after removal of the coil pusher. Significantly larger amounts of air bubbles were observed in Target coils. Conclusion: Variable volumes of air bubbles are observed while delivering detachable embolization coils, particularly after removal of the coil pusher and especially with Target coils.

Keywords

References

  1. Dunn GD. Microscopic air embolism and cerebral angiography. Lancet 1993;341:1215-1216
  2. Markus H. Transcranial Doppler detection of circulating cerebral emboli. A review. Stroke 1993;24:1246-1250 https://doi.org/10.1161/01.STR.24.8.1246
  3. Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 1999;354:1594-1597 https://doi.org/10.1016/S0140-6736(99)07083-X
  4. Heiserman JE. Silent embolism after cerebral angiography-- what harm? Lancet 1999;354:1577-1578 https://doi.org/10.1016/S0140-6736(99)00277-9
  5. Sayama T, Mitani M, Inamura T, Yagi H, Fukui M. Normal diffusion-weighted imaging in cerebral air embolism complicating angiography. Neuroradiology 2000;42:192-194 https://doi.org/10.1007/s002340050043
  6. Chuah KC, Stuckey SL, Berman IG. Silent embolism in diagnostic cerebral angiography: detection with diffusionweighted imaging. Australas Radiol 2004;48:133-138 https://doi.org/10.1111/j.1440-1673.2004.01273.x
  7. Gupta R, Vora N, Thomas A, Crammond D, Roth R, Jovin T, et al. Symptomatic cerebral air embolism during neuroangiographic procedures: incidence and problem avoidance. Neurocrit Care 2007;7:241-246 https://doi.org/10.1007/s12028-007-0041-9
  8. Mamourian AC, Weglarz M, Dunn J, Cromwell LD, Saykin AJ. Injection of air bubbles during flushing of angiocatheters: an in vitro trial of conventional hardware and techniques. AJNR Am J Neuroradiol 2001;22:709-712
  9. Markus H, Loh A, Israel D, Buckenham T, Clifton A, Brown MM. Microscopic air embolism during cerebral angiography and strategies for its avoidance. Lancet 1993;341:784-787 https://doi.org/10.1016/0140-6736(93)90561-T
  10. Bendszus M, Koltzenburg M, Bartsch AJ, Goldbrunner R, Günthner-Lengsfeld T, Weilbach FX, et al. Heparin and air filters reduce embolic events caused by intra-arterial cerebral angiography: a prospective, randomized trial. Circulation 2004;110:2210-2215 https://doi.org/10.1161/01.CIR.0000144301.82391.85
  11. Derdeyn CP. Diffusion-weighted imaging as a surrogate marker for stroke as a complication of cerebrovascular procedures and devices. AJNR Am J Neuroradiol 2001;22:1234-1235
  12. Soeda A, Sakai N, Murao K, Sakai H, Ihara K, Yamada N, et al. Thromboembolic events associated with Guglielmi detachable coil embolization with use of diffusion-weighted MR imaging. Part II. Detection of the microemboli proximal to cerebral aneurysm. AJNR Am J Neuroradiol 2003;24:2035-2038
  13. Kim SJ, Roh HG, Jeon P, Kim KH, Lee KH, Byun HS, et al. Cerebral ischemia detected with diffusion-weighted MR imaging after protected carotid artery stenting: comparison of distal balloon and filter device. Korean J Radiol 2007;8:276- 285 https://doi.org/10.3348/kjr.2007.8.4.276
  14. Chung SW, Baik SK, Kim Y, Park J. Thromboembolic events after coil embolization of cerebral aneurysms: prospective study with diffusion-weighted magnetic resonance imaging follow-up. J Korean Neurosurg Soc 2008;43:275-280 https://doi.org/10.3340/jkns.2008.43.6.275
  15. Helps SC, Meyer-Witting M, Reilly PL, Gorman DF. Increasing doses of intracarotid air and cerebral blood flow in rabbits. Stroke 1990;21:1340-1345 https://doi.org/10.1161/01.STR.21.9.1340
  16. Helps SC, Parsons DW, Reilly PL, Gorman DF. The effect of gas emboli on rabbit cerebral blood flow. Stroke 1990;21:94-99 https://doi.org/10.1161/01.STR.21.1.94
  17. Muth CM, Shank ES. Gas embolism. N Engl J Med 2000;342:476-482 https://doi.org/10.1056/NEJM200002173420706
  18. Um SJ, Lee SK, Yang DK, Son C, Kim KN, Lee KN, et al. Four cases of a cerebral air embolism complicating a percutaneous transthoracic needle biopsy. Korean J Radiol 2009;10:81-84 https://doi.org/10.3348/kjr.2009.10.1.81
  19. Menzel M, Doppenberg EM, Zauner A, Soukup J, Reinert MM, Bullock R. Increased inspired oxygen concentration as a factor in improved brain tissue oxygenation and tissue lactate levels after severe human head injury. J Neurosurg 1999;91:1- 10 https://doi.org/10.3171/jns.1999.91.1.0001
  20. Goodman JC, Valadka AB, Gopinath SP, Uzura M, Robertson CS. Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 1999;27:1965-1973 https://doi.org/10.1097/00003246-199909000-00041
  21. van Hulst RA, Lameris TW, Hasan D, Klein J, Lachmann B. Effects of cerebral air embolism on brain metabolism in pigs. Acta Neurol Scand 2003;108:118-124
  22. Hossmann KA. Experimental models for the investigation of brain ischemia. Cardiovasc Res 1998;39:106-120 https://doi.org/10.1016/S0008-6363(98)00075-3
  23. Annane D, Troche G, Delisle F, Devauchelle P, Hassine D, Paraire F, et al. Kinetics of elimination and acute consequences of cerebral air embolism. J Neuroimaging 1995;5:183-189
  24. Han MH, Kwon OK, Yoon CJ, Kwon BJ, Cha SH, Chang KH. Gas generation and clot formation during electrolytic detachment of Guglielmi detachable coils: in vitro observations and animal experiment. AJNR Am J Neuroradiol 2003;24:539-544

Cited by

  1. Thromboembolic Events Associated with Electrolytic Detachment of Guglielmi Detachable Coils and Target Coils : Comparison with Use of Diffusion-Weighted MR Imaging vol.54, pp.1, 2012, https://doi.org/10.3340/jkns.2013.54.1.19
  2. Design and biocompatibility of endovascular aneurysm filling devices vol.103, pp.4, 2012, https://doi.org/10.1002/jbm.a.35271
  3. Microembolism after Endovascular Treatment of Unruptured Cerebral Aneurysms: Reduction of its Incidence by Microcatheter Lumen Aspiration vol.10, pp.2, 2012, https://doi.org/10.5469/neuroint.2015.10.2.67
  4. Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors vol.124, pp.3, 2012, https://doi.org/10.3171/2015.3.jns142835
  5. In Vitro Evaluation of Fusiform-Shaped Stents for Wide-Neck Intracranial Aneurysm Treatment vol.13, pp.2, 2012, https://doi.org/10.5469/neuroint.2018.00976
  6. Intra-aneurysmal air after flow diversion treatment in intracranial aneurysms: incidence, characteristics and clinical significance vol.37, pp.7, 2019, https://doi.org/10.1007/s11604-019-00842-2