Effect of Guglielmi detachable coil placement on intraaneurysmal pressure: experimental study in canines.

BACKGROUND AND PURPOSE Treatment of ruptured aneurysms with Guglielmi detachable coils (GDCs) has been shown to prevent repeat bleeding. To assess whether GDC coiling alters aneurysmal pressure, we measured intraaneurysmal pressure in two canine types of carotid artery aneurysms before and after GDC placement. METHODS A 0.014-inch guidewire with a pressure transducer was inserted into parent arteries and domes of surgically created aneurysms. Intravascular static pressures were recorded before and during saline power injections (10, 20, and 30 mL over 1 and 2 s), before and after GDC placement. Common femoral arterial pressure was monitored. RESULTS Saline power injections reproducibly and abruptly increased pressure in parent arteries and aneurysms. Mean intraaneurysmal pressure varied (18 +/- 4 [10 mL] to 75 +/- 15 mm Hg [30 mL]), independent of injection duration. Intraaneurysmal baseline pressures were higher after GDC placement (111 +/- 10 versus 93 +/- 15 mm Hg; P =.05). Aneurysmal pressure increases with saline injections were slightly higher after GDC placement, which dampened intraaneurysmal pressure amplitude at baseline (26.5 +/- 5.6 versus 19.6 +/- 7.4 mm Hg; P =.003) and during hypertension (25.3 +/- 5.4 versus 19.8 +/- 7.5 mm Hg, P =.002). The pressure increase slope with saline injection was delayed with GDC placement (0.24 +/- 0.1 versus 0.38 +/- 0.19 s; P <.001). CONCLUSION Graded saline power injections into parent arteries can rapidly increase intraaneurysmal pressure. GDC treatment did not attenuate mean intraaneurysmal pressures, but both dampened the pressure amplitude and delayed pressure increases during locally induced hypertension.

[1]  D. Rüfenacht,et al.  Treatment of carotid artery aneurysms with platinum coils: an experimental study in dogs. , 1990, AJNR. American journal of neuroradiology.

[2]  P. Novak,et al.  Pulsation-pressure relationship in experimental aneurysms: observation of aneurysmal hysteresis. , 1996, Neurological research.

[3]  W. J. German,et al.  Experimental production of carotid aneurysms. , 1954, The New England journal of medicine.

[4]  U. Gessner Chapter 10 – Vascular Input Impedance , 1972 .

[5]  T. Sorimachi,et al.  Intra-aneurysmal pressure changes during angiography in coil embolization. , 1997, Surgical neurology.

[6]  W. Stehbens,et al.  Etiology of intracranial berry aneurysms. , 1989, Journal of neurosurgery.

[7]  W. Schievink,et al.  Controlled pressure-volume factors in the enlargement of intracranial aneurysms. , 1989, Neurosurgery.

[8]  Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. , 1995, Neurosurgery.

[9]  D. Bergel Cardiovascular fluid dynamics , 1972 .

[10]  G. Ferguson Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. , 1972, Journal of neurosurgery.

[11]  H. Boecher-Schwarz,et al.  Ex vivo study of the physical effect of coils on pressure and flow dynamics in experimental aneurysms. , 2000, AJNR. American journal of neuroradiology.

[12]  A. Algra,et al.  Treatment of intracranial aneurysms by embolization with coils: a systematic review. , 1999, Stroke.

[13]  C M Strother,et al.  Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. , 1995, Neurosurgery.

[14]  A. Sahs Intracranial aneurysms and subarachnoid hemorrhage : a cooperative study , 1969 .

[15]  H J Steiger,et al.  Pathophysiology of development and rupture of cerebral aneurysms. , 1990, Acta neurochirurgica. Supplementum.

[16]  G. Ferguson,et al.  Direct measurement of mean and pulsatile blood pressure at operation in human intracranial saccular aneurysms. , 1972, Journal of neurosurgery.