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Histologic Evaluation of Platinum Coil Embolization in an Aneurysm Model in Rabbits¹

¹ From the Departments of Radiology (D.F.K., T.A.A., H.M.D.), Neurological Surgery (G.A.H., S.B.H.), and Pathology (J.W.M.), University of Virginia Health Services, Box 170, Charlottesville, VA 22908; and the Department of Radiology, Emory University, Atlanta, Ga (H.J.C.). Received September 22, 1998; revision requested November 20; revision received January 19, 1999; accepted April 30. T.A.A. supported in part by the RSNA Research and Education Foundation as a 1997 Research Resident. D.F.K. supported in part by the RSNA Research and Education Foundation as a 1997 Bracco/RSNA Scholar. Address reprint requests to D.F.K. (e-mail: dfk3b@virginia .edu).

View larger version (27K): [in a new window]   Figure 1a. (a) Line drawing depicts the construction technique for the aneurysm, with balloon occlusion of the origin of the right common carotid artery and elastase infusion into the proximal portion. At the end of the procedure, the vessel is tied off just proximal to the arteriotomy site. The proximal right common carotid artery subsequently dilates, which forms the aneurysm. (b) Digital subtraction angiogram depicts a right common carotid arterial aneurysm (a) that arises from the apex of a curving vessel. Note the anomalous origin (short arrow) of the left vertebral artery from the aortic arch. The left common carotid artery (long arrow) arises from the brachiocephalic trunk. (c) Anteroposterior digital subtraction angiogram, with the catheter tip in the ascending aorta, demonstrates coil embolization (arrowheads) of a left common carotid arterial aneurysm. Note the bifurcated morphology of the aneurysm, which is nestled between the brachiocephalic trunk and aortic arch, and the right common carotid artery (long straight arrow), right vertebral artery (curved arrow), and left vertebral artery (short straight arrow). (d) Anteroposterior digital subtraction angiogram, with the catheter tip in the brachiocephalic trunk, demonstrates coil embolization (arrowheads) of a right common carotid arterial aneurysm, which arises from the apex of the curve of the brachiocephalic trunk. Note the right vertebral artery (curved arrow), the subclavian artery (long straight arrow), and the faint opacification caused by reflux of contrast material into the left common carotid artery (short straight arrow). Radiopaque sizing spheres (2-6-mm in diameter) are also present in b and d.

View larger version (130K): [in a new window]   Figure 1b. (a) Line drawing depicts the construction technique for the aneurysm, with balloon occlusion of the origin of the right common carotid artery and elastase infusion into the proximal portion. At the end of the procedure, the vessel is tied off just proximal to the arteriotomy site. The proximal right common carotid artery subsequently dilates, which forms the aneurysm. (b) Digital subtraction angiogram depicts a right common carotid arterial aneurysm (a) that arises from the apex of a curving vessel. Note the anomalous origin (short arrow) of the left vertebral artery from the aortic arch. The left common carotid artery (long arrow) arises from the brachiocephalic trunk. (c) Anteroposterior digital subtraction angiogram, with the catheter tip in the ascending aorta, demonstrates coil embolization (arrowheads) of a left common carotid arterial aneurysm. Note the bifurcated morphology of the aneurysm, which is nestled between the brachiocephalic trunk and aortic arch, and the right common carotid artery (long straight arrow), right vertebral artery (curved arrow), and left vertebral artery (short straight arrow). (d) Anteroposterior digital subtraction angiogram, with the catheter tip in the brachiocephalic trunk, demonstrates coil embolization (arrowheads) of a right common carotid arterial aneurysm, which arises from the apex of the curve of the brachiocephalic trunk. Note the right vertebral artery (curved arrow), the subclavian artery (long straight arrow), and the faint opacification caused by reflux of contrast material into the left common carotid artery (short straight arrow). Radiopaque sizing spheres (2-6-mm in diameter) are also present in b and d.

View larger version (127K): [in a new window]   Figure 1c. (a) Line drawing depicts the construction technique for the aneurysm, with balloon occlusion of the origin of the right common carotid artery and elastase infusion into the proximal portion. At the end of the procedure, the vessel is tied off just proximal to the arteriotomy site. The proximal right common carotid artery subsequently dilates, which forms the aneurysm. (b) Digital subtraction angiogram depicts a right common carotid arterial aneurysm (a) that arises from the apex of a curving vessel. Note the anomalous origin (short arrow) of the left vertebral artery from the aortic arch. The left common carotid artery (long arrow) arises from the brachiocephalic trunk. (c) Anteroposterior digital subtraction angiogram, with the catheter tip in the ascending aorta, demonstrates coil embolization (arrowheads) of a left common carotid arterial aneurysm. Note the bifurcated morphology of the aneurysm, which is nestled between the brachiocephalic trunk and aortic arch, and the right common carotid artery (long straight arrow), right vertebral artery (curved arrow), and left vertebral artery (short straight arrow). (d) Anteroposterior digital subtraction angiogram, with the catheter tip in the brachiocephalic trunk, demonstrates coil embolization (arrowheads) of a right common carotid arterial aneurysm, which arises from the apex of the curve of the brachiocephalic trunk. Note the right vertebral artery (curved arrow), the subclavian artery (long straight arrow), and the faint opacification caused by reflux of contrast material into the left common carotid artery (short straight arrow). Radiopaque sizing spheres (2-6-mm in diameter) are also present in b and d.

View larger version (128K): [in a new window]   Figure 1d. (a) Line drawing depicts the construction technique for the aneurysm, with balloon occlusion of the origin of the right common carotid artery and elastase infusion into the proximal portion. At the end of the procedure, the vessel is tied off just proximal to the arteriotomy site. The proximal right common carotid artery subsequently dilates, which forms the aneurysm. (b) Digital subtraction angiogram depicts a right common carotid arterial aneurysm (a) that arises from the apex of a curving vessel. Note the anomalous origin (short arrow) of the left vertebral artery from the aortic arch. The left common carotid artery (long arrow) arises from the brachiocephalic trunk. (c) Anteroposterior digital subtraction angiogram, with the catheter tip in the ascending aorta, demonstrates coil embolization (arrowheads) of a left common carotid arterial aneurysm. Note the bifurcated morphology of the aneurysm, which is nestled between the brachiocephalic trunk and aortic arch, and the right common carotid artery (long straight arrow), right vertebral artery (curved arrow), and left vertebral artery (short straight arrow). (d) Anteroposterior digital subtraction angiogram, with the catheter tip in the brachiocephalic trunk, demonstrates coil embolization (arrowheads) of a right common carotid arterial aneurysm, which arises from the apex of the curve of the brachiocephalic trunk. Note the right vertebral artery (curved arrow), the subclavian artery (long straight arrow), and the faint opacification caused by reflux of contrast material into the left common carotid artery (short straight arrow). Radiopaque sizing spheres (2-6-mm in diameter) are also present in b and d.

View larger version (182K): [in a new window]   Figure 2. Subject 3. Photomicrograph of a 2-week coil implantation sample shows the aneurysm lumen (L) and wall (W) and the interface between them (straight arrows). The aneurysm lumen is filled entirely with red blood cells, which represent either acute, premortem, or postmortem thrombus. Note the former locations of coil winds (curved arrow) that were displaced during sectioning. The contents within the coil wind remain in place and are characterized by unorganized thrombus. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (173K): [in a new window]   Figure 3. Subject 4. Photomicrograph of a 6-week coil implantation sample shows the aneurysm neck (N). The aneurysm lumen is filled predominantly with unorganized thrombus, with prominent areas of laminated thrombus (straight arrow). Coil winds are present predominantly along the outer portions of the aneurysm. Hemosiderin is present in the central portion and along the periphery of the aneurysm lumen. Note the former locations of coil winds (curved arrow) that were displaced during sectioning. The contents within the coil wind remain in place and are characterized by unorganized thrombus. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (146K): [in a new window]   Figure 4. Subject 7. Photomicrograph of a 6-week coil implantation sample shows the aneurysm wall (W). The majority of the tissue within the aneurysm lumen is characterized by large amounts of faintly basophilic extracellular matrix (arrows). This tissue surrounds multiple loops of displaced coils. Also present are areas of subacute unorganized thrombus (T). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (147K): [in a new window]   Figure 5. Subject 10. (a) Photomicrograph of a 12-week coil implantation sample shows the aneurysm neck (N) and lumen (L). Coil winds have been displaced, but appear predominantly along the periphery of the aneurysm lumen, which is filled entirely with loosely packed mesenchymal cells embedded within large amounts of extracellular matrix. There is no evidence of fibrosis within the aneurysm lumen. A very thin membrane (arrow) covers the surface of one of the coil winds along the neck of the aneurysm. (Hematoxylin-eosin stain; original magnification, x20.) (b) Photomicrograph of the same sample as in a reveals loosely arranged spindled-to-stellate cells, which fill the aneurysm lumen. There is a predominance of faintly basophilic matrix, which is consistent with a proteoglycan-rich substance. Hemosiderin is present in some macrophages (arrow). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (165K): [in a new window]   Figure 5. Subject 10. (a) Photomicrograph of a 12-week coil implantation sample shows the aneurysm neck (N) and lumen (L). Coil winds have been displaced, but appear predominantly along the periphery of the aneurysm lumen, which is filled entirely with loosely packed mesenchymal cells embedded within large amounts of extracellular matrix. There is no evidence of fibrosis within the aneurysm lumen. A very thin membrane (arrow) covers the surface of one of the coil winds along the neck of the aneurysm. (Hematoxylin-eosin stain; original magnification, x20.) (b) Photomicrograph of the same sample as in a reveals loosely arranged spindled-to-stellate cells, which fill the aneurysm lumen. There is a predominance of faintly basophilic matrix, which is consistent with a proteoglycan-rich substance. Hemosiderin is present in some macrophages (arrow). (Hematoxylin-eosin stain; original magnification, x100.)