İntrakranial anevrizmaların GDC ile endovasküler embolizasyon tedavisi

Abstract

ÖZET Elektrolizisle ayrılabilir özel dizayn edilmiş bir çeşit platin coil olan GDC intrakranial anevrizmaların endovasküler oklüzyonunda kullanılan son derece yumuşak ve atravmatik bir yöntem olup bu dizaynın en önemli avantajı coilin geri alınarak repozisyonu veya tamamen dışarı alınmasının mümkün olmasıdır. Platin coilin anevrizma içerisinde uygun bir konuma yerleştirilmesini takiben düşük bir elektrik akımının uygulanmasıyla coil anevrizma lümeninde bırakılmakta ve eşlik eden elektrotromboz olayı ile anevrizma oklüzyonu sağlanabilmektedir. Çalışmamızda intrakranial anevrizma saptanan 17 hastada uygulanan GDC coil ile endovasküler oklüzyon tedavisi ve diğer endovasküler ve cerrahi tedavi yöntemlerine göre sahip olduğu üstünlükleri ve olumsuzlukları literatür bilgileri ışığında tartışılmıştır. Bu tekniğin başlıca avantajları hem endovasküler yaklaşımın kullanımı, hem de kanama sonrası erken dönemde bile güvenilir bir şekilde kullanılabilir olmasıdır. Kuzey Amerika ve ünitemizin de içinde bulunduğu Avrupa'daki çok merkezli devam eden klinik çalışmalar GDC coil ile anevrizma embolizasyonunun uzun dönemde sonuçlarının, etkinliğinin ortaya 96konulmasına ve diğer tedavi edici yöntemlere göre avantaj ve dezavantajlarının daha belirgin olmasına yol açacaktır. SUMMARY The development of the Guglielmi electro thrombotic coil in 1991 was the first major advancemet in treating intracranial aneurysms by endovascular techniques since the detachable balloon. This coil is extremely soft, pliable and atraumatic. The major advance of this design is the ability to withdraw, reposition or remove the coil. The preformed platinum coil is attached to a stainless steel guidewire with a solder junction. A small electrical current is then applied to the guidewire after proper placement of the coil inside the lumen of the aneurysm for detachment. In addition to the achieved mechanical occlusion, the use of an electrical current induces thrombosis within the aneurysm during the procedure. This technique is currently being evaluated in a multicenter clinical trial in North America and Europe which includes Cerrahpaşa Medical Faculty, Department of Radiology from Turkey. In this preliminary study 17 patients with high risk intracranial aneurysms were treated using GDC coils via an endovascular approach. The follow-up period is short, this is because the tecnique has only recently been applied in the clinical setting. The overall clinical findings at the time being support the indication that GDC system is intended for embolizing certain intracranial aneurysms that are considered by treating neurosurgical team to be very high risk for management by traditional operative techniques or inoperable because of their morphology, their location, or the patient's general medical condition. Long-term angiographic and clinical follow-up 97

konulmasına ve diğer tedavi edici yöntemlere göre avantaj ve dezavantajlarının daha belirgin olmasına yol açacaktır. SUMMARY The development of the Guglielmi electro thrombotic coil in 1991 was the first major advancemet in treating intracranial aneurysms by endovascular techniques since the detachable balloon. This coil is extremely soft, pliable and atraumatic. The major advance of this design is the ability to withdraw, reposition or remove the coil. The preformed platinum coil is attached to a stainless steel guidewire with a solder junction. A small electrical current is then applied to the guidewire after proper placement of the coil inside the lumen of the aneurysm for detachment. In addition to the achieved mechanical occlusion, the use of an electrical current induces thrombosis within the aneurysm during the procedure. This technique is currently being evaluated in a multicenter clinical trial in North America and Europe which includes Cerrahpaşa Medical Faculty, Department of Radiology from Turkey. In this preliminary study 17 patients with high risk intracranial aneurysms were treated using GDC coils via an endovascular approach. The follow-up period is short, this is because the tecnique has only recently been applied in the clinical setting. The overall clinical findings at the time being support the indication that GDC system is intended for embolizing certain intracranial aneurysms that are considered by treating neurosurgical team to be very high risk for management by traditional operative techniques or inoperable because of their morphology, their location, or the patient's general medical condition. Long-term angiographic and clinical follow-up 97monitoring is necessary to achieve an accurate idea about the advantages and limitations of this occlusion device in details. ( 98