Paper50-Morphologic-Changes-Neo-Intimal-Proliferation-Experimental-Aneurysm-After-Coil-Embolization-

Paper50-Morphologic-Changes-Neo-Intimal-Proliferation-Experimental-Aneurysm-After-Coil-Embolization-

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Introduction During the past decades, great advances have been made in the field of endovascular surgery for cerebral aneu- rysms after the introduction of a Guglielmi detachable coil (GDC). In recent years, endovascular surgery with GDCs has been regarded as a noninvasive proce- dure as compared to conventional clipping surgery [8, 9]. However, several complications of coil emboliza- tion, including recanalization and re-bleeding, remain major drawbacks of this procedure, and clipping is still considered to be the gold standard for the treatment of choice [6, 10, 11, 19, 24, 45]. However, recently reported results of the European ISAT trial have revealed significantly decreased morbidity and mortality with the coiling of aneurysms compared to surgical clipping [15]. The goal of aneurysm treatment by coil emboliza- tion is to isolate the lumen of the aneurysm completely from the cerebral circulation by neointimal prolifera- tion of the aneurysmal orifice. In the treatment of ruptured aneurysm, it is important to achieve a strong Ken Hino Yoshifumi Konishi Atsushi Shimada Hiroki Kurita Eishi Sato Mitsuhiro Hara Yoshiaki Shiokawa Isamu Saito Morphologic changes in neo-intimal proliferation in an experimental aneurysm after coil embolization: effect of factor XIII administration Received: 3 May 2004 Accepted: 10 September 2004 Published online: 5 November 2004 Ó Springer-Verlag 2004 Abstract We investigated histologi- cal changes in aneurysmal orifices after embolization with Guglielmi detachable coils (GDCs) and deter- mined the effects of the wound- healing factor, factor XIII, on pro- moting intimal proliferation by scanning electron microscopy (SEM). GDC embolization was performed in an experimental model of aneurysm in swine. In the control group (17 aneurysms), the aneu- rysms were resected immediately after surgery, at 1 and 3 weeks after the procedure. In the factor XIII- administered group (13 aneurysms), the swine received factor XIII post- operatively, and the aneurysms were excised at 1 and 3 weeks. The endothelial cell proliferation changes in the aneurysm orifices in both groups were evaluated by SEM. The histological changes at the orifices began immediately after the proce- dure, and endothelialization was observed at 1 week. One week after the procedure, the rate of endothelial cell proliferation was significantly higher in the factor XIII group ( P <0.05). But no difference was observed at 3 weeks, when endo- thelialization of the orifices was essentially completed. The process of intimal proliferation after coil embolization was similar to the wound-healing process after vascu- lar intimal injury. Administration of the wound-healing factor, factor XIII, would contribute rapid intimal proliferation and may be effective to facilitate complete obliteration of aneurysms after coil embolization.
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  • Spring '08
  • Staff
  • Internal carotid artery, Common carotid artery, external carotid artery, cerebral aneurysm, Factor XIII, aneurysmal orifices

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