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(Stroke. 2004;35:1471.)
© 2004 American Heart Association, Inc.

Original Contributions

Role of the Endothelial Lining in Recurrences After Coil Embolization

Prevention of Recanalization by Endothelial Denudation

Jean Raymond, MD; François Guilbert, MD; Annick Metcalfe, MSc; Guylaine Gévry, BSc; Igor Salazkin, MD Olivier Robledo, PhD

From the Radiology Department (J.R., F.G.) and Research Centre (J.R., A.M., G.G., I.S., O.R.), CHUM Notre-Dame Hospital, Quebec, Canada.

Correspondence to Dr Jean Raymond, CHUM Notre-Dame Hospital, Interventional Neuroradiology Laboratory, 1560 Sherbrooke East, Suite M-8203, Montreal, Quebec, Canada H2L 4M1. E-mail jean.raymond.chum{at}ssss.gouv.qc.ca

Background and Purpose— Endovascular treatment can improve the outcome of patients treated for ruptured intracranial aneurysms as compared with surgical clipping, but angiographic recurrences are frequent. Endothelial denudation before coil embolization may prevent recanalization and improve results of endovascular treatment.

Methods— We compared angiographic and pathological results 3 months after coil occlusion of paired canine arteries (n=16), with or without previous denudation of the endothelial lining using an endovascular device. The technique was then used to denude the neck of carotid venous pouch bifurcation aneurysms before coil embolization in 8 dogs, and the angiographic evolution at 12 weeks was compared with 7 control aneurysms treated by coiling only. Qualitative scoring systems were used to compare angiographic results with time and neointimal coverage at the neck of aneurysm after necropsy. The evolution of angiographic scores was analyzed using Wilcoxon signed rank tests whereas angiographic and neointimal scores of the 2 groups were compared using the Mann–Whitney test.

Results— All arteries embolized with platinum coils recanalized, whereas most arteries (12/16 or 75%) denuded before coil embolization remained occluded at 3 and 12 weeks (P<0.001). Aneurysms treated with coils without previous denudation tended to recur, with angiographic scores significantly worse at 12 weeks as compared with T₀ (P=0.015). Median angiographic and neointimal scores were significantly better at 12 weeks with endothelial denudation (P=0.011 and 0.026, respectively).

Conclusion— Endothelial denudation can prevent recanalization after coil embolization.

Key Words: aneurysm • embolization • endothelium • animal models • recurrences

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