Published Online
on April 22, 2004

A more recent version of this article appeared on June 1, 2004

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Submitted on November 24, 2003
Revised on January 21, 2004
Accepted on February 9, 2004

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; and 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.

^* To whom correspondence should be addressed. 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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