Guglielmi Detachable Coil

A Guglielmi Detachable Coil or GDC ( Guglielmi Detachable Coil ) is a platinum coil that is commonly used to close cerebral aneurysms . Soft, stretched, hair-thin platinum coils are brought forward endovascularly to the aneurysm with a microcatheter and placed inside the aneurysm, where they resume their spiral shape and form balls. The procedure, also known as coiling or endovascular aneurysm occlusion , was first introduced in 1990 by the Italian neurosurgeon Dr. Guido Guglielmi and was widely used in the 1990s as an alternative to surgical clipping of blood vessels. Since the procedure was approved in Germany in 1995 , several thousand patients have been treated.

Procedure

The functioning of the coils is based on two principles: On the one hand, the platinum spirals immediately return to their original shape after being removed from the catheter due to a memory effect , and on the other hand, they can be removed from the supporting catheter by low currents. As many platinum coils are inserted that the interior of the aneurysm is filled as much as possible. The procedure itself and the success of the measure are checked by angiographic representations . The effect of coiling as the elimination of the aneurysm from the blood circulation consists in a short-term effect, namely stasis and thrombosis of the blood between the coil meshes, and a long-term effect in the tissue remodeling in the aneurysm and in the endothelialization of the coil boundary to the actual blood vessel exists and takes several weeks.

Coiling is only suitable for aneurysms with a relatively narrow neck (e.g. pear-shaped). Aneurysms with a relatively wide neck cannot be supplied with coils, or only with the help of remodeling techniques , as there is a great risk that the coils will fall out of the aneurysm into the carrier vessel and close it or be washed into narrower vessels with the bloodstream . Whether the prognosis of patients after coiling is better compared to surgical treatment (clipping) is controversial and must be decided by the treating physician on a case-by-case basis. A meta-analysis published in 2005 only showed a better result after coiling for patients with ruptured (torn) aneurysms who were in good clinical condition.

advantages

As a minimally invasive measure, coiling is associated with fewer intraoperative risks than open neurosurgical treatment of aneurysms. Aneurysms that are difficult or impossible to reach surgically can also be eliminated. According to a meta-analysis published in 2006, the occurrence of vascular spasms after the introduction of GDCs is just as common as after an open surgical procedure.

Risks

Aneurysm after coil placement.
Resection specimen after neurosurgical intervention that becomes necessary when the bleeding occurs again.

When the GDCs are brought forward and placed using a catheter, thrombi may form or mobilize, and the vessel wall may be perforated. Furthermore, as with all invasive measures, there is a risk of infection.

There is also the risk that the aneurysm will revascularize and bleed again.

Individual evidence

↑ Guglielmi et al .: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. In: Neurosurg. 1991 Jul; 75 (1), pp. 8-14, PMID 2045924 .
↑ Forsting and Wanke: Endovascular therapy of intracranial aneurysms. In: Neurologist. 2006; 77 (Supplement 01), pp. 31-38, PMID 16897047 (current German-language review.
↑ van der Schaaf et al: Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage . Cochrane Database Syst Rev. 2005 Oct 19; (4): CD003085. PMID 16235314 .
↑ de Oliveira et al .: Comparison between clipping and coiling on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. In: Neurosurgical Review 2006; PMID 17061137 .

[1] Guglielmi et al .: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. In: Neurosurg. 1991 Jul; 75 (1), pp. 8-14, PMID 2045924 .

[2] Forsting and Wanke: Endovascular therapy of intracranial aneurysms. In: Neurologist. 2006; 77 (Supplement 01), pp. 31-38, PMID 16897047 (current German-language review.

[3] van der Schaaf et al: Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage . Cochrane Database Syst Rev. 2005 Oct 19; (4): CD003085. PMID 16235314 .

[4] Oliveira et al .: Comparison between clipping and coiling on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. In: Neurosurgical Review 2006; PMID 17061137 .