Technique

Guglielmi detachable coils consist of a soft platinum coil attached by solder to a stainless steel delivery wire. This allows an individual coil to be repositioned or removed from an aneurysm under fluoroscopic control should its position or size not be correct or optimal. Various coils are available. They vary in the size of the helical diameter (2-20 mm) and length. The diameter of the core wire and primary coil also comes in two sizes: the GDC 10 and the GDC 18. More flexible or soft coils have been developed. A 2-D coil is also available, designed to prevent the first loop of the coil herniating out of the aneurysm into the parent artery. With this coil, the first one-and-a-half loops' helical diameter is smaller than the rest of the coil. A 3-D coil is also available, with a complex shape designed to better pack larger wider-necked aneurysms so that wide-necked aneurysms can be treated.

During the procedure, which is performed under general anesthetic, we aim to maintain heparinization at two to three times baseline. Heparinization prevents intra-arterial thrombosis, which can occur in up to 8% of procedures if unheparinized [15]. Should perioperative rupture occur, heparin can immediately be reversed with protamine sulphate IV [16].

Once the guide catheter is in situ, a micro-catheter over a wire is navigated into the aneurysm. The aneurysm is sized, usually using a UK penny or US dime placed on the patient's head. This allows for magnification to a certain degree. The first coil selected should have a helical diameter near the diameter of the aneurysmal sac and be as long as feasible. A

Fig. 19.2. a Left internal carotid angiogram, showing large lobular right anterior communicating artery aneurysm. b Angiogram showing total occlusion of the aneurysm post-coiling with 5 GDC coils. cLeft vertebral angiogram, showing a lobular aneurysm arising from the basilar trunk at the origin of the anterior inferior cerebellar artery (AICA). d Appearance post-coiling, with preservation of the AICA.

Fig. 19.2. a Left internal carotid angiogram, showing large lobular right anterior communicating artery aneurysm. b Angiogram showing total occlusion of the aneurysm post-coiling with 5 GDC coils. cLeft vertebral angiogram, showing a lobular aneurysm arising from the basilar trunk at the origin of the anterior inferior cerebellar artery (AICA). d Appearance post-coiling, with preservation of the AICA.

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