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Background and Purpose: Many wide-necked aneurysms are difficult or impossible to treat with the Guglielmi detachable coil (GDC). The purpose of this study was to evaluate the use of a neck bridging device, the TriSpan coil, in combination with standard GDCs for the treatment of wide-necked aneurysms in an experimental canine aneurysm model., Methods: Of 24 experimental aneurysms in 12 animals, 19 (7 lateral and 12 terminal) were treated with the TriSpan coil in conjunction with standard GDCs. Digital subtraction angiography (DSA) was performed on all animals immediately after treatment. In 6 animals, follow-up DSA and histological evaluation were performed 4 weeks after treatment. In the remaining 6, DSA was done at both 90 and 180 days after treatment. Histological evaluation was done immediately after the 180-day angiographic evaluation., Results: The TriSpan was easy to use in conjunction with the standard GDC. Because of their geometry, some lateral aneurysms were difficult or impossible to treat with this device. Greater than 90% aneurysm occlusion was obtained in all 19 aneurysms. In no instance was there evidence of coil migration, herniation, or aneurysm recanalization. Histological evaluation of the tissue surrounding the TriSpan coil showed tissue responses similar to that seen with standard GDCs., Conclusions: These results show that the TriSpan coil in conjunction with standard GDCs can be used safely and effectively for the treatment of wide-necked aneurysms in this canine model. Positioning and deployment of the neck bridge in aneurysms having an acute angle with the long axis of their parent artery are difficult or impossible. It is likely that this device, used in conjunction with the standard GDC, will allow treatment of some wide-necked aneurysms that are not treatable with the GDC alone.

Background and Purpose: Previous studies have depicted arterial and aneurysmal anatomy with three-dimensional time-of-flight (3D-TOF) MR angiography before and after treatment with Guglielmi detachable coils (GDCs) and with CT angiography before and after treatment with stents and stent-grafts. We investigated the ability of time-resolved contrast-enhanced 3D MR angiography (3D MR digital subtraction angiography [DSA]) to accurately depict the anatomy of experimental lateral aneurysms before and after treatment with GDCs and a variety of stents or stent-grafts, and compared these findings with 3D-TOF MR angiography without and with contrast enhancement and CT angiography., Methods: Two nitinol stents, two nitinol-polytetrafluoroethylene (PTFE) stent-grafts, and two stainless steel stents were deployed in three dogs with experimental carotid aneurysms. In a fourth animal, one of three aneurysms was completely occluded with GDCs. The other two aneurysms were loosely packed to ensure persistence of some residual aneurysmal lumen. Cut-film angiography, CT angiography, 3D-TOF MR angiography without and with contrast enhancement, and 3D MR DSA were performed in all dogs before and 3 weeks after treatment., Results: 3D MR DSA was superior to conventional 3D-TOF MR angiography without and with contrast enhancement in accurately depicting experimental lateral aneurysms and superior to CT angiography in depicting aneurysms treated by GDCs. 3D MR DSA and CT angiography were comparable in depicting vessels treated with nitinol stents and stent-grafts, whereas CT angiography was superior for showing vessels treated by stainless steel stents., Conclusion: We recommend further development and clinical evaluation of 3D MR DSA for imaging cerebral aneurysms before and after treatment with GDCs. 3D MR DSA or CT angiography may be useful for evaluating vessels containing nitinol stents or nitinol-PTFE stent-grafts, whereas CT angiography should be used for follow-up of vessels treated by stainless steel stents.

Purpose: To study the feasibility of using an iodinated particulate contrast agent, iodipamide ethyl ester (IDE), for angiography., Materials and Methods: IDE at doses of 40-100 mg of iodine per kilogram was diluted to a total volume of 5-20 mL and used for digital subtraction angiography in nine dogs under general anesthesia. Equivalent images were obtained by using water-soluble contrast medium (WSCM) for comparison (iohexol) in seven animals. All images were reviewed by blinded reviewers and graded subjectively on a five-point scale., Results: Angiographic studies of multiple vascular territories performed with IDE yielded images of slightly lower overall quality compared with images obtained with WSCM (P = .14, Mann-Whitney U test). Arterial phase images were subjectively superior with WSCM when compared with IDE (P < .0001, chi 2.) Depiction of the corresponding veins during the venous phase on the IDE angiograms was superior to that on WSCM angiograms in 12 of 21 cases, although this did not reach statistical significance (P > .05 chi 2). Images of the renal vein and portal vein achieved with IDE were graded as superior to those achieved with WSCM in eight of 10 reviews., Conclusion: Angiography is feasible with IDE. Compared with WSCM, IDE produced images of lesser quality during the arterial phase, but of equal or superior quality in the venous phase depending on the vessel studied. Because it is excreted slowly in bile and is isotonic, it may prove useful in patients with renal insufficiency, diabetes, multiple myeloma, or severe coronary disease.

Rationale and Objectives: We assessed whether intestinal ischemia would result in transudation of orally administered gadopentetate dimeglumine into the peritoneal cavity., Methods: Twenty-eight rats were anesthetized and midline laparotomy was performed. Animals were divided into four groups: control, ligation of a single mesenteric arcade, ligation of six consecutive arcades, and ligation of the anterior mesenteric artery (analogous to the superior mesenteric artery in humans). A 1.0-ml enteric bolus of gadopentetate dimeglumine diluted with sterile water (1:1) was given via gavage. Magnetic resonance imaging was performed 2 hr after laparotomy and reviewed for the presence of intraperitoneal gadopentetate dimeglumine by two experienced observers. Animals were sacrificed 24 hr after surgery for pathologic examination., Results: Four animals died prior to sacrifice. The bladder had a grossly high signal in all cases, implying some degree of intravascular absorption of the contrast material. A correlation was found between increasing mean radiology scores and increasing numbers of ligated vessels. The intraperitoneal signal tended to be higher in experimental animals than in control animals. Histologic damage was more severe in experimental animals (ischemic changes extending deeper into the intestinal wall) than in control animals., Conclusion: Direct visualization of spilled gastrointestinal gadopentetate dimeglumine helped discriminate ischemic from control rats in this model.

Purpose: To determine the effect of proximal flow arrest on the frequency and timing of distal embolic events during occlusion of the common femoral artery with detachable coils., Methods: Twenty-three complex fibered platinum coils were delivered into 10 common femoral arteries without proximal flow arrest. The arteries were continuously monitored for flow and embolic events by Doppler sonography during delivery and for at least 10 minutes after delivery of each coil. Thirty-four coils were delivered into 6 arteries after proximal flow arrest by inflation of a nondetachable balloon. After balloon deflation, each artery was monitored by Doppler sonography for 10 minutes., Results: In the 10 arteries occluded without flow arrest, 87 events (8.7 per artery) occurred, of which 47 were embolic and 40 were indeterminate. In the 6 arteries with flow arrest, the number of emboli detected was 3 (0.5 per artery). Embolic events occurred only if there was residual flow. In those arteries that were occluded when the flow-arrest balloon was deflated, no emboli were detected., Conclusions: Proximal flow arrest virtually eliminates the risk of distal emboli during arterial occlusion with detachable fibered coils. The use of fibered coils, in conjunction with proximal flow arrest, allows for safe arterial occlusion when detachable balloons are not available or their use is not feasible.

Our objective was to evaluate the efficacy of MR imaging as compared with conventional hysterosalpingography (HSG) for the detection of fallopian tube patency after uterine injection of contrast material. Rabbit uterine horns (n= 18) were catheterized transvaginally. Five fallopian tubes were ligated and 11 were left unaltered. T1-weighted gradient-echo MR images were obtained before, during, and after injection of 1.0-3.0 mL of a dilute gadolinium-containing contrast agent. Corresponding conventional studies were performed with an equivalent volume of iohexol. Images were evaluated by two blinded readers. Observers agreed in all cases on the presence (n = 11) or absence (n = 5) of peritoneal spill with conventional HSG. Interpretation of MR HSG concurred with conventional HSG in 14 of 16 cases for each observer (P > .05). Reasons for misdiagnosis included small amounts of spill (n = 2), artifact (n = 1), and subtle spill between bowel loops (n = 1). Sensitivity and specificity for MR HSG were 95.5% and 70%, respectively, for the diagnosis of tubal patency/occlusions. No statistical difference was found between MR HSG and conventional HSG for the diagnosis of fallopian tube patency/obstruction. Potential advantages of MR HSG include no ionizing radiation, potentially diminished local contrast toxicity, superior visualization of uterine fibroids and endometriosis, and visualization of ovaries. We conclude that this technique warrants further study, including the use of a primate model to better simulate human anatomy.

Rationale and Objectives: We conducted a pilot study to determine the potential advantages of using liver-specific targeted computed tomography (CT) contrast agents for lesion detection., Methods: Eight dogs had liver infarcts created by percutaneous injections of ethanol. Each dog underwent CT scans with four imaging techniques: unenhanced, intravenous contrast enhanced (IVCE), CT arterial portography (CTAP), and targeted liver enhancement with iodipamide ethylester (IDE) particles. Lesions were assessed quantitatively to determine liver-to-lesion density differences and the drop in density across liver edge as a quantitative measure of edge sharpness. Expert readers subjectively analyzed data to determine lesion visibility and edge sharpness., Results: Liver-to-lesion density differences were greatest with CTAP (56.4 +/- 35.5 Hounsfield units [H]) followed by IDE (41.1 +/- 7.0 H), i.v. (22.7 +/- 6.0 H), and unenhanced scans (13.6 +/- 4.1 H; ps < .05 for CTAP versus unenhanced and IDE versus unenhanced). Edges were best defined both subjectively and quantitatively on IDE-enhanced scans., Conclusion: Targeted liver-specific contrast agents have potential to increase lesion visibility when compared with standard i.v. contrast enhancement of the liver by increasing lesion edge definition and liver-to-lesion attenuation differences. Further work in animal tumor models, and clinical trials as agents become available, appears justified.

A new retrieval device for use in small vessels was evaluated in a canine model. Retrieval was attempted on 25 coils, three silicone balloons, and five catheter and guide wire fragments placed in the renal, pulmonary, hepatic, brachiocephalic, subclavian, carotid, and maxillary arteries. This was successful in 91% (30/33). The snare could also be selectively placed in the vertebral and proximal basilar arteries.

A canine model of terminal aneurysms using a venous pouch surgical technique is described. This model mimics the anatomy and hemodynamics of some types of carotid and basilar tip aneurysms. This technique produces aneurysms 15 x 21 mm in size. The aneurysms have been used to investigate the hemodynamics and treatment of terminal aneurysms.

Purpose: To evaluate and compare the deliverability, positioning, stability, and effectiveness of aneurysm occlusion and the incidence of parent-artery thrombosis of two different types of platinum coils, using a canine carotid aneurysm model., Methods: 29 experimental canine carotid aneurysms (19 lateral, 6 bifurcation, and 4 terminal) were constructed and treated with complex-shaped fibered platinum coils and simple curved nonfibered platinum Guglielmi detachable coils (GDCs)., Results: Fibered complex coils were stable, producing 38% complete aneurysm occlusion and 61% average reduction in aneurysm lumen size but resulting in 19% parent artery occlusions. GDC coils were stable, producing 31% complete aneurysm occlusion and 95% average reduction in aneurysm lumen size with no parent-artery occlusions., Conclusions: GDC coils produced an average reduction in aneurysm lumen size of 95% without any associated parent-artery occlusions. There were no delayed migrations of GDC coils. The ability to remove, reposition, and detach a coil was the most significant feature of the GDC coil.

This study was designed to investigate the thrombogenicity, inflammatory response, and endothelial response to the presence of sterilized, 1-French polyethylene catheters implanted into the arterial system and subcutaneous tissues of 18 rats and two dogs. At time periods ranging from 1 week to 6 months, repeat angiography was done, the animals sacrificed, and the tissues containing the catheter removed for histologic study. In the subcutaneous tissues the catheter became encased in a very thin (less than 0.5 mm) coating of fibrous tissue with no evidence of inflammation. In large vessels, the catheter at all time periods appeared identical both angiographically and histologically to that at the time of implantation. In small to medium-sized vessels a slight increase in vessel size (25% increase in diameter of the rat iliac) was observed angiographically. On histologic evaluation, there was evidence of myointimal hypertrophy, which was asymmetrically placed, centered around the position of the catheter. There was no evidence of thrombi or of incorporation of the catheter itself into the hypertrophic tissue. In dogs and rats, an implanted 1-French polyethylene catheter is well tolerated: the animals showed no evidence of thrombotic, thromboembolic, or inflammatory complications. Myointimal hypertrophy was observed in small to medium-sized arteries, which is of unknown significance.

The objectives of this study were to investigate the consistency, patency, and natural history of a vein graft canine aneurysm model and to determine the effectiveness of various coil designs on inducing aneurysm thrombosis. Twenty-one sacculuslike aneurysms were created in mongrel dogs by anastomosing a vein pouch to the common carotid artery. The model produced wide-neck aneurysms with 100% patency. The canine vein graft aneurysm provided an excellent model for the evaluation of endovascular devices. Three types of specially designed platinum coils were placed in the aneurysms: those with simple curves, those with complex curves, and those with flower petal curves and silk fibers. These coils were placed by the endovascular route by means of microcatheters. Flower petal coils with silk fibers were effective in producing thrombosis of the aneurysms, suggesting that coils of the appropriate design may be useful in the endovascular treatment of aneurysms. The other coil designs evaluated, those with simple and complex curves without silk fibers, demonstrated insufficient thrombogenicity and spatial stability.