Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Abstract

PurposeTo evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs).Materials and MethodsThirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9–83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5–6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6–36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135–0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography.ResultsIn 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2–47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization.ConclusionsHydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study

“…First, one of the most effective strategies towards improving outcomes in patients with haemoptysis would be to reduce the number of recanalisation events after ssBACE, because we have shown that this is the most common mechanism of recurrent haemoptysis. The evaluation of recently introduced hydrogel-polymer-coated platinum coils is anticipated in future studies [21][22][23]. Second, we revealed that 2nd series ssBACE can be performed with a 97.7% procedural success rate even if the proximal part of HRAs was embolised during 1st series ssBACE.…”

“…To avoid this kind of recanalisation, or to reduce the incidence of recurrent haemoptysis, we speculate that a high-packing-density-coil deployment manoeuvre, using a hydrogel-polymer-coated platinum coil or a high thrombogenic coil, might be pertinent issues in this field. The efficacy of this manoeuvre has already been shown in neurovascular and gastrointestinal areas, as well as in the treatment of pulmonary arteriovenous malformations [21][22][23].…”

Long-Term Single-Center Retrospective Follow-Up After Embolization of Pulmonary Arteriovenous Malformations Treated Over a 20-year Period: Frequency of Re-canalization with Various Embolization Materials and Clinical Outcome

“…. Newer special coil types like detachable coils and hydrocoils may also be useful in preventing re-canalization [30].…”

“…Numbers of PAVMs, feeding artery sizes, morphology of the PAVMs, treatment sessions, clinical data, contrast echocardiography (CE), and radiological examinations (chest X-ray, CT and pulmonary angiography) have been recorded. All patients who had a PAVM with feeding artery ≥ 3 mm or in some cases even smaller were treated and thus included in this analysisIn the period 1996 -2001the procedure was performed with use of DSB [30] were also used in selected cases in the last years. The embolization materials were used according to availability on the market in the respective periods.…”

Comments to “Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations”

“…We read with interest the article titled ''Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations'' [1]. The authors describe the effectiveness of using hydrogel-coated coils for the embolization of venous sac and distal arterial feeders in pulmonary AVMs.…”