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401

Technical

Platinum

Microcoils

for Therapeutic

Nonneuroradiologic Steven

S. Morse,1

Robert

A. Clark,

and Ann Puffenbarger

was

catheterization

of small

and/or

microcoil

(Cook

introduced

tortuous

microcoil occlusion

obtained

0179.

January

Address

AJR 155:401-403,

30, 1990;

Department

accepted

of Radiology,

all correspondence

after revision

coaxially

via

coils

were

by pinching

the

loaded

into

the

microcatheten

with

with a coil pusher. Hilal coils were

introducer

between

thumb

and

forefinger

embolization

at the

level

of

the

inguinal

ring.

Successful

was assessed angiographically, and clinical follow-up where applicable, ranging from 2 to 1 0 months later.

was

for symptomatic varicoFour patients with mus-

culoskeletal sarcoma underwent nedistributive, reductive embolization to permit single catheter intraarterial chemotherapy; branches of the superficial femoral artery were embolized in two, a popliteal artery branch in one, and subclavian artery branches in one. One patient had redistributive embolization of distal hepatic artery branches to exclude a cavernous hemangioma before hepatic artery chemoembolization. One

patient had an interlobar renal artery embolized for a postnephrostomy pseudoaneurysm and arteniovenous fistula. One patient underwent embolization of the anterior divisions of the

March 13, 1990.

H. Lee Moffitt

Cancer

and Aesearch

Institute at the University

to S. S. Morse.

August 1990 0361 -803X/90/1

Flower

plunger and delivered

Three patients had embolization cele, with relief of pain in all three.

were developed for neunoradiologic used platinum microcoils, delivered in a variety of nonneunoradiologic

during

All authors:

placed

Results

microcoils were used for therapeutic embolization in i 0 an 8-month period. The patients ranged in age from 20 to 79 years. Six were women and four were men. Flower coils were used in nine patients and Hilal coils in one. The Tracker catheter

1

in all 1 0 patients,

Co., Bloomington,

and Methods

Received

coil delivery

and removing the shipping stylet and were delivered with standard 0.014-0.01 8 in. (0.035-0.045 cm) guidewines. Platinum microcoils, 2-4 mm in diameter, were the sole embolic agent in five patients and were combined with Ivalon (Pacific Medical, San Diego, CA) particles 250-590 m in diameter in two patients. The three patients with vancocele had steel coils placed at the gonadal vein origin after

Platinum

patients

The

the supplied

clinical contexts. Materials

for

in diameter.

vessels can be accomplished readily with commercially available microcatheters, such as the 2.2-French Tracker-i 8 (Target Therapeutics, Santa Monica, CA) catheter. Standard steel coils cannot be delivered via microcathetens, however. Platinum microcoils, originally developed for neunoradiologic intervention, were designed to be compatible with microcatheter delivery systems. Two types are commercially available: the Flower microcoil (Target Therapeutics, Santa Monica, CA) and the Hilal IN). Although they originally use, we have successfully via the Tracker catheter,

used

standard 5.0- to 6.5-French angiognaphic catheters. The microcatheter was placed oven guidewines 0.01 4-0.01 8 in. (0.035-0.045 cm)

delivery catheter at the desired location of coil occlusion, which may not be possible with very small on very tortuous vessels and standard angiographic catheters. selective

Embolization:

Applications

Mechanical coil embolization devices have been in widespread use for a number of years and are effective in creating a localized, permanent vascular occlusion [1 , 2]. A limitation of standard steel coils is the need to place the tip of the

Highly

Note

552-0401

C American

Roentgen

Ray Society

of South

Florida,

P.O. Box

2801 79, Tampa,

FL 33682-

402

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hypogastnic

MORSE

arteries

to control

hemorrhage

from

bladder

san-

coma. Successful occlusion was documented angiognaphically in all 10 patients. No episodes of inadvertent coil embolization, coil migration, vessel perforation, on other known complications of standard coil embolotherapy were encountered.

Discussion The platinum microcoils that are currently available oniginally were developed to meet a need for highly selective embolization in the brain and spine, and evolved from “homemade” fragments of platinum tip guidewines [3]. Microcoils combine the attractive features of standard embolization coils, that is, ease of delivery, apparent permanence, and safety, with the ability to be delivered via versatile microcathetens. Among currently available embolization devices, the detachable miniballoon [4] is most analogous in terms of per-

ET AL.

AJR:155, August 1990

manence and size. Our own small, successful experience in using platinum micnocoils distally in the gonadal vein suggests that they may be a reasonable alternative agent for vanicocele embolization, with less set-up time and experience required for their use. The microcatheter delivery system is easy to place as far distally in the gonadal vein as desired, on both the night and left sides. Collateral branches can be easily selected as well (Fig. 1). Detachable miniballoons remain the gold standard in vanicocele embolothenapy, with a reported experience of 650 patients during a i 0-year period [5]. The indication for embolization in five of our patients was reduction or redistribution of arterial supply before chemoinfusion of musculoskeletal sarcomata or chemoembolization of the liven. Previous experience with nedistnibutive embolization in larger vessels has shown the efficacy of standard steel coils in providing a desirable hemodynamic result [6]. Our own experience (Fig. 2) suggests that platinum microcoils are similarly effective in smaller arteries, as judged by precheFig. 1-39-year-old man with scrotal pain. A, Left gonadal venogram obtained during Valsalva maneuver shows a varicocele and yeseel tortuosity (arrow). B, Venogram obtained after embolization

shows Flower coils in place distally vein, despite

in gonadal

tortuosity.

Fig. 2-76-year-old A, Left superficial a branch of proximal

woman with liposarcoma. femoral arteriogram shows pophteal

artery

supplying

lower pole of patient’s liposarcoma (arrow). B, Profunda femoral arteriogram obtained after embolization of popliteal artery branch shows a uniform parenchymal blush (straight arrows). Note retrograde filling of embolized popliteal artery branch to point of coil placement (curied

arrows).

PLATINUM

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AJR:155, August 1990

moinfusion 99mTc-labelled macroaggnegated albumin intnaarterial perfusion scanning. In embolizing small, tortuous branches of the superficial femonal on popliteal arteries, the ease of distal placement of the delivery micnocatheten adds to procedural safety, minimizing the risk of inadvertent embolization of the major conduits of the leg. Substantial precedent for steel coil embolization in larger renal arteries exists, primarily for neoplastic disease [7]. Small-vessel renal-sparing embolization for bleeding intrarenal arterial lesions has been accomplished most often with manually prepared Gelfoam (Upjohn, Kalamazoo, MI) pledgets [8]. Platinum micnocoils are similar in size to the usual Gelfoam pledget and can be readily delivered at the distal intenloban arterial level with the added advantage of permanency. An alternative to standard stainless steel coils that may be appropriate for small vessels is Giantunco minicoils (Cook Co., Bloomington, IN), which can be delivered via catheters ta-

pered to a 0.025 in. (0.063 cm) guidewine and are available in 2-, 3-, and 5-mm diameters. Our experience with these minicoils has been limited, platinum micnocoils.

precluding

a direct

comparison

with

403

MICROCOILS

The two types of commercially available microcoils differ somewhat in design (Fig. 3). The Flower coil, as the name suggests, assumes a multilobular configuration when vessel size permits complete expansion, lacks fibers, and requires a separate “pusher” catheter with a long Teflon segment for delivery. The Hilal coil is available in straight on curved shapes, is braided with synthetic fibers, and can be delivered with a guidewire. Our experience with the Hilal microcoil has been limited, precluding a direct comparison between the two types of microcoils. In summary, platinum microcoils, of proved value in the CNS, appear to be a valuable addition to the array of available embolic agents for the viscera and extremities.

REFERENCES

1 . Gianturco

C, Anderson

JH,

Wallace

S. Mechanical

devices

for arterial

occlusion. AJR 1975;124:428-435 VP, Wallace 5, Gianturco C. A new improved coil for tapered-tip catheter for arterial occlusion. Radiology 1980;1 35:507-509 3. Yang PJ, Halbach VV, Higashida AT, Hieshima GB. Platinum wire: a new transvascular embolic agent. AJNR 1988;9:547-550 2. Chuang

4. White RI Jr, Kaufman Occlusion of vancoceles 327-334

SL, Barth KH, with detachable

Kadir 5, Smith JW, balloons. Radiology

Walsh PC. 1981;139:

5. Dunnick NA, Illescas FF, Mitchell 5, Cohan RH, Saeed M. Interventional uroradiology. Invest Radio! 1989;24:831 -841 6. Chuang VP, Wallace S. Hepatic arterial redistribution for intraarterial infusion of hepatic

neoplasms.

Radiology

1980;135:295-297

7. Wallace 5, Chuang VP, Swanson D, et al. Embolization experience with 100 patients. Radiology 8. Barry JW, Bookstein JJ. Transcatheter tract. Uro! Radio! 1981;2:21 1-221

of renal carcinoma:

1981;138:563-570 hemostasis in the genitourinary