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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurointervention

Suspected Metallic Embolism following Endovascular Treatment of Intracranial Aneurysms

R. Yasuda, M. Maeda, M. Umino, Y. Nakatsuka, Y. Umeda, N. Toma, H. Sakaida and H. Suzuki
American Journal of Neuroradiology September 2016, 37 (9) 1696-1699; DOI: https://doi.org/10.3174/ajnr.A4804
R. Yasuda
aFrom the Departments of Neurosurgery (R.Y., Y.N., Y.U., N.T., H.Sakaida, H.Suzuki)
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M. Maeda
bRadiology (M.U., M.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan.
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M. Umino
bRadiology (M.U., M.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan.
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Y. Nakatsuka
aFrom the Departments of Neurosurgery (R.Y., Y.N., Y.U., N.T., H.Sakaida, H.Suzuki)
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Y. Umeda
aFrom the Departments of Neurosurgery (R.Y., Y.N., Y.U., N.T., H.Sakaida, H.Suzuki)
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N. Toma
aFrom the Departments of Neurosurgery (R.Y., Y.N., Y.U., N.T., H.Sakaida, H.Suzuki)
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H. Sakaida
aFrom the Departments of Neurosurgery (R.Y., Y.N., Y.U., N.T., H.Sakaida, H.Suzuki)
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H. Suzuki
aFrom the Departments of Neurosurgery (R.Y., Y.N., Y.U., N.T., H.Sakaida, H.Suzuki)
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    Fig 1.

    A left ICA aneurysm in case 1 (A) is embolized by using multiple coils (B). Postprocedural DWI shows abnormal low-intensity spots with a hyperintense halo (white arrow) in the left parietal (C) and frontal (D) lobes. These are different from a bright spot in the left parietal lobe (E), indicating thromboembolism. These abnormal spots are low intensity on T1WI (F) and T2WI (G) and show a blooming effect on T2*-weighted images (H). Follow-up MR imaging obtained 13 months after the procedure shows that all the abnormal signal spots remain without any signal changes (I–L).

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    Fig 2.

    An anterior communicating artery aneurysm in case 5 (A) is embolized by using multiple coils (B). Postprocedural DWI shows an abnormal low-intensity spot with a hyperintense halo (white arrow) in the right frontal lobe (C), which is undetectable on the postprocedural CT (D). Follow-up MR imaging obtained 3 years after the procedure shows that the lesion remains without any signal changes (E and F).

Tables

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    Table 1:

    Patient characteristics

    Case No.Patient Age (yr)/SexLocation of AneurysmAneurysm Size (mm)ProcedureProcedural Time (min)Postprodedural Symptoms
    168/FLeft ICA10.2 × 8.2 × 7.3Coil embolization170None
    256/MRight vertebral artery15.6 × 7.1 × 6.5Internal trapping135None
    380/FRight ICA12.6 × 10.3 × 11.0Coil embolization150None
    445/FRight ICA4.9 × 4.5 × 4.3Coil embolization158None
    570/MAnterior communicating artery9.6 × 7.1 × 9.5Coil embolization145None
    641/FLeft ICA5.6 × 4.9 × 3.8Coil embolization150None
    • View popup
    Table 2:

    Devices used for treatment in each case

    Devices123456
    0.035-inch Radifocus Standarda○○○○○○
    0.035-inch Radifocus Stiffa○
    0.035-inch Quick Flex Standardb○
    0.010–0.014-inch Tenroub○○○○○
    0.014-inch CHIKAIc○○○○
    0.010-inch X-Pediond○
    0.010-inch SilverSpeedd○
    0.014-inch Traxcesse○
    Excelsior SL-10f○○○○○
    Headway17e○○
    Prowler Select Plusg○
    Hydrogel coilse○○
    ED coilsb○○○○
    Target coilsf○○○
    Cashmereg○
    VFCe○
    Orbit Galaxyg○○○
    Deltapaqg○
    Deltaplushg○
    Matrix coilsf○
    Scepter XCe○○
    HyperFormd○
    Enterprise VRDg○
    Amplatz GooseNeck Snared○
    • Note:—○ indicates that the product was used.

    • ↵a Terumo, Tokyo, Japan.

    • ↵b Kaneka Medix, Osaka, Japan.

    • ↵c Asahi Intecc, Aichi, Japan.

    • ↵d Covidien, Irvine, California.

    • ↵e MicroVention, Tustin, California.

    • ↵f Stryker, Kalamazoo, Michigan.

    • ↵g Codman & Shurtleff, Raynham, Massachusetts.

    • View popup
    Table 3:

    Past cases of suspected metallic embolism

    AuthorPatient/SexT2WI/ProtonT2*-Weighted ImageCTSuspected EtiologySymptom
    Wingerchuk et al735/FLow intensity haloLow intensity bloomingNormalProsthetic cardiac valveNone
    Naumann et al866/MLow intensity haloNot availableNot availableProsthetic cardiac valveSeizure
    Jassal et al955/MLow intensity haloNot availableNormalCoronary guidewireHeadache
    Roshal et al1055/FLow intensityLow intensity blooming, haloNormalCoronary guidewire, robotic surgeryHeadache
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American Journal of Neuroradiology: 37 (9)
American Journal of Neuroradiology
Vol. 37, Issue 9
1 Sep 2016
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Cite this article
R. Yasuda, M. Maeda, M. Umino, Y. Nakatsuka, Y. Umeda, N. Toma, H. Sakaida, H. Suzuki
Suspected Metallic Embolism following Endovascular Treatment of Intracranial Aneurysms
American Journal of Neuroradiology Sep 2016, 37 (9) 1696-1699; DOI: 10.3174/ajnr.A4804

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Suspected Metallic Embolism following Endovascular Treatment of Intracranial Aneurysms
R. Yasuda, M. Maeda, M. Umino, Y. Nakatsuka, Y. Umeda, N. Toma, H. Sakaida, H. Suzuki
American Journal of Neuroradiology Sep 2016, 37 (9) 1696-1699; DOI: 10.3174/ajnr.A4804
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