CELLULOSE-ACETATE POLYMER THROMBOSIS FOR THE EMERGENCY TREATMENT OF ANEURYSMS - ANGIOGRAPHIC FINDINGS, CLINICAL-EXPERIENCE, AND HISTOPATHOLOGICAL STUDY

CELLULOSE ACETATE POLYMER solution is a liquid thrombotic material tha t hardens into the shape of an aneurysm into which it is injected. The rapy using this solution is a rapid technique that helps prevent the r upture of aneurysms, especially those that extravasate contrast materi al during angiography in the acute stage of subarachnoid hemorrhage. U sing this polymer solution and an endovascular technique, we treated t wo patients who had aneurysms of the basilar and anterior communicatin g arteries with extravasation of contrast material during angiography a few hours after the initial subarachnoid hemorrhage. In one patient with an aneurysm of the anterior communicating artery, the aneurysm's wall was perforated with the catheter during neurointerventional proce dures. In both patients, postoperative angiograms demonstrated obliter ation of the aneurysmal dome, including the site of extravasation or p erforation. The parent artery and surrounding perforating branches wer e preserved. Although we do not advocate aggressive therapy for patien ts who bleed during angiography, we pursued this therapy in these two patients because of the opportunity to introduce cellulose acetate pol ymer in an attempt to preserve the patients' lives. Unfortunately, bot h patients died. Histopathological studies performed at the time of au topsy demonstrated that the luminal surface of cellulose acetate polym er was covered with thrombus by 6 days after cellulose acetate polymer thrombosis. By 10 days, the thrombus had a prominent fibrin network, a concentrated plasma component, and few fibrocytes adhering to its lu minal surface. The clinical description and results of treatment and h istopathological studies are presented here.