The Guglielmi Detachable Coil in the Treatment of Arteriovenous Fistulae

Abstract

This report describes the use of the Guglielmi Detachable Coil (GDC) (Target Therapeutics, Fremont CA) in the treatment of cervicocerebral arteriovenous fistulae. From March, 1993 to May 1995 we used GDCs in an IRB approved protocol as part of the endovascular treatment of 11 patients with arteriovenous fistulae of internal carotid, external carotid, or vertebral vessels. The patient population included four patients with dural arteriovenous fistulae, three patients with direct carotid cavernous fistulae, three patients with vein of Galen malformations, and one patient with a vertebral artery - vertebral vein fistula. In six of the 11 patients the AVF were completely occluded. Fistula occlusion occurred in two patients immediately, in three patients in a delayed fashion (three days to nine months) and in one patient the fistula was closed immediately, reopened spontaneously, and then reoccluded at a second procedure 17 months later. In five patients the fistula was incompletely occluded (20–95%). In all cases but one the coils were used in conjunction with another embolic agent. In this small series of patients we found that GDCs generally could be deposited predictably at the desired site, and that they could be observed prior to detachment to help ensure that the coil was in a secure position, decreasing the chances of unintended passage into the venous outlet. Although they rarely proved thrombogenic enough to stop the fistula, GDCs can slow the flow in a fistula, allowing other, more thrombogenic embolic agents to be deposited with a decreased risk of distal embolisation. In conclusion, we found GDCs to be a useful tool in the treatment of AV fistulae. In combination with other embolic agents, this device can aid in the safe, effective closure of these lesions.