Cellulose acetate polymer solution is a liquid thrombotic material that hardens into the shape of an
aneurysm into which it is injected.
Therapy using this
solution is a rapid technique that helps prevent the
rupture of
aneurysms, especially those that extravasate
contrast material during angiography in the acute stage of
subarachnoid hemorrhage. Using this
polymer solution and an
endovascular technique, we treated two patients who had
aneurysms of the basilar and anterior communicating 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 procedures. In both patients, postoperative angiograms demonstrated obliteration of the aneurysmal dome, including the site of extravasation or perforation. The parent artery and surrounding perforating branches were preserved. Although we do not advocate aggressive
therapy for patients who bleed during angiography, we pursued this
therapy in these two patients because of the opportunity to introduce
cellulose acetate polymer in an attempt to preserve the patients' lives. Unfortunately, both patients died. Histopathological studies performed at the time of autopsy demonstrated that the
luminal surface of
cellulose acetate polymer 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
luminal surface.(ABSTRACT TRUNCATED AT 250 WORDS)