European Conference on Embolotherapy
ET countries

June 1-4 | Vienna, Austria

Mastering embolization

June 1-4 | Vienna, Austria

Mastering embolization

June 1-4 | Vienna, Austria

Mastering embolization

June 1-4 | Vienna, Austria

June 1-4 | Vienna, Austria

ProgrammeHighlight topicsPlugs and coils – tips and tricks

Plugs and coils – tips and tricks


Three reasons to watch my lecture on demand

  1. Plugs and coils are very important tools for different kind of embolization procedures and every IR should be familiar with these great IR tools.
  2. Plugs and coils might be used by beginners in IR as well as highly experienced IRs in complex interventions – the lecture will bring a benefit to all stages of IR experience.
  3. The four lectures in this session will deal with coils and plugs and possible complications as well as tips & tricks in order to achieve the best embolization result.

Dr. Florian Wolf
Speaker bio | Watch lecture

Plugs and coils are very important tools in interventional radiology. Whenever you want to occlude something, plugs and/or coils might be used. The classical application of those devices is any kind of vessel sacrifice (e.g. endoleak treatment, arterial bleeding, preventive embolization before surgery, etc.) or any kind of aneurysm (cerebral or peripheral). Various smaller and some larger studies deal with the question if coils or plugs are the preferable choice. However, in reality the IR has to decide from case to case what device is the better choice, also depending on the local situation, availability of the respective tools, own experience, and costs.

Vascular plugs

The most common plugs on the market are the Amplatz vascular plugs and more recent the microvascular plugs. The Amplatz plugs are available in different types (Amplatz vascular plug, Amplatz vascular plug II and IV) that are different in size and length and are available in diameters up to 22mm. The plugs are delivered via a macrocatheter for the smaller plugs and via guiding catheters or sheaths for the larger plugs. The sizing of the plug depends on the indication and placement location but the oversizing might be up to 50%. The plugs are made of an nitinol mesh and in most cases there is not an instant occlusion achievable since it needs some time to get enough clotting for a complete vessel occlusion. This does not matter in indications like vessel sacrifice for example before stentgraft placement, but definitively might be a problem in bleeding indications. The microvascular plugs are available in 4 different sizes between 3 and 9mm and have a treatment range between 1.5mm and 9mm. The microvascular plugs are delivered via micro- or macrocatheters and consist of a self-expandable nitinol network covered with a membrane. These plugs achieve instant vessel occlusion and have only minor artefacts in following CT controls (in contrary to coils and larger vascular plugs).


The market of coils is a very huge one and many different coils from multiple vendors are available. In general the following classes of coils are available:

  • Macrocoils delivered via macrocatheters, these coils might be pushable or detachable
  • High volume detachable microcoils – these coils are thicker than normal microcoils with a consecutive large volume but can be delivered via a 0.025’’ microcatheter.
  • Detachable microcoils (with or without fibers)
  • Pushable microcoils (with or without fibers)

Fibered versus unfibered coils

The coils might have fibres or not, one vendor provide coils with a hydrogel coating – different studies deal with the question if the use of fibered/coated coils lead to a quicker and more durable vessel/aneurysm occlusion, nevertheless no clear data is available about that question.

Pushable versus detachable coils

In general pushable coils are cheaper than detachable coils. Nevertheless detachable coils are in longer lengths available (up to 60cm). If more coils are used in an embolization procedure detachable coils might end with the same or cheaper procedure price since a smaller number of coils is necessary for a successful embolization.

There are different mechanical or electrical detachment mechanisms available and most of the detachable coils have dedicated detachment handles in order to place the coil. The use of detachable coils is safer than the use of pushable coils. Detachable coils always can be pulled back if they do not go in the right direction or are pushed back out of the aneurysm etc.

Packing density

One important topic for all kind of coils is the packing density – the more coils are packed in a vessel/aneurysm, the higher is the packing density. With a higher packing density less compaction and recanalization of coils is achieved, this might be important especially in aneurysms – the packing density in order to achieve a durable occlusion in aneurysms should be 24% or more.

In summary, every IR should be familiar with the available plugs and coils on the market and in every IR institution a selection of plugs and coils should be available in order to be ready for all different kind of embolization procedures like bleedings or aneurysms or even any kind of vessel sacrifice.

Image 1a-c: Pulmonary AVM before (a) and after (b) embolization with a microvascular plug including CT control (C).
Image 2a-c: Combination of a vascular plug and microcoils for the embolization of an internal iliac artery aneurysm before stentgraft placement in order to prevent type II endoleak.


Florian Wolf

Medical University of Vienna, Vienna/AT

Dr. Florian Wolf, EBIR, EBIR-ES, FCIRSE, EBCR, MBA is an interventional radiologist at the largest hospital in Vienna/Austria. He is the Vice Chair of the Division of Cardiovascular and Interventional Radiology at the Department of Biomedical Imaging and Image-Guided Therapy at the Medical University of Vienna. Dr. Wolf is an associate professor and performs a large range of vascular and non-vascular interventional procedures including stroke treatment and complex aortic aneurysm treatment. Embolization procedures are Dr. Wolf's favourite IR treatments, as every case is different and requires lots of creativity, different interventional tools, and highly sophisticated imaging to achieve the best result.
Dr. Wolf is an active member of CIRSE and has served on the programme committees of its annual congress and the European Conference on Embolotherapy (ET). He has also been a member of the Cardiac and Vascular Subcommittee of the European Congress of Radiology. Dr. Wolf is committed to teaching and education - he is a reader in radiology and interventional radiology at the Medical University of Vienna and has given a large number of talks at national and international congresses, meetings, and courses. He has co-organized several courses on prostate artery embolization and cardiac CT and is a reviewer and editorial board member of several highly respected journals.



  1. Johnson P, Wong K, Chen Z, Bercu ZL, Newsome J, West DL, Dariushnia S, Findeiss LK, Kokabi N. Meta-analysis of Intraprocedural Comparative Effectiveness of Vascular Plugs Vs Coils in Proximal Splenic Artery Embolization and Associated Patient Radiation Exposure. Curr Probl Diagn Radiol. 2021 Sep-Oct;50(5):623-628. doi: 10.1067/j.cpradiol.2020.05.004. Epub 2020 Jun 1. PMID: 32561153.
  2. Wong K, Johnson P, Chen Z, Newsome J, Bercu Z, Findeiss LK, Dariushnia S, Rajani R, Kokabi N. A Meta-analysis of Comparative Outcome and Cost-Effectiveness of Internal Iliac Artery Embolization with Vascular Plug Versus Coil. Cardiovasc Intervent Radiol. 2020 May;43(5):706-713. doi: 10.1007/s00270-020-02425-5. Epub 2020 Feb 26. PMID: 32103305.
  3. Yu Q, Funaki B, Navuluri R, Zangan S, Zhang A, Cao D, Leef J, Ahmed O. Empiric Transcatheter Embolization for Acute Arterial Upper Gastrointestinal Bleeding: A Meta-Analysis. AJR Am J Roentgenol. 2021 Apr;216(4):880-893. doi: 10.2214/AJR.20.23151. Epub 2021 Feb 10. Erratum in: AJR Am J Roentgenol. 2021 May;216(5):1407. PMID: 33566631.
  4. Tipaldi MA, Orgera G, Krokidis M, Rebonato A, Maiettini D, Vagnarelli S, Ambrogi C, Rossi M. Trans Arterial Embolization of Non-variceal Upper Gastrointestinal Bleeding: Is the Use of Ethylene-Vinyl Alcohol Copolymer as Safe as Coils? Cardiovasc Intervent Radiol. 2018 Sep;41(9):1340-1345. doi: 10.1007/s00270-018-1981-5. Epub 2018 May 10. PMID: 29748820.
  5. Trerotola SO, Pressler GA, Premanandan C. Nylon Fibered Versus Non-Fibered Embolization Coils: Comparison in a Swine Model. J Vasc Interv Radiol. 2019 Jun;30(6):949-955. doi: 10.1016/j.jvir.2018.10.004. Epub 2019 Mar 29. PMID: 30935867.
  6. Fohlen A, Namur J, Ghegediban H, Laurent A, Wassef M, Pelage JP. Peripheral Embolization Using Hydrogel-Coated Coils Versus Fibered Coils: Short-Term Results in an Animal Model. Cardiovasc Intervent Radiol. 2018 Feb;41(2):305-312. doi: 10.1007/s00270-017-1834-7. Epub 2017 Nov 1. PMID: 29094195.
  7. Hongo N, Kiyosue H, Ota S, Nitta N, Koganemaru M, Inoue M, Nakatsuka S, Osuga K, Anai H, Yasumoto T, Tanoue S, Maruno M, Kamei N, Kichikawa K, Abe T, Hasebe T, Asayama Y. Vessel Occlusion using Hydrogel-Coated versus Nonhydrogel Embolization Coils in Peripheral Arterial Applications: A Prospective, Multicenter, Randomized Trial. J Vasc Interv Radiol. 2021 Apr;32(4):602-609.e1. doi: 10.1016/j.jvir.2020.12.001. Epub 2021 Mar 4. PMID: 33676799.
  8. Mathevosian S, Sparks HD, Cusumano LR, Roberts DG, Majumdar S, McWilliams JP. Embolization of De Novo Pulmonary Arteriovenous Malformations Using High-Volume Detachable Non-Fibered Coils: Propensity-Matched Comparison to Traditional Coils. J Clin Med. 2024 Jan 23;13(3):648. doi: 10.3390/jcm13030648. PMID: 38337343; PMCID: PMC10856390.
  9. Botsford A, Tradi F, Loubet A, Tantawi S, Soulez G, Giroux MF, Faughnan ME, Gauthier A, Perreault P, Bouchard L, Holderbaum do Amaral R, Chartrand-Lefebvre C, Therasse E. Transarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs. J Vasc Interv Radiol. 2024 Mar;35(3):349-360. doi: 10.1016/j.jvir.2023.11.018. Epub 2023 Nov 25. PMID: 38013007.
  10. Yasumoto T, Osuga K, Yamamoto H, Ono Y, Masada M, Mikami K, Kanamori D, Nakamura M, Tanaka K, Nakazawa T, Higashihara H, Maeda N, Tomiyama N. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013 Dec;24(12):1798-807. doi: 10.1016/j.jvir.2013.04.030. Epub 2013 Jun 27. PMID: 23810652.