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Abstract
Introduction Coiling is the most used method for interventional aneurysm occlusion. The choice of the specific coil has an important influence on secondary regrowth, requiring retreatment, and is made based on expert opinions. Individual simulations of the coiling procedure could provide additional information and save costs for rejected coils..
Aim of Study To simulate coiling in different aneurysm geometries and to compare simulation results with clinical recurrence.
Methods In a proof-of-principle study, we simulated coiling in 6 anterior circulation cases treated with a single coil, out of which 50% had a regrowth, defined as Raymond & Roy class 2 or 3, observed in a follow–up angiography after 6 months using a newly developed numerical approach to simulate coil shapes. We then correlated simulation results with aneurysm recurrence.
Results The simulation showed various coil shapes depending on the variability in possible microcatheter positions. Aneurysms with a later recurrence showed a tendency for more frequent successful coiling attempts. Further trends suggested lower simulated packing densities in aneurysms with reoccurrence. Simulated packing densities did not correlate with those calculated by conventional software, indicating the potential for our approach to offer additional predictive value.
Conclusion Our study pioneers a comprehensive numerical model for the simulation of aneurysm coiling, providing insights into individualized treatment strategies and outcome prediction. This simulation framework holds promise for enhancing clinical decision-making and optimizing patient outcomes in endovascular aneurysm treatment after refinement in the future.
Inserted coils were characterized using Diameters D1 of the coil stock wire (A) D2, the radius of the helical shape(B) and D3 representing the macroscopic shape (C). Coiling attempts were either classified as successful (A) or unsuccessful (B) based on the Raymond & Roy classification and potential protrusion into the carrier vessel
Simulation of a coiling in a specific aneurysm. Angiographic screenshots show results immediately after coiling (left) and 6 months after coiling (right). Case 2 had a full occlusion after 6 months (R & R 1), Case 4 had a coil compactation with a neck remnant after 6 months (R & R 2) and Case 5 had an aneurysm reoccurrence classified (R & R 3B)
Disclosure of Interest no.