Introduction/Purpose Despite continuous improvements in imaging quality and therapeutic options, there has been no satisfactory method to easily calculate aneurysm volumes, packing densities or occlusion grades. Previous models have been simplistic and of questionable accuracy, and rotational angiography suffers from poor spatial resolution and contrast. We describe a new software package available on the iPad and iPhone which allows for easy quantification of these entities with high accuracy based on digital subtraction angiography. Catheter compatibilities as well as a complete inventory of all endovascular coils and embolic agents allows for real-time guidance during cases. Finally, case report summaries allow for the standardization of data reporting and easy sharing with others.
Methods Mathematical models were developed for aneurysm volume calculations that are more complex than previously described 3D geometric models. These models more readily approximate common aneurysm morphologies, using the two dimensional data from a digital subtraction angiogram to create a 3D model of known depth. This model was tested against all current geometric models, and validated with known mathematical volumes and phantom models. A database of commonly utilized endovascular coils, catheters, and guide catheters was created. Exact coil lengths were used to create an algorithm, which allows for real-time packing density estimation without internet connectivity. Volumes of coils are based on manufacturer specifications. A second feature was added which easily enables assessments of catheter, balloon, and sheath compatibilities. Additionally, occlusion grades can be easily determined by taking a picture of the post-coiling aneurysm from the phone or iPad directly. Then, the application compares the pre-embolization angiogram to the post-embolization angiogram to estimate the degree of occlusion. Lastly, standard nomenclature was assembled to allow for standardized reporting. This facilitates case follow-up, on call sharing with partners, and HIPPA compliant sharing of cases with other physicians or industry representatives.
Results The AngioSuite-Neuro Edition application for the iPhone/iPad became available on iTunes late in 2010 with a recent upgrade in February of 2011. The application has proven easy to use, accurate, and has helped facilitate coil selection real-time during neurointerventional cases. This has changed how the developer of the application, a private practice neuro-interventionalist, performs aneurysm embolization. Knowing how certain coils will affect the packing density prior to coil selection has allowed the user to achieve high packing densities. Particularly, the first coil selection is now predicated by checking the resultant packing density, with a trend to achieve at least 10% packing density with the first coil selection. The data management function has helped easily disseminate important information among partners covering these patients on call. The functions of the application will be demonstrated during the presentation.
Conclusions AngioSuite-Neuro Edition is a facile, user-friendly, accurate software tool to aid in the performance of cerebral endovascular aneurysm coilings. The application is available to all interventionalists free on iTunes.
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Disclosures B. Woodward: ev3, Codman, Penumbra, Stryker, Concentric, Microvention. D. Forsberg: ev3, Codman, Penumbra, Stryker, Concentric, MicroVention.