Objective The duration and complications of coiling are dependent on several factors. These include experience with the armamentarium and the expertise of the operator. Also, the angioarchitecture of the blood vessel can play an important role in the duration of the procedure and outcome.
Methods 41 patients underwent endovascular coiling. The angioarchitecture of the vessels in terms of the course of the blood vessels from the arch of the aorta to the aneurysm, and the angles between the arch and its branches, between the parent and feeding arteries, and between the feeding artery and the aneurysm were measured. During coiling, duration, attempts, complications, and outcome were recorded. A correlation was made between angioarchitecture and difficulty during coiling.
Results Based on number of attempts of coiling, two groups were defined. In group I, 26 patients underwent a single attempt with a mean duration of 61 min and in group II, 15 patients had more than one attempt with a mean duration of 98 min. The mean angle between the arch and its branches, between the internal carotid artery and the anterior cerebral artery, and between the anterior communicating artery and the aneurysm was more acute in group II compared with group I. Spearman's correlation suggested that as the angle at different vessel levels decreased, duration, attempt, and complications increased, and vice versa.
Conclusions Angioarchitecture analysis revealed that the sharper the angle (acute angle) between various vessels, the greater the difficulty in negotiating a microcatheter through the vessels and the more complications, duration, number of attempts, and poor outcome. We therefore feel that angioarchitecture analysis should be done carefully in all patients in whom the decision to undergo coiling is taken.
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Contributors DS is the main coordinating investigator of the neurological center; he designed and conducted the study. HS is the coordinating investigator of the neurological centers and helped conduct the study. KP collected and analyzed the data. MT and PG are coordinating investigators of the anesthesiology center, and participated in the design of the study and writing of the manuscript. PN is the coordinating investigator of the radiology center, and has participated in writing the manuscript and collecting the data.
Competing interests None declared.
Ethics approval The study was approved by the institutional ethics board, Maulana Azad Medical College, Delhi.
Provenance and peer review Not commissioned; externally peer reviewed.