RT Journal Article
SR Electronic
T1 How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 157
OP 162
DO 10.1136/neurintsurg-2021-018361
VO 15
IS 2
A1 Mingqi Zhang
A1 Zhongbin Tian
A1 Yisen Zhang
A1 Ying Zhang
A1 Kun Wang
A1 Xiaochang Leng
A1 Xinjian Yang
A1 Jianping Xiang
A1 Jian Liu
YR 2023
UL http://jnis.bmj.com/content/15/2/157.abstract
AB Background Pipeline embolization device (PED) deployment combined with coil therapy for large complex intracranial aneurysms is effective and considered superior to PED deployment alone. However, the optimal strategy for use of coils remains unclear. We used patient-specific aneurysm models and finite element analysis to determine the ideal packing density of coils after PED placement.Methods Finite element analysis was used to provide a higher-fidelity model for accurate post-treatment computational fluid dynamics analysis to simulate the real therapeutic process of PED and all coils. We then calculated and analyzed the reduction ratio of velocity to identify the hemodynamic change during PED deployment and each coil embolization.Results Sixteen consecutive patients underwent PED plus coil procedures to treat internal carotid artery intracranial aneurysms. After PED deployment, the intra-aneurysmal flow velocity significantly decreased (15.3 vs 10.0 cm/s; p<0.001). When the first coil was inserted, the flow velocity in the aneurysm further decreased and the reduction was significant (10.0 vs 5.3 cm/s; p<0.001). Analysis of covariance showed that the effect of the reduction ratio of velocity of the second coil was significantly lower than that of the first coil (p<0.001)—that is, when the packing density increased to 7.06%, the addition of coils produced no further hemodynamic effect.Conclusion Adjunct coiling could improve the post-PED hemodynamic environment in treated intracranial aneurysms. However, dense packing is not necessary because the intra-aneurysmal hemodynamics tend to stabilize as the packing density reaches an average of 7.06% or after insertion of the second coil.Data are available upon reasonable request. Not applicable.