How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint

Area of Science:

• Neurosurgery
• Biomedical Engineering
• Medical Imaging

Background:

• Large complex intracranial aneurysms require effective treatment strategies.
• Pipeline embolization device (PED) combined with coil embolization is superior to PED alone.
• Optimal coil usage strategy after PED placement remains unclear.

Purpose of the Study:

• To determine the ideal coil packing density after PED placement for intracranial aneurysms.
• To analyze the hemodynamic changes associated with PED and coil deployment.
• To optimize treatment strategies for complex intracranial aneurysms.

Main Methods:

• Patient-specific aneurysm models and finite element analysis were utilized.
• Computational fluid dynamics (CFD) simulated the therapeutic process.
• Intra-aneurysmal flow velocity reduction ratios were calculated and analyzed.

Main Results:

• PED deployment significantly reduced intra-aneurysmal flow velocity (15.3 to 10.0 cm/s).
• The first coil further decreased velocity (10.0 to 5.3 cm/s).
• No significant hemodynamic effect was observed after reaching 7.06% packing density or inserting the second coil.

Conclusions:

• Adjunct coiling improves the post-PED hemodynamic environment.
• Dense coil packing is unnecessary for intracranial aneurysms.
• Intra-aneurysmal hemodynamics stabilize around 7.06% packing density or after the second coil.