Hemodynamic effect of coil packing density after tubridge flow diverter for anterior circulation small and...

Investigating the impact of coil embolization rate on hemodynamic parameters within the aneurysm sac after treating anterior circulation small and medium-sized aneurysms with the Tubridge (TB) flow diverter. Twenty-six patients with 29 intracranial aneurysms were collected between September 2020 and December 2022. The finite element method simulated preoperative conditions, after TB deployment alone, and with TB plus different coil embolization rates. Different hemodynamic parameters were analyzed under these treatment scenarios. Variance analysis and multiple comparisons were conducted to find an appropriate embolization rate. Twenty-nine aneurysms from 26 patients showed, with increasing TB deployment and coil embolization rates, a continuous improvement in the aneurysm sac's Qinflow, Va, WSS, and normalized and ratio residual blood volume (nRFV and rRFV) under different thresholds (0.1 m/s, 0.15 m/s). Quantitative analysis indicated the impact on hemodynamics was not significant (P > 0.05) when the coil embolization rate reached 5% and beyond for Qinflow, Va, WSS, and RFV under different thresholds (0.1 m/s, 0.15 m/s). Adjunctive embolization can improve the hemodynamic environment within the small and medium-sized aneurysm sac when using the Tubridge flow diverter. However, once the embolization rate within the sac reaches 5%, the hemodynamic environment tends to stabilize, making dense embolization unnecessary.