title: Assessment of endovascular coil configuration for embolization of intracranial aneurysms using computational fluid dynamics.
abstract: Endovascular coil embolization of arterial aneurysms is often complicated by reduced blood flow to branching arteries. To determine the optimal coil configuration for safe embolization of endovascular aneurysms without compromising blood flow in branching arteries. A 3-dimensional voxel model, built based on an unruptured vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm, predicted to show impairment of flow in the PICA during endovascular coil embolization (Case 0). Six different models of final coil configuration were generated and applied to this aneurysm. Case 1 was a round coil mass. Case 2 was designed with a stent assist. Cases 3, and 4 were designed with a neck remnant and Cases 5 and 6 incorporated a balloon neck remodeling technique. Computational fluid dynamics was used to analyze the flow in the PICA in each model. The average outflow to the PICA was highest in Case 0 and lowest in Case 2 (in descending order, Case 0, 5, 4, 6, 1, 3, and 2). There was better preservation of outflow to the PICA in the balloon neck remodeling models than in the neck remnant models. In a model of endovascular coil embolization, we found considerable differences in outflow to the branching artery with small changes in coil configuration. Careful preoperative planning is important to minimize the risk of thromboembolic events during and after endovascular coil embolization.
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ohshima
authors.affiliation: Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyachi
authors.affiliation: Department of Computational Science and Engineering, Nagoya University Graduate School of Engineering, Nagoya, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takahashi
authors.affiliation: Department of Computational Science and Engineering, Nagoya University Graduate School of Engineering, Nagoya, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Ishii
keywords: coil embolization; computational fluid dynamics; intracranial aneurysms