Introduction: Assessment of the occlusion status of the aneurysms after coiling is often a challenge. Superimposing the coil mass over the parent artery or branch vessels, make their visualization difficult. Moreover, location of protruded coils into the parent artery cannot be evaluated by usual tri-dimensional reconstruction (3DR).
Methods: Data was prospectively collected and reviewed. After coiling each aneurysm, in addition to conventional angiogram, 3D rotational angiography was also performed and data was post processed on Leonardo workstation (Leonardo, Siemens, Germany). Tri-dimensional reconstruction of data was performed with both single volume (SV) and dual volume (DV) techniques. Two neurosurgeons compared aneurysm’s occlusion status, parent or branch vessel patency and position of possible extruded coil loop with two methods of reconstruction.
Results: Thirty-five aneurysms in 34 patients were included. The average age was 54+7 years. Aneurysms were located in the following arteries: Internal Carotid (16) (including ophthalmic, anterior choroidal and posterior communicating arteries), basilar apex (6), anterior communicating (10), posterior inferior cerebellar (2), and middle cerebral arteries (2). For detection of the residual aneurysm, DV and SV reconstructions showed a sensitivity and specifity of DV: 100%, 97%; SV: 83%, 89%, respectively. For parent or branch vessel occlusion, these numbers are 66% and 94% with both modalities, respectively. While it is impossible to localize and track the prolapsed coils with SVR, DVR has 100% sensitivity and specifity in depicting tridimensional position of the migrated coils with respect to the parent artery lumen.
Conclusions: Dual volume reconstruction significantly improves the quality of 3D angiography over single volume in assessment of residual aneurysm, its location in relation to the coil mass and understanding the position of the migrated coils. This helps in appropriate treatment planning for residual aneurysm and prevention of thromboembolic complications of wondering coils inside the parent artery.
Patient Care: This helps in appropriate treatment planning for residual aneurysm and prevention of thromboembolic complications of migrrated coils inside the parent artery, if we prove they are inside the lumen.
Learning Objectives: Dual volume reconstruction post coiling is very important for
in assessment of residual aneurysm, its location in relation to the coil mass and understanding the position of the migrated coils.