Abstract 2764: Assessment Of Intravascular Ultrasonography Assisted Aneurysm Coil Embolization

Abstract

Background: Intravascular ultrasonography (IVUS) has been previously used for guiding intravascular stent placement in interventional cardiology. Objective: To evaluate the feasibility of aneurysm embolization using detachable coils under IVUS guidance. Method: Two different experimental models of aneurysm were used. IVUS guided embolization in conjunction with flouroscopic imaging and subsequently alone were performed in a silicone model with a side wall aneurysm. IVUS guided embolization in conjunction with flouroscopic imaging was also used in in-vitro model of side wall aneurysm created using sheep vessels. The visibility of aneurysm, microcatheter, and coils ascertained by the IVUS was graded as excellent, good, or poor based on visualization of these items as distinct structures. The agreement between simultaneously acquired angiographic and IVUS images for detecting increasing intra-aneurysmal coil mass and coil prolapse was assessed in 10 and 6 simultaneously acquired angiographic and IVUS images, respectively. Results: IVUS measurements of the aneurysm dimensions strongly correlated with actual dimensions and measurements acquired by contrast angiography (Pearson’s coefficient of 0.96 and 0.99 for silicone model and arterial segment model, respectively) ( Figure 1 ). IVUS visualization of aneurysm, microcatheter tip, and coil loops were graded as excellent in the silicone aneurysm model and good in carotid artery model ( Figure 2 ). The agreement between simultaneously acquired angiographic and IVUS images was very high, for detecting increasing intra-aneurysmal coil mass (Spearman’s rank correlation coefficient of 0.98) and coil prolapse (83% agreement). We were able to successfully perform and complete embolization of silicone aneurysm model with IVUS alone (complete obliteration confirmed by direct visualization). Conclusion: This study shows IVUS-guidance during aneurysm embolization may improve the procedure by providing intravascular aneurysmal measurements and visualization of devices used in the procedure.