Influence of neurovascular embolic coil primary wind diameter on aneurysm packing density and case costs

Abstract

Aims Endovascular coiling is a common modality for treating intracranial aneurysms; however, recanalization occurs in approximately 1 in 5 cases, with downstream consequences of regrowth and rupture. Aneurysm packing density >24% reduces recanalization risk; packing density can be increased by inserting additional coils or by using coils with larger volumetric filling. Coil volume depends on length and primary wind diameter (PWD). This study evaluated the influence of PWD on packing density and total case costs. Materials and methods Two hypothetical scenarios and one case study were analyzed. In scenario one, the number of coils required to achieve packing density >24% in a hypothetical aneurysm was determined for 0.012″ vs. 0.010″ PWD coils. In scenario two, the total length of 0.010″ vs. 0.012″ PWD coils required to achieve a packing density >24% was analyzed relative to aneurysm volume. In the case study, packing densities with one 0.012″ PWD coil (actual scenario) and one 0.010″ PWD coil (theoretical scenario) were compared. Results In scenario one, cost savings would be realized by using four 0.012″ PWD coils vs. seven 0.010″ PWD coils to achieve packing density >24%. In scenario two, greater volumetric filling of 0.012″ vs. 0.010″ PWD coils was correlated with lower total length of coil required. In the case study, a 0.012″ PWD coil achieved packing density >24%, whereas an equivalent length 0.010″ PWD coil would not. Limitations Theoretical modeling was used to explore the impact of coil PWD on aneurysm packing density. In clinical practice, packing density depends not only on PWD but on its length, shape, distribution within an aneurysm, and other recanalization risk factors. Conclusions Coil PWD influences packing density, the number of coils required to achieve a specific packing density, and total case costs. Using 0.012″ PWD coils may provide cost and procedural efficiencies.