A study of correlation of angioarchitecture of intracranial blood vessels with difficulty during endovascular coiling of aneurysms.

Objective: The duration and complications of coiling are dependent on several factors. These include experience with the armamentarium and the expertise of the operator. Also, the angioarchitecture of the blood vessel can play an important role in the duration of the procedure and outcome.

Methods: 41 patients underwent endovascular coiling. The angioarchitecture of the vessels in terms of the course of the blood vessels from the arch of the aorta to the aneurysm, and the angles between the arch and its branches, between the parent and feeding arteries, and between the feeding artery and the aneurysm were measured. During coiling, duration, attempts, complications, and outcome were recorded. A correlation was made between angioarchitecture and difficulty during coiling.

Results: Based on number of attempts of coiling, two groups were defined. In group I, 26 patients underwent a single attempt with a mean duration of 61 min and in group II, 15 patients had more than one attempt with a mean duration of 98 min. The mean angle between the arch and its branches, between the internal carotid artery and the anterior cerebral artery, and between the anterior communicating artery and the aneurysm was more acute in group II compared with group I. Spearman's correlation suggested that as the angle at different vessel levels decreased, duration, attempt, and complications increased, and vice versa.

Conclusions: Angioarchitecture analysis revealed that the sharper the angle (acute angle) between various vessels, the greater the difficulty in negotiating a microcatheter through the vessels and the more complications, duration, number of attempts, and poor outcome. We therefore feel that angioarchitecture analysis should be done carefully in all patients in whom the decision to undergo coiling is taken.