Virtual coil images can optimize the visualization of the neckline of intracranial aneurysms during coil embolization: A technical note

BACKGROUND: During coil embolization of intracranial aneurysms, the aneurysmal neck needs to be evaluated because coil protrusion into the parent artery may lead to ischemic complications. However, the neck cannot always be clearly visualized due to the limitation of the angiography system and due to the structure of the aneurysm. As a visual aid, we propose a color-coded fusion imaging method that generates “virtual coil” images using preoperative three-dimensional digital subtraction angiography (3D-DSA) images. CASE DESCRIPTION: Coil embolization for intracranial aneurysms was performed using the working angles determined from the preoperative 3D-DSA. The aneurysms were located at the middle cerebral artery, anterior communicating artery (A-com), and posterior communicating artery (P-com). The A-com and P-com aneurysms were recurrent. During the later phase of the procedure, physicians could not judge whether coils protruded into the parent artery on two-dimensional digital subtraction angiography (2D-DSA) images because an optimal working angle could not be realized. Virtual coil images were displayed on the angiography system’s monitor to show the expected completed embolization, which could be compared to the current 2D-DSA images as a visual aid. CONCLUSION: Virtual coil images can provide visual aid to the treating physician during aneurysm coil embolization, which is useful when an accurate working angle cannot be reached.