Rupture of intracranial aneurysms results in severe subarachnoidal hemorrhage, which is associated with high morbidity and mortality. Neurointerventional occlusion of the aneurysm through coiling has evolved to a therapeutical standard. The choice of the specific coil has an important influence on secondary regrowth requiring retreatment. Aneurysm occlusion was simulated either through virtual implantation of a preshaped 3D coil or with a porous media approach. In this study, we used a recently developed numerical approach to simulate aneurysm shapes in specific challenging aneurysm anatomies and correlated these with aneurysm recurrence 6 months after treatment. The simulation showed a great variety of coil shapes depending on the variability in possible microcatheter positions. Aneurysms with a later recurrence showed a tendency for more successful coiling attempts. Results revealed further trends suggesting lower simulated packing densities in aneurysms with reoccurrence. Simulated packing densities did not correlate with those calculated by conventional software, indicating the potential for our approach to offer additional predictive value. Our study, therefore, pioneers a comprehensive numerical model for simulating aneurysm coiling, providing insights into individualized treatment strategies and outcome prediction. Future directions involve expanding the model's capabilities to simulate intraprocedural outcomes and long-term predictions, aiming to refine occlusion quality criteria and validate prediction parameters in larger patient cohorts. This simulation framework holds promise for enhancing clinical decision-making and optimizing patient outcomes in endovascular aneurysm treatment.

翻译：颅内动脉瘤破裂会导致严重的蛛网膜下腔出血，具有高致残率和死亡率。通过弹簧圈栓塞进行神经介入性动脉瘤闭塞已成为标准疗法。特定弹簧圈的选择对需要再次治疗的继发性再生具有重要影响。本研究通过虚拟植入预成形三维弹簧圈或采用多孔介质方法模拟动脉瘤闭塞。我们使用新近开发的数值方法模拟特定挑战性动脉瘤解剖结构中的动脉瘤形态，并将其与治疗6个月后的动脉瘤复发情况相关联。模拟显示，根据微导管可能位置的变异性，弹簧圈形态呈现出极大差异。后续复发的动脉瘤在栓塞尝试中表现出更高的成功率倾向。进一步结果揭示，复发性动脉瘤的模拟填塞密度较低。模拟填塞密度与常规软件计算结果无相关性，表明我们的方法可能提供额外预测价值。因此，本研究开创性地建立了用于模拟动脉瘤栓塞的综合性数值模型，为个体化治疗策略及预后预测提供了见解。未来方向包括扩展模型能力以模拟术中结果和长期预测，旨在优化闭塞质量标准并在更大患者队列中验证预测参数。该模拟框架有望增强血管内动脉瘤治疗的临床决策并改善患者预后。