Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
Health Economics & Market Access, Cerenovus, Johnson & Johnson, Irvine, CA, USA.
J Med Econ. 2021 Jan-Dec;24(1):345-351. doi: 10.1080/13696998.2021.1885194.
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.
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.
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.
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.
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.
血管内线圈栓塞是治疗颅内动脉瘤的常见方法；然而，大约有 1/5 的病例会发生再通，其后果是动脉瘤重新生长和破裂。动脉瘤填塞密度>24%可降低再通风险；填塞密度可以通过插入更多的线圈或使用体积更大的线圈来增加。线圈的体积取决于长度和初级缠绕直径（PWD）。本研究评估了 PWD 对填塞密度和总病例成本的影响。
分析了两种假设情况和一个病例研究。在第一种情况下，确定了在假设动脉瘤中使用 0.012"和 0.010" PWD 线圈达到>24%填塞密度所需的线圈数量。在第二种情况下，分析了达到>24%填塞密度所需的 0.010"和 0.012" PWD 线圈的总长度与动脉瘤体积的关系。在病例研究中，比较了一个 0.012" PWD 线圈（实际情况）和一个 0.010" PWD 线圈（理论情况）的填塞密度。
在第一种情况下，使用四个 0.012" PWD 线圈而非七个 0.010" PWD 线圈达到>24%填塞密度可节省成本。在第二种情况下，0.012" PWD 线圈比 0.010" PWD 线圈具有更大的体积填充，所需的线圈总长度也更低。在病例研究中，一个 0.012" PWD 线圈达到了>24%的填塞密度，而同等长度的 0.010" PWD 线圈则没有。
理论模型用于探讨线圈 PWD 对动脉瘤填塞密度的影响。在临床实践中，填塞密度不仅取决于 PWD，还取决于其长度、形状、在动脉瘤内的分布以及其他再通风险因素。
线圈 PWD 影响填塞密度、达到特定填塞密度所需的线圈数量和总病例成本。使用 0.012" PWD 线圈可能会带来成本和程序效率方面的优势。
