case_images: PMC10559515_01
case_images: Case 1: Planned working angles from preoperative three-dimensional digital subtraction angiography image. (a and b) View aiming at separating M1 and M2 superior trunk for stent placement. (c and d) View aiming at separating the aneurysm from the M2 inferior trunk.
case_images: SNI-14-349-g002.jpg
case_images: PMC10559515_01_SNI-14-349-g002.jpg
case_images: F2
case_images: The working angles decided based on the 3D-DSA image acquired at the beginning of the procedure could not separate the aneurysm and parent artery due to the complex shape of the aneurysm [Figure 2].
case_images: Case 1: (a and b) Virtual coil images generated from the preoperative three-dimensional digital subtraction angiography (DSA) images with the aneurysm area to be coiled (red). (c and d) Two-dimensional DSA after the embolization shows the coil masses as suggested by the virtual coil images.
case_images: SNI-14-349-g003.jpg
case_images: PMC10559515_01_SNI-14-349-g003.jpg
case_images: F3
case_images: To facilitate visualization of the aneurysm for embolization, virtual coil images were generated from the 3D-DSA image [Figure 3].
case_images: PMC10559515_02
case_images: Case 2: (a and b) Three-dimensional digital subtraction angiography image before the retreatment with coil mass (purple) from the first treatment.
case_images: SNI-14-349-g004.jpg
case_images: PMC10559515_02_SNI-14-349-g004.jpg
case_images: F4
case_images: A de novo-like bump was observed in front of the coil mass [Figure 4].
case_images: Case 2: (a and b) Preoperative virtual coil images with coils from the first treatment (blue) and recurred aneurysm area to be embolized (red).
case_images: SNI-14-349-g005.jpg
case_images: PMC10559515_02_SNI-14-349-g005.jpg
case_images: F5
case_images: Virtual coil images were created from preoperative 3D-DSA [Figure 5] that suggested the final shape of the coil mass and facilitated the distinction between the existing coil and the area to be embolized.
case_images: The virtual coil image was displayed next to the two-dimensional digital subtraction angiography images both inside the operation room and on a monitor in the operators' room.
case_images: SNI-14-349-g006.jpg
case_images: PMC10559515_02_SNI-14-349-g006.jpg
case_images: F6
case_images: Virtual coil images were displayed on the monitor during the procedure and compared to the 2D-DSA images [Figure 6].
case_images: Case 2: (a and b) Three-dimensional digital subtraction angiography images of the total coil mass (purple) after the retreatment. (c and d) Corresponding two-dimensional digital subtraction angiography images. The shape of the new coil mass matches the mass shown on the virtual coil images in Figure 5.
case_images: SNI-14-349-g007.jpg
case_images: PMC10559515_02_SNI-14-349-g007.jpg
case_images: F7
case_images: Complete occlusion and no protrusion were confirmed [Figure 7].
case_images: PMC10559515_03
case_images: Case 3: (a and b) Barrel view (three-dimensional digital subtraction angiography [3D-DSA] and two-dimensional digital subtraction angiography [2D-DSA]) achieved by the angiography system. (c and d) View aiming at separating the aneurysm and parent artery (3D-DSA and 2D-DSA) could not be achieved.
case_images: SNI-14-349-g008.jpg
case_images: PMC10559515_03_SNI-14-349-g008.jpg
case_images: F8
case_images: Two working angles were determined using the 3D-DSA image, but the angles that would clearly separate the aneurysm and parent artery could not be achieved during the procedure due to the limitation of the angiography system [Figure 8].
case_images: Case 3: (a) Preoperative virtual coil image with coil mass from the first coil embolization (blue), coil mass to be deployed during retreatment (red). (b) Postoperative 2-dimensional digital subtraction angiography of the same view as the virtual coil images. Yellow outline shows the overlap area of the aneurysm and parent artery.
case_images: SNI-14-349-g009.jpg
case_images: PMC10559515_03_SNI-14-349-g009.jpg
case_images: F9
case_images: The 2D-DSA images were then compared to the virtual coil images [Figure 9], and the aneurysm was diagnosed as complete occlusion based on these images and on inspection of the postoperative 3D-DSA.