Microcatheter Shaping for Intracranial Aneurysm Coiling using 3D Printing

Introduction: To Investigate the feasibility and efficacy of 3D printing-assisted precision microcatheter shaping for intracranial aneurysm coiling.

Methods: A scoping review was conducted following the methodology outlined by Arksey and O’Malley. MEDLINE, EMBASE, CINAHL, and Cochrane were queried from inception to present. Data were extracted according to pre-defined criteria. Papers were included if they investigated the feasibility and efficacy of patient-specific 3D-printed microcatheters for intracranial aneurysm coiling. No qualitative appraisal of methodological rigor or formal assessment of study design heterogeneity was attempted due to limited available evidence. Descriptive statistics were used to present parameter frequencies.

Results: Seven papers met the inclusion criteria, with the earliest publication in 2013. Only one study had a control group; the others were pilot feasibility studies. Two studies employed 3D-printed catheters intraoperatively, while four used hollow silicone models based on patient-specific vasculature. A total of 119 microcatheters were utilized across 119 distinct aneurysm cases, with 42 instances providing real-time, intraoperative data detailing the application of 3D-shaped microcatheters in elective, unruptured aneurysms. Paraclinoid Internal Carotid Artery aneurysms were the most studied, followed by Anterior Communicating and Posterior Communicating Artery aneurysms. Few posterior circulation aneurysms and only two basilar tip aneurysms were involved. Stereolithography was the most common printing technique, followed by Digital Light Processing. Costs ranged from 0.67 to 600 USD, with an average printing/processing time of 3 hours per catheter. Intraoperatively, 3D-printed microcatheters significantly reduced the number of deployed coils and procedure duration. No significant differences were reported for clinical outcomes or complication rates. Studies employing silicone models consistently demonstrated improved accessibility, positioning, precision, and stability, particularly in the context of geometrically intricate small aneurysms. However, in vitro investigations reported prolonged operative times due to disparities in elasticity when compared to actual vessels, leading to higher rates of catheter reshaping during these experiments.

Conclusion : Custom 3D-printed microcatheters hold promise for improving procedural and angiographic outcomes in patients with small, geometrically complex, unruptured intracranial aneurysms. Further research is warranted to assess their impact on clinical outcomes.