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Wiśniewski K, Tyfa Z, Tomasik B, Reorowicz P, Bobeff EJ, Posmyk BJ, Hupało M, Stefańczyk L, Jóźwik K, Jaskólski DJ. Risk Factors for Recanalization after Coil Embolization. J Pers Med 2021; 11:jpm11080793. [PMID: 34442437 PMCID: PMC8398571 DOI: 10.3390/jpm11080793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
The aim of our study was to identify risk factors for recanalization 6 months after coil embolization using clinical data followed by computational fluid dynamics (CFD) analysis. Methods: Firstly, clinical data of 184 patients treated with coil embolization were analyzed retrospectively. Secondly, aneurysm models for high/low recanalization risk were generated based on ROC curves and their cut-off points. Afterward, CFD was utilized to validate the results. Results: In multivariable analysis, aneurysm filling during the first embolization was an independent risk factor whilst packing density was a protective factor of recanalization after 6 months in patients with aSAH. For patients with unruptured aneurysms, packing density was found to be a protective factor whilst the aneurysm neck size was an independent risk factor. Complex flow pattern and multiple vortices were associated with aneurysm shape and were characteristic of the high recanalization risk group. Conclusions: Statistical analysis suggested that there are various factors influencing recanalization risk. Once certain values of morphometric parameters are exceeded, a complex flow with numerous vortices occurs. This phenomenon was revealed due to CFD investigations that validated our statistical research. Thus, the complex flow pattern itself can be treated as a relevant recanalization predictor.
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Affiliation(s)
- Karol Wiśniewski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (M.H.); (D.J.J.)
- Correspondence: ; Tel.: +48-042-6776770
| | - Zbigniew Tyfa
- Institute of Turbomachinery, Medical Apparatus Division, Lodz University of Technology, Wolczanska 219/223, 90-924 Lodz, Poland; (Z.T.); (P.R.); (K.J.)
| | - Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 15 Mazowiecka St., 92-215 Lodz, Poland;
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Piotr Reorowicz
- Institute of Turbomachinery, Medical Apparatus Division, Lodz University of Technology, Wolczanska 219/223, 90-924 Lodz, Poland; (Z.T.); (P.R.); (K.J.)
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (M.H.); (D.J.J.)
| | - Bartłomiej J. Posmyk
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (M.H.); (D.J.J.)
| | - Marlena Hupało
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (M.H.); (D.J.J.)
| | - Ludomir Stefańczyk
- Department of Radiology-Diagnostic Imaging, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland;
| | - Krzysztof Jóźwik
- Institute of Turbomachinery, Medical Apparatus Division, Lodz University of Technology, Wolczanska 219/223, 90-924 Lodz, Poland; (Z.T.); (P.R.); (K.J.)
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (M.H.); (D.J.J.)
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Muschenborn AD, Ortega JM, Szafron JM, Szafron DJ, Maitland DJ. Porous media properties of reticulated shape memory polymer foams and mock embolic coils for aneurysm treatment. Biomed Eng Online 2013; 12:103. [PMID: 24120254 PMCID: PMC3853193 DOI: 10.1186/1475-925x-12-103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background Shape memory polymer (SMP) foams are being investigated as an alternative aneurysm treatment method to embolic coils. The goal of both techniques is the reduction of blood flow into the aneurysm and the subsequent formation of a stable thrombus, which prevents future aneurysm rupture. The purpose of this study is to experimentally determine the parameters, permeability and form factor, which are related to the flow resistance imposed by both media when subjected to a pressure gradient. Methods The porous media properties—permeability and form factor—of SMP foams and mock embolic coils (MECs) were measured with a pressure gradient method by means of an in vitro closed flow loop. We implemented the Forchheimer-Hazen-Dupuit-Darcy equation to calculate these properties. Mechanically-reticulated SMP foams were fabricated with average cell sizes of 0.7E-3 and 1.1E-3 m, while the MECs were arranged with volumetric packing densities of 11-28%. Results The permeability of the SMP foams was an order of magnitude lower than that of the MECs. The form factor differed by up to two orders of magnitude and was higher for the SMP foams in all cases. The maximum flow rate of all samples tested was within the inertial laminar flow regime, with Reynolds numbers ranging between 1 and 35. Conclusions The SMP foams impose a greater resistance to fluid flow compared to MECs, which is a result of increased viscous and inertial losses. These results suggest that aneurysms treated with SMP foam will have flow conditions more favorable for blood stasis than those treated with embolic coils having packing densities ≤ 28%.
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Faure F, Duriez C, Delingette H, Allard J, Gilles B, Marchesseau S, Talbot H, Courtecuisse H, Bousquet G, Peterlik I, Cotin S. SOFA: A Multi-Model Framework for Interactive Physical Simulation. STUDIES IN MECHANOBIOLOGY, TISSUE ENGINEERING AND BIOMATERIALS 2012. [DOI: 10.1007/8415_2012_125] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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