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Tobe Y, Robertson AM, Ramezanpour M, Cebral JR, Watkins SC, Charbel FT, Amin-Hanjani S, Yu AK, Cheng BC, Woo HH. Comapping Cellular Content and Extracellular Matrix with Hemodynamics in Intact Arterial Tissues Using Scanning Immunofluorescent Multiphoton Microscopy. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2024; 30:342-358. [PMID: 38525887 PMCID: PMC11057816 DOI: 10.1093/mam/ozae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
Deviation of blood flow from an optimal range is known to be associated with the initiation and progression of vascular pathologies. Important open questions remain about how the abnormal flow drives specific wall changes in pathologies such as cerebral aneurysms where the flow is highly heterogeneous and complex. This knowledge gap precludes the clinical use of readily available flow data to predict outcomes and improve treatment of these diseases. As both flow and the pathological wall changes are spatially heterogeneous, a crucial requirement for progress in this area is a methodology for acquiring and comapping local vascular wall biology data with local hemodynamic data. Here, we developed an imaging pipeline to address this pressing need. A protocol that employs scanning multiphoton microscopy was developed to obtain three-dimensional (3D) datasets for smooth muscle actin, collagen, and elastin in intact vascular specimens. A cluster analysis was introduced to objectively categorize the smooth muscle cells (SMC) across the vascular specimen based on SMC actin density. Finally, direct quantitative comparison of local flow and wall biology in 3D intact specimens was achieved by comapping both heterogeneous SMC data and wall thickness to patient-specific hemodynamic results.
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Affiliation(s)
- Yasutaka Tobe
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Mehdi Ramezanpour
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, VA 22030, USA
| | - Simon C Watkins
- Department of Cell Biology, University of Pittsburgh, PA 15261, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Sepideh Amin-Hanjani
- Department of Neurological Surgery, University Hospital Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Alexander K Yu
- Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Boyle C Cheng
- Neuroscience and Orthopedic Institutes, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY 11549, USA
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2
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Hadad S, Mut F, Slawski M, Robertson AM, Cebral JR. Evaluation of predictive models of aneurysm focal growth and bleb development using machine learning techniques. J Neurointerv Surg 2024; 16:392-397. [PMID: 37230750 PMCID: PMC10674044 DOI: 10.1136/jnis-2023-020241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The presence of blebs increases the rupture risk of intracranial aneurysms (IAs). OBJECTIVE To evaluate whether cross-sectional bleb formation models can identify aneurysms with focalized enlargement in longitudinal series. METHODS Hemodynamic, geometric, and anatomical variables derived from computational fluid dynamics models of 2265 IAs from a cross-sectional dataset were used to train machine learning (ML) models for bleb development. ML algorithms, including logistic regression, random forest, bagging method, support vector machine, and K-nearest neighbors, were validated using an independent cross-sectional dataset of 266 IAs. The models' ability to identify aneurysms with focalized enlargement was evaluated using a separate longitudinal dataset of 174 IAs. Model performance was quantified by the area under the receiving operating characteristic curve (AUC), the sensitivity and specificity, positive predictive value, negative predictive value, F1 score, balanced accuracy, and misclassification error. RESULTS The final model, with three hemodynamic and four geometrical variables, along with aneurysm location and morphology, identified strong inflow jets, non-uniform wall shear stress with high peaks, larger sizes, and elongated shapes as indicators of a higher risk of focal growth over time. The logistic regression model demonstrated the best performance on the longitudinal series, achieving an AUC of 0.9, sensitivity of 85%, specificity of 75%, balanced accuracy of 80%, and a misclassification error of 21%. CONCLUSIONS Models trained with cross-sectional data can identify aneurysms prone to future focalized growth with good accuracy. These models could potentially be used as early indicators of future risk in clinical practice.
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Affiliation(s)
- Sara Hadad
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Martin Slawski
- Statistics Department, George Mason University, Fairfax, Virginia, USA
| | - Anne M Robertson
- Departmnet of Mechanical enginering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
- Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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3
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Pionteck A, Abderezaei J, Fillingham P, Chuang YC, Sakai Y, Belani P, Rigney B, De Leacy R, Fifi JT, Chien A, Colby GP, Jahan R, Duckwiler G, Sayre J, Holdsworth SJ, Mossa-Basha M, Levitt MR, Mocco J, Kurt M, Nael K. Intracranial aneurysm wall displacement depicted by amplified Flow predicts growth. J Neurointerv Surg 2024:jnis-2023-021227. [PMID: 38320850 DOI: 10.1136/jnis-2023-021227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Abnormal intracranial aneurysm (IA) wall motion has been associated with IA growth and rupture. Recently, a new image processing algorithm called amplified Flow (aFlow) has been used to successfully track IA wall motion by combining the amplification of cine and four-dimensional (4D) Flow MRI. We sought to apply aFlow to assess wall motion as a potential marker of IA growth in a paired-wise analysis of patients with growing versus stable aneurysms. METHODS In this retrospective case-control study, 10 patients with growing IAs and a matched cohort of 10 patients with stable IAs who had baseline 4D Flow MRI were included. The aFlow was used to amplify and extract IA wall displacements from 4D Flow MRI. The associations of aFlow parameters with commonly used risk factors and morphometric features were assessed using paired-wise univariate and multivariate analyses. RESULTS aFlow quantitative results showed significantly (P=0.035) higher wall motion displacement depicted by mean±SD 90th% values of 2.34±0.72 in growing IAs versus 1.39±0.58 in stable IAs with an area under the curve of 0.85. There was also significantly (P<0.05) higher variability of wall deformation across IA geometry in growing versus stable IAs depicted by the dispersion variables including 121-150% larger standard deviation ([Formula: see text]) and 128-161% wider interquartile range [Formula: see text]. CONCLUSIONS aFlow-derived quantitative assessment of IA wall motion showed greater wall motion and higher variability of wall deformation in growing versus stable IAs.
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Affiliation(s)
- Aymeric Pionteck
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Javid Abderezaei
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Patrick Fillingham
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ya-Chen Chuang
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Yu Sakai
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Puneet Belani
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Brian Rigney
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aichi Chien
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Reza Jahan
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Gary Duckwiler
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - James Sayre
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Mahmud Mossa-Basha
- Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mehmet Kurt
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Kambiz Nael
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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4
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Salimi Ashkezari SF, Mut F, Robertson AM, Cebral JR. Differences Between Ruptured Aneurysms With and Without Blebs: Mechanistic Implications. Cardiovasc Eng Technol 2023; 14:92-103. [PMID: 35819581 PMCID: PMC10029732 DOI: 10.1007/s13239-022-00640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Blebs are known risk factors for intracranial aneurysm (IA) rupture. We analyzed differences between IAs that ruptured with blebs and those that ruptured without developing blebs to identify distinguishing characteristics among them and suggest possible mechanistic implications. METHODS Using image-based models, 25 hemodynamic and geometric parameters were compared between ruptured IAs with and without blebs (n = 673), stratified by location. Hemodynamic and geometric differences between bifurcation and sidewall aneurysms and for aneurysms at five locations were also analyzed. RESULTS Ruptured aneurysms harboring blebs were exposed to higher flow conditions than aneurysms that ruptured without developing blebs, and this was consistent across locations. Bifurcation aneurysms were exposed to higher flow conditions than sidewall aneurysms. They had larger maximum wall shear stress (WSS), more concentrated WSS distribution, and larger numbers of critical points than sidewall aneurysms. Additionally, bifurcation aneurysms were larger, more elongated, and had more distorted shapes than sidewall aneurysms. Aneurysm morphology was associated with aneurysm location (p < 0.01). Flow conditions were different between aneurysm locations. CONCLUSION Aneurysms at different locations are likely to develop into varying morphologies and thus be exposed to diverse flow conditions that may predispose them to follow distinct pathways towards rupture with or without bleb development. This could explain the diverse rupture rates and bleb presence in aneurysms at different locations.
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Affiliation(s)
- Seyedeh Fatemeh Salimi Ashkezari
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Fernando Mut
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan R Cebral
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Department of Mechanical Engineering, George Mason University, Fairfax, VA, USA
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5
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Satoh T, Yagi T, Sawada Y, Sugiu K, Sato Y, Date I. Association of bleb formation with peri-aneurysmal contact in unruptured intracranial aneurysms. Sci Rep 2022; 12:6075. [PMID: 35414058 PMCID: PMC9005541 DOI: 10.1038/s41598-022-10064-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/01/2022] [Indexed: 11/09/2022] Open
Abstract
The mechanism of bleb formation in unruptured intracranial aneurysms (UIAs) remains unclear. This study aimed to investigate the association between peri-aneurysmal contact (PAC) and bleb formation. Forty-five aneurysms were classified depending on the presence of blebs and PAC using computed tomographic angiography and magnetic resonance imaging. Aneurysmal hemodynamics were assessed using computational fluid dynamics. The independent variables associated with bleb formation were statistically assessed. Fourteen aneurysms (31.1%) had blebs, all of which were located at the site of PAC (group A). Thirty-one aneurysms (68.9%) had no bleb, of which 13 had a PAC (group B) and 18 had no PAC (group C). PAC was the only independent variable associated with bleb formation (p < 0.05). Aneurysmal volumes were significantly higher in group A, followed by groups B and C in series. Aneurysmal wall shear stress (WSS) tended to be lowest in group A, followed by groups B and C in series. The maximum WSS at the blebs was only 17% of the maximum WSS at the aneurysmal domes. This study demonstrated that bleb formation in UIAs was associated with the establishment of PAC during their growth, which may have more detrimental effects on bleb formation than hemodynamics.
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Affiliation(s)
- Toru Satoh
- Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, 5-23-23 Matsunaga, Fukuyama, Hiroshima, 729-0104, Japan.
| | - Takanobu Yagi
- Center for Advanced Biomedical Sciences, Waseda University, 2-2 Wakamatsucho, Shinjukuku, Tokyo, 162-8480, Japan.
| | - Yoichi Sawada
- Department of Contemporary Welfare, Faculty of Health and Welfare, Okayama Prefectural University, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Yu Sato
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
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6
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Galloy AE, Raghuram A, Nino MA, Varon Miller A, Sabotin R, Osorno-Cruz C, Samaniego EA, Raghavan SML, Hasan D. Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging. Front Neurol 2021; 12:764063. [PMID: 34956050 PMCID: PMC8702555 DOI: 10.3389/fneur.2021.764063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Biomechanical computational simulation of intracranial aneurysms has become a promising method for predicting features of instability leading to aneurysm growth and rupture. Hemodynamic analysis of aneurysm behavior has helped investigate the complex relationship between features of aneurysm shape, morphology, flow patterns, and the proliferation or degradation of the aneurysm wall. Finite element analysis paired with high-resolution vessel wall imaging can provide more insight into how exactly aneurysm morphology relates to wall behavior, and whether wall enhancement can describe this phenomenon. In a retrospective analysis of 23 unruptured aneurysms, finite element analysis was conducted using an isotropic, homogenous third order polynomial material model. Aneurysm wall enhancement was quantified on 2D multiplanar views, with 14 aneurysms classified as enhancing (CRstalk≥0.6) and nine classified as non-enhancing. Enhancing aneurysms had a significantly higher 95th percentile wall tension (μ = 0.77 N/cm) compared to non-enhancing aneurysms (μ = 0.42 N/cm, p < 0.001). Wall enhancement remained a significant predictor of wall tension while accounting for the effects of aneurysm size (p = 0.046). In a qualitative comparison, low wall tension areas concentrated around aneurysm blebs. Aneurysms with irregular morphologies may show increased areas of low wall tension. The biological implications of finite element analysis in intracranial aneurysms are still unclear but may provide further insights into the complex process of bleb formation and aneurysm rupture.
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Affiliation(s)
- Adam E Galloy
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
| | - Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Marco A Nino
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
| | - Alberto Varon Miller
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Ryan Sabotin
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Carlos Osorno-Cruz
- Department of Neurosurgery, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States.,Department of Neurosurgery, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States.,Department of Radiology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Suresh M L Raghavan
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
| | - David Hasan
- Department of Neurosurgery, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
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7
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Salimi Ashkezari SF, Mut F, Slawski M, Cheng B, Yu AK, White TG, Woo HH, Koch MJ, Amin-Hanjani S, Charbel FT, Rezai Jahromi B, Niemelä M, Koivisto T, Frosen J, Tobe Y, Maiti S, Robertson AM, Cebral JR. Prediction of bleb formation in intracranial aneurysms using machine learning models based on aneurysm hemodynamics, geometry, location, and patient population. J Neurointerv Surg 2021; 14:1002-1007. [PMID: 34686573 PMCID: PMC9023610 DOI: 10.1136/neurintsurg-2021-017976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bleb presence in intracranial aneurysms (IAs) is a known indication of instability and vulnerability. OBJECTIVE To develop and evaluate predictive models of bleb development in IAs based on hemodynamics, geometry, anatomical location, and patient population. METHODS Cross-sectional data (one time point) of 2395 IAs were used for training bleb formation models using machine learning (random forest, support vector machine, logistic regression, k-nearest neighbor, and bagging). Aneurysm hemodynamics and geometry were characterized using image-based computational fluid dynamics. A separate dataset with 266 aneurysms was used for model evaluation. Model performance was quantified by the area under the receiving operating characteristic curve (AUC), true positive rate (TPR), false positive rate (FPR), precision, and balanced accuracy. RESULTS The final model retained 18 variables, including hemodynamic, geometrical, location, multiplicity, and morphology parameters, and patient population. Generally, strong and concentrated inflow jets, high speed, complex and unstable flow patterns, and concentrated, oscillatory, and heterogeneous wall shear stress patterns together with larger, more elongated, and more distorted shapes were associated with bleb formation. The best performance on the validation set was achieved by the random forest model (AUC=0.82, TPR=91%, FPR=36%, misclassification error=27%). CONCLUSIONS Based on the premise that aneurysm characteristics prior to bleb formation resemble those derived from vascular reconstructions with their blebs virtually removed, machine learning models can identify aneurysms prone to bleb development with good accuracy. Pending further validation with longitudinal data, these models may prove valuable for assessing the propensity of IAs to progress to vulnerable states and potentially rupturing.
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Affiliation(s)
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Martin Slawski
- Department of Statistics, George Mason University, Fairfax, Virginia, USA
| | - Boyle Cheng
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Alexander K Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Tim G White
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Matthew J Koch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Töölö Hospital, University of Helsinki, Helsinki, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Juhana Frosen
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland.,Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
| | - Yasutaka Tobe
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Spandan Maiti
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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8
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Tone O, Sato Y, Tamaki M, Takada Y. Bleb Embolization of Ruptured Cerebral Aneurysms with Coils and n-Butyl Cyanoacrylate Following Proximal Flow Control: Two Case Reports. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:313-319. [PMID: 37501897 PMCID: PMC10370545 DOI: 10.5797/jnet.cr.2021-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/14/2021] [Indexed: 07/29/2023]
Abstract
Objective Morphologically challenging cerebral aneurysms cannot be treated through standard endovascular procedures. We report two cases of ruptured aneurysms treated using coils and n-butyl cyanoacrylate (NBCA). Case Presentations Case 1 was an 80-year-old woman diagnosed with a subarachnoid hemorrhage (SAH). An angiogram revealed a large and wide-necked basilar artery bifurcation aneurysm. Bilateral superior cerebellar and posterior cerebral arteries (PCAs) originated from the aneurysmal wall. A 3-mm-diameter bleb was detected on the aneurysmal fundus. The bleb enlarged 1 month following coil insertion. During the second treatment, we infused a small volume of 33% NBCA into the coil-framed bleb following proximal flow control of the bilateral vertebral arteries (VAs). The complete bleb obliteration was confirmed by the angiogram at 6 months later. The coil shape was followed up via plane X-ray for 5 years. No rebleeding occurred. Case 2 was a 41-year-old woman diagnosed with SAH. An angiogram revealed a dissecting aneurysm of the left PCA (P1 and P2 segments) accompanying a bleb on the P1 segment. Endovascular treatment was performed, and a coil was inserted into the bleb, infusing 33% NBCA into the coil frame following proximal flow control of bilateral VAs and the right internal carotid artery. Angiograms conducted at 3 months, 1 year, and 9 years and an MRA conducted 12 years later revealed a lack of bleb recanalization. Conclusion We developed a Coil and NBCA technique to obliterate ruptured blebs following proximal flow control. This technique can be considered an effective alternative for treating morphologically challenging cerebral aneurysms.
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Affiliation(s)
- Osamu Tone
- Stroke Center, Ome Municipal General Hospital, Ome, Tokyo, Japan
| | - Yohei Sato
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Masashi Tamaki
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Yoshiaki Takada
- Department of Neurosurgery, Ome Municipal General Hospital, Ome, Tokyo, Japan
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9
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Levitt MR, Aliseda A, Fiorella D, Sadasivan C. One way to get there. J Neurointerv Surg 2021; 13:401-402. [PMID: 33785640 DOI: 10.1136/neurintsurg-2021-017559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Michael R Levitt
- Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Alberto Aliseda
- Mechanical Engineering, Neurological Surgery, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Chander Sadasivan
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
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10
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Liu W, Dai D, Ding YH, Liu Y, Temnyk K, Shen TW, Cardinal KO, Kallmes DF, Kadirvel R. Cellular responses to flow diverters in a tissue-engineered aneurysm model. J Neurointerv Surg 2020; 13:746-751. [PMID: 33158994 DOI: 10.1136/neurintsurg-2020-016593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Notwithstanding the widespread implementation of flow diverters (FDs) in the treatment of intracranial aneurysms, the exact mechanism of action of these devices remains elusive. We aimed to advance the understanding of cellular responses to FD implantation using a 3D tissue-engineered in vitro aneurysm model. METHODS Aneurysm-like blood vessel mimics (aBVMs) were constructed by electrospinning polycaprolactone nanofibers onto desired aneurysm-like geometries. aBVMs were seeded with human aortic smooth muscle cells (SMCs) followed by human aortic endothelial cells (ECs). FDs were then deployed in the parent vessel of aBVMs covering the aneurysm neck and were cultivated for 7, 14, or 28 days (n=3 for each time point). The EC and SMC coverage in the neck was measured semi-quantitatively. RESULTS At day 7, the device segment in contact with the parent vessel was partially endothelialized. Also, the majority of device struts, but not pores, at the parent vessel and neck interface were partially covered with ECs and SMCs, while device struts in the middle of the neck lacked cell coverage. At 14 days, histology verified a neointimal-like lining had formed, partially covering both the struts and pores in the center of the neck. At 28 days, the majority of the neck was covered with a translucent neointimal-like layer. A higher degree of cellular coverage was seen on the struts and pores at the neck at 28 days compared with both 7 and 14 days. CONCLUSION aBVMs can be a valuable alternative tool for evaluating the healing mechanisms of endovascular aneurysm devices.
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Affiliation(s)
- Wenjing Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Geriatrics, China Medical University First Hospital, Shenyang, China
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen Temnyk
- Biomedical Engineering Department, Cal Poly, San Luis Obispo, California, USA
| | - Tiffany W Shen
- Biomedical Engineering Department, Cal Poly, San Luis Obispo, California, USA
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Salimi Ashkezari SF, Mut F, Chung BJ, Yu AK, Stapleton CJ, See AP, Amin-Hanjani S, Charbel FT, Rezai Jahromi B, Niemelä M, Frösen J, Maiti S, Robertson AM, Cebral JR. Hemodynamics in aneurysm blebs with different wall characteristics. J Neurointerv Surg 2020; 13:642-646. [PMID: 33020208 PMCID: PMC8294199 DOI: 10.1136/neurintsurg-2020-016601] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Blebs are important secondary structures of intracranial aneurysms associated with increased rupture risk and can affect local wall stress and hemodynamics. Mechanisms of bleb development and evolution are not clearly understood. We investigate the relationship between blebs with different wall characteristics and local hemodynamics and rupture sites. METHODS Blebs with different wall appearances in intra-operative videos were analyzed with image-based computational fluid dynamics. Thin red blebs were compared against thick atherosclerotic/hyperplastic white/yellow blebs. Rupture points were identified in videos of ruptured aneurysms harboring blebs. RESULTS Thin blebs tended to be closer to the inflow than atherosclerotic blebs of the same aneurysm (P=0.0234). Blebs near the inflow had higher velocity (P=0.0213), vorticity (P=0.0057), shear strain rate (P=0.0084), wall shear stress (WSS) (P=0.0085), and WSS gradient (P=0.0151) than blebs far from the inflow. In a subset of 12 ruptured aneurysms harboring blebs, rupture points were associated with thin blebs in 42% of aneurysms, atherosclerotic blebs in 25%, and were away from blebs in the remaining 33%. CONCLUSIONS Not all blebs are equal; some have thin translucent walls while others have thick atherosclerotic walls. Thin blebs tend to be located closer to the inflow than atherosclerotic blebs. Blebs near the inflow are exposed to stronger flows with higher and spatially variable WSS than blebs far from the inflow which tend to have uniformly lower WSS. Aneurysms can rupture at thin blebs, atherosclerotic blebs, and even away from blebs. Further study of wall failure in aneurysms with different bleb types is needed.
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Affiliation(s)
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Alexander K Yu
- Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Alfred P See
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Juhana Frösen
- Department of Neurosurgery, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Spandan Maiti
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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