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Ren X, Li H, Xu K, Li Z, Gao B, Lu W, Yang G, Wang Y, Yin Y, Chen T. Hemodynamic study on the therapeutic effects of varying diameter embolic coils in the treatment of intracranial aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3807. [PMID: 38281812 DOI: 10.1002/cnm.3807] [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: 09/13/2023] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
Endovascular coiling is the predominant method for treating cerebral aneurysms. Extensive reports on selecting coil length, hardness, and material are available. However, the impact of coil diameter on postoperative outcomes remains unclear. This study enrolled six personalized geometric models of intracranial aneurysms: three bifurcation aneurysms and three sidewall aneurysms. Four coil models were constructed by changing the coil diameter. Coil embolization was simulated using the finite element method. Computational fluid dynamics was used to characterize hemodynamics in the aneurysms after embolization. Evaluation parameters included velocity reduction, wall shear stress (WSS), low WSS (LWSS), oscillatory shear index (OSI), relative residence time (RRT), and residual flow volume in the aneurysms. At the peak time (t = 0.17 s), the proportion of LWSS area in bifurcation aneurysms increase with the rise in coil diameter: 0.8D, 71.28 ± 12.62% versus 1D, 74.97 ± 19.17% versus 1.2D, 78.88 ± 18.56% versus 1.4D, 84.00 ± 11.53% (mean ± SD). The proportion of high OSI area decreases as the coil diameter increases: 0.8D, 4.41% ± 2.82% versus 1.0D, 3.78 ± 3.33% versus 1.2D, 2.28% ± 1.77% versus 1.4D, 1.58% ± 1.11% (mean ± SD). The proportion of high RRT area increases as the coil diameter rises: 0.8D, 3.40% ± 1.68% versus 1.0D, 7.67 ± 4.12% versus 1.2D, 9.84% ± 9.50% versus 1.4D, 22.29% ± 14.28% (mean ± SD). Side wall aneurysms do not exhibit the aforementioned trend. Bifurcation aneurysms plugged with a coil of 1.4 times the diameter have the largest RFVs (<10 mm/s) within the group. Aforementioned patterns are not found in sidewall aneurysms. In the treatment of aneurysms with coiling, varying coil diameters can result in different hemodynamic environments within the aneurysm. Larger coil diameters have improved hemodynamic performance for bifurcation aneurysms. However, coil diameter and embolization effectiveness have no significant relationship for sidewall aneurysms.
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Affiliation(s)
- Xiaoyu Ren
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Haoran Li
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Kaihang Xu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Zhongkai Li
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bin Gao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Wangsheng Lu
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Guangming Yang
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Yunjie Wang
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Yin Yin
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Tao Chen
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
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Fujitani S, Tsuruta W, Tomioka A, Ishigami D, Sekine T, Hosoo H, Kamiya Y, Matsumaru Y. Aneurysm Isolation is Associated with Complete Occlusion of Aneurysms After Flow Diverter Treatment. Clin Neuroradiol 2023; 33:1087-1093. [PMID: 37428198 DOI: 10.1007/s00062-023-01312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Some aneurysms remain patent after treatment with flow diverters (FD) due to residual blood flow in the aneurysm. Several studies have proposed that branches and residual flow are associated with delayed aneurysm occlusion. We propose that aneurysm isolation (i.e., the complete disconnection of the aneurysm from surrounding vessels) might be a possible factor facilitating aneurysm occlusion. This study aimed to determine if aneurysm isolation was a factor associated with aneurysm occlusion after FD treatment. METHODS We reviewed 80 internal carotid artery (ICA) aneurysms treated with FDs between October 2014 and April 2021. Aneurysm isolation was assessed in high-resolution cone-beam computed tomograms at the end of each treatment. Aneurysms with incorporated branches and those with connections to other branches due to stent malapposition were deemed to be nonisolated. Other factors, such as patient age, sex, anticoagulant use, aneurysm size, adjunct coil use, and the presence of incorporated branches, were considered. The degree of aneurysm occlusion (complete or incomplete) was assessed by follow-up angiograms 12 months after treatment. RESULTS Complete occlusion was achieved in 57 of 80 aneurysms (71%). Completely occluded aneurysms had a significantly higher ratio of isolation compared to incompletely occluded aneurysms (91.2% vs. 69.6%, P = 0.032). Multivariate logistic regression analysis showed that aneurysm isolation was the sole significant predictor of complete aneurysm occlusion (odds ratio, OR 19.38; 95% confidence interval, CI 2.280-164.657; P = 0.007). CONCLUSION Aneurysm isolation is a significant factor contributing to complete occlusion after FD treatment.
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Affiliation(s)
- Shigeta Fujitani
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan.
| | - Arisa Tomioka
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daiichiro Ishigami
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomokazu Sekine
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Hisayuki Hosoo
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuki Kamiya
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Zhou M, Wu Z, Maalim AA, Zeng Y, Guo X, Zhang Z, Yuan X, Enos ZM, Shu K, Lei T, Zhu M. Overlapping Stent Treatment for Ruptured Dissecting Aneurysms in Posterior Circulation. Brain Sci 2023; 13:1507. [PMID: 38002469 PMCID: PMC10669846 DOI: 10.3390/brainsci13111507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
Ruptured dissecting aneurysms in posterior intracranial circulation present significant clinical challenges and often cause poor prognoses. Our cohort used overlapping stents as the primary treatment. We analyzed the medical records of 27 patients (18 men/nine women) with ruptured posterior circulation dissecting aneurysms (PCDAs). Their average age was 52 years. We selected 11 patients who used Enterprise (EP) and LVIS stents overlappingly and matched them 1:1 with counterparts who received either EP or LVIS stents individually. Overlapping stents was a feasible treatment in all 27 cases. We successfully followed up 26 patients for ≥6 months. Regrettably, one patient died from intracranial hypertension on Day 7 post-procedure. Immediate post-procedure angiographies indicated Raymond grade I, II, and III occlusions of PCDAs in 16 (59.3%), 7 (25.9%), and 4 (14.8%) cases, respectively. At an average follow-up duration of 16.2 months, 25 patients (96.2%) had modified Rankin Scale scores of 0-2, signifying positive outcomes. One patient (3.8%) had a score of 3-4. Recurrence rates for the EP and LVIS stent groups were higher than those of the overlapping stent group (45.45% vs. 9.09%, p = 0.15 and 27.27% vs. 9.09%, p = 0.59, respectively). No significant difference in recurrence rates existed between the overlapping and single-stent groups. Similarly, follow-up outcomes were consistent between the two groups. Overlapping stents could be an efficient method for treating ruptured PCDAs.
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Affiliation(s)
- Minghui Zhou
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Zengbao Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Ali Abdi Maalim
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Ying Zeng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Xiao Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Zhenhua Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Xiaohong Yuan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Zacharia Majaliwa Enos
- Department of Neurosurgery, Tongji Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430030, China;
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
| | - Mingxin Zhu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.); (A.A.M.); (Y.Z.); (X.G.); (Z.Z.); (X.Y.); (K.S.); (T.L.)
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