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Wang M, Shi SN, Xiang JP, Wan S. Establishing surgical plan of endovascular intervention for intracranial aneurysm using AneuPlan™ - An exploratory study. Asian J Surg 2024:S1015-9584(24)01183-7. [PMID: 38880670 DOI: 10.1016/j.asjsur.2024.05.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024] Open
Affiliation(s)
- Ming Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China; Brain Center, Zhejiang Hospital, Hangzhou, China; Zhejiang Province Engineering Research Center for Precision Medicine in Cerebrovascular Diseases, Hangzhou, China
| | - Shu-Nan Shi
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | | | - Shu Wan
- Brain Center, Zhejiang Hospital, Hangzhou, China; Zhejiang Province Engineering Research Center for Precision Medicine in Cerebrovascular Diseases, Hangzhou, China.
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Panneerselvam NK, Sudhir BJ, Kannath SK, Patnaik BSV. Influence of framing coil orientation and its shape on the hemodynamics of a basilar aneurysm model. Med Biol Eng Comput 2024:10.1007/s11517-024-03146-4. [PMID: 38856881 DOI: 10.1007/s11517-024-03146-4] [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: 12/16/2023] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
Aneurysms are bulges of an artery, which require clinical management solutions. Due to the inherent advantages, endovascular coil filling is emerging as the treatment of choice for intracranial aneurysms (IAs). However, after successful treatment of coil embolization, there is a serious risk of recurrence. It is well known that optimal packing density will enhance treatment outcomes. The main objective of endovascular coil embolization is to achieve flow stasis by enabling significant reduction in intra-aneurysmal flow and facilitate thrombus formation. The present study numerically investigates the effect of framing coil orientation on intra-aneurysmal hemodynamics. For the purpose of analysis, actual shape of the embolic coil is used, instead of simplified ideal coil shape. Typically used details of the framing coil are resolved for the analysis. However, region above the framing coil is assumed to be filled with a porous medium. Present simulations have shown that orientation of the framing coil loop (FCL) greatly influences the intra-aneurysmal hemodynamics. The FCLs which were placed parallel to the outlets of basilar tip aneurysm (Coil A) were found to reduce intra-aneurysmal flow velocity that facilitates thrombus formation. Involving the coil for the region is modeled using a porous medium model with a packing density of 20 % . The simulations indicate that the framing coil loop (FCL) has a significant influence on the overall outcome.
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Affiliation(s)
- Nisanth Kumar Panneerselvam
- Department of Applied Mechanics and Biomedical Engineering, Indian Institute of Technology Madras, Chennai, 600036, Tamilnadu, India
| | - B J Sudhir
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, Kerala, India.
| | - Santhosh K Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, Kerala, India
| | - B S V Patnaik
- Department of Applied Mechanics and Biomedical Engineering, Indian Institute of Technology Madras, Chennai, 600036, Tamilnadu, India.
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You W, Wei D, Gui S, Jiang J, Chen T, Tang Y, Ye W, Lv J, Lin J, Chen P, Wang Z, Gong W, Jin H, Ge H, Jiang Y, Sun Y, Li Y. Quantitative Analysis of Hemodynamic Changes in Branch Arteries Covered by Flow Diverters. Neurosurgery 2024:00006123-990000000-01184. [PMID: 38819159 DOI: 10.1227/neu.0000000000002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding post-treatment hemodynamic alterations and their association with the patency of covered branch arteries is limited. This study aims to identify hemodynamic changes after flow diverter stenting and investigate their correlation with the patency status of covered branch arteries. METHODS All patients treated with pipeline embolization device for anterior cerebral artery aneurysms at our center between 2016 and 2020 were screened for inclusion. Quantitative digital subtraction angiography was used to analyze changes in hemodynamic parameters pre- and post-stenting. The patency status of covered branch arteries after stenting was categorized as either patent or flow impairment (defined as artery stenosis or occlusion). RESULTS A total of 71 patients, encompassing 89 covered branch arteries, were enrolled. Flow impairment was observed in 11.2% (10/89) of the branches. The mean transit time and full width at half maximum (FWHM) in covered branches were significantly prolonged post-stenting (P = .004 and .023, respectively). Flow-impaired branch arteries exhibited hemodynamic shifts contrary to those in patent branch arteries. Specifically, flow-impaired branches showed marked reductions in time to peak, FWHM, and mean transit time (decreases of 32.8%, 32.6%, and 29%, respectively; P = .006, .002, and .002, respectively). Further multivariate analysis revealed that reductions in FWHM in the branches (odds ratio = 0.97, 95% CI: 0.95-0.99, P = .007) and smoking (odds ratio = 14.5, 95% CI: 1.39-151.76, P = .026) were independent predictors of flow impairment of covered branches. CONCLUSION Pipeline embolization device stenting can cause a reduction in blood flow in branch arteries. Compared with patent branches, flow-impaired branches exhibit an increase in blood flow velocity after stenting. Smoking and ΔFWHM in the covered branches indicate flow impairment.
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Affiliation(s)
- Wei You
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurointerventional Engineering and Technology (NO: BG0287), Beijing Engineering Research Center, Beijing, China
| | - Dachao Wei
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurointerventional Engineering and Technology (NO: BG0287), Beijing Engineering Research Center, Beijing, China
| | - Siming Gui
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jia Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ting Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Yudi Tang
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wanxing Ye
- Artificial Intelligence Research Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jian Lv
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jun Lin
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Peike Chen
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ziyao Wang
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wentao Gong
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hengwei Jin
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Huijian Ge
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yong Sun
- Department of Neurosurgery, The First People's Hospital of Lianyungang, Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Youxiang Li
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurointerventional Engineering and Technology (NO: BG0287), Beijing Engineering Research Center, Beijing, China
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Li W, Wang C, Wang Y, Zhao Y, Yang X, Liu X, Liu J. A model with multiple intracranial aneurysms: possible hemodynamic mechanisms of aneurysmal initiation, rupture and recurrence. Chin Neurosurg J 2024; 10:13. [PMID: 38711139 PMCID: PMC11071235 DOI: 10.1186/s41016-024-00364-5] [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: 01/14/2022] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states. METHODS We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms. RESULTS The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm. CONCLUSIONS Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.
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Affiliation(s)
- Wenqiang Li
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Wang
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Yanmin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yapeng Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jian Liu
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China.
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Fu Y, Bian X, Zou R, Jin R, Leng X, Fan F, Wei S, Cui X, Xiang J, Guan S. Hemodynamic alterations of flow diverters on aneurysms at the fetal posterior communicating artery: A simulation study using CFD to compare the surpass streamline, pipeline flex, and tubridge devices. J Neuroradiol 2024; 51:74-81. [PMID: 37442272 DOI: 10.1016/j.neurad.2023.07.002] [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: 12/01/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Traditional flow diverters (FDs) for treating aneurysms at the fetal posterior communicating artery are unsatisfactory. Surpass Streamline is a novel FD with different mesh characteristics; however, the outcomes for such aneurysms remain unclear. This study aimed to compare hemodynamic alterations induced by Surpass Streamline, Pipeline Flex, and Tubridge devices and explore possible strategies for aneurysms at the fetal posterior communicating artery. METHODS Two simulated aneurysms (Case 1, Case 2) were constructed from digital subtraction angiography (DSA). The three FDs were virtually deployed, and hemodynamic analysis based on computational fluid dynamics was performed. Hemodynamic parameters, including the sac-averaged velocity magnitude (Velocity), high-flow volume (HFV), and wall shear stress (WSS), were compared between each FD and the untreated model (control). Surpass Streamline was performed in real life for two aneurysms and the clinical outcomes were collected for analysis. RESULTS Compared to the control, the Surpass resulted in the most significant reduction in flow. In Case 1, the Velocity, HFV, and WSS were reduced by 51.6%, 78.1%, and 64.3%, respectively. In Case 2, the Velocity, HFV, and WSS were reduced by 48.0%, 81.1%, and 65.3%, respectively. Tubridge showed slightly larger changes in hemodynamic parameters than Pipeline. In addition, our analysis suggested that metal coverage was correlated with the WSS, Velocity, and HFV. The postoperative DSA showed that the aneurysm was nearly occluded in Case 1 and decreased in Case 2. CONCLUSION Compared to that with the Pipeline and Tubridge, the Surpass resulted in the greatest reduction in hemodynamic parameters and might be effective for aneurysms at the fetal posterior communicating artery. Virtual FD deployment and computational fluid dynamics analysis may be used to predict the treatment outcomes.
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Affiliation(s)
- Yu Fu
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Bian
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Rongbo Jin
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | - Feng Fan
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Wei
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuan Cui
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Sheng Guan
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Shim HS, Ryu CW, Shin HS. Progression from Early Minor Recanalization to Major Recanalization in Ruptured Intracranial Aneurysms After Successful Coil Embolization: Risk Factors and Proposal of a Novel Predicting Variable. World Neurosurg 2024; 181:e294-e302. [PMID: 37839571 DOI: 10.1016/j.wneu.2023.10.041] [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: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The risk factors for the progression from early minor recanalization to major recanalization are not well established. Herein, we evaluated ruptured intracranial aneurysms (IAs) with minor recanalization within 1 year of coiling and their progression to major recurrence. METHODS We retrospectively reviewed our database of coiled IAs and searched for ruptured saccular IAs that were successfully embolized without residual sacs. We selected IAs with minor recanalization confirmed on radiological studies within 1 year of coil embolization. All the IA cases had a follow-up period longer than 36 months based on the radiological results. RESULTS Minor recanalization occurred in 45 IAs within 1 year of coil embolization. Among them, 14 IAs (31.1%) progressed to major recanalization, and 31 remained stable. Progression to major recanalization was detected 12 months after minor recanalization in 2 patients, 24 months in 7 patients, and 36 months in 5 patients. Moreover, the progression to major recanalization occurred more frequently in IAs at the posterior location (P = 0.024, odds ratio 11.20) and IAs with a proportional forced area > 9 mm2 (P = 0.002, odds ratio 17.13), which was a newly proposed variable in the present study. CONCLUSIONS Our results showed that approximately one third of the ruptured IAs with early minor recanalization after coiling progressed to major recanalization within 3 years. Physicians should focus on the progression of ruptured IAs from minor to major recanalization, especially those with a posterior circulation location and a proportional forced area >9 mm2.
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Affiliation(s)
- Hwan Seok Shim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
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Nariai Y, Takigawa T, Kawamura Y, Hyodo A, Suzuki K. Inflow Angle and Height-Width Ratio are Predictors of Incomplete Occlusion at One and Two Years After Flow Diverter Treatment for Small- and Medium-Sized Internal Carotid Artery Aneurysms. World Neurosurg 2023; 180:e716-e728. [PMID: 37821031 DOI: 10.1016/j.wneu.2023.10.014] [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: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE We investigated the association between the inflow angle of aneurysms and their occlusion status at 1 and 2 years after flow diverter (FD) treatment. METHODS We retrospectively analyzed 42 consecutive patients from a single center with 43 untreated, unruptured internal carotid artery (ICA) proximal to communicating segment, saccular aneurysms sized <12 mm. RESULTS At 1 year posttreatment, the complete occlusion (CO) rate was 58.1%. On univariate analyses, the proportion of inflow angle >90° was significantly lower in the CO group than in the incomplete occlusion group (20.0% VS. 83.3%; P < 0.001). The CO incidence decreased with a height-width (H/W) ratio of <1.2 (P = 0.059). On multivariate analysis, an H/W ratio of <1.2 (odds ratio [OR], 0.076; P = 0.027) and an inflow angle of >90° (OR, 0.020; P = 0.0011) significantly influenced CO at 1 year post FD. At 2 years posttreatment, the CO rate was 76.3% (29/38 cases with available follow-up data). On univariate analyses, in the CO group compared to the incomplete occlusion group, the proportion of H/W ratio <1.2 was significantly lower (P = 0.005) and the proportion of inflow angle >90° was significantly lower (P = 0.021); aneurysm dome size tended to be larger (8.5 mm vs. 7.1 mm; P = 0.080). On multivariate analysis, an H/W ratio <1.2 (OR, 0.042; P = 0.015) and an inflow angle >90° (OR: 0.088; P = 0.031) significantly influenced CO at 2 years post FD. CONCLUSIONS The inflow angle of >90° and H/W ratio <1.2 may significantly influence the CO rate in small- or medium-sized internal carotid artery aneurysms 1 and 2 years post FD.
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Affiliation(s)
- Yasuhiko Nariai
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Kamagaya General Hospital, Chiba, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Tanaka K, Furukawa K, Ishida F, Suzuki H. Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery. Acta Neurochir (Wien) 2023; 165:3697-3706. [PMID: 37870661 DOI: 10.1007/s00701-023-05840-y] [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: 06/23/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The recanalization of posterior communicating artery (PCoA) aneurysms after endovascular treatment has been analyzed by various factors. However, the differences between adult and fetal types of posterior cerebral artery (PCA) have not been fully investigated. The main aim of this study was to investigate hemodynamic differences of PCoA aneurysms between adult and fetal types using computational fluid dynamics (CFD). METHODS Fifty-five PCoA aneurysms were evaluated by 3D CT angiography and divided into unruptured aneurysms with adult-type or fetal-type PCAs (19 cases, UA group; 9 cases, UF group) and ruptured aneurysms with adult-type or fetal-type PCAs (17 cases, RA group; 10 cases, RF group). These native aneurysms were analyzed by CFD regarding morphological and hemodynamic characteristics. To evaluate simulated endovascular treatment of aneurysms, CFD was performed using porous media modeling. RESULTS Morphologically, the RA group had significantly smaller parent artery diameter (2.91 mm vs. 3.49 mm, p=0.005) and higher size ratio (2.54 vs. 1.78, p=0.023) than the RF group. CFD revealed that the UA group had significantly lower oscillatory shear index (OSI) (0.0032 vs. 0.0078, p=0.004) than the UF group and that the RA group had lower WSS (3.09 vs. 11.10, p=0.001) and higher OSI (0.014 vs. 0.006, p=0.031) than the RF group, while the RF group presented significantly higher intra-aneurysmal flow velocity (0.19 m/s vs. 0.061 m/s, p=0.002) than the RA group. Porous media modeling of simulated treatment revealed higher residual flow volume in the fetal-type groups. CONCLUSIONS These results suggested that PCoA aneurysms with fetal-type PCAs had different morphological features and hemodynamic characteristics compared with those with adult-type PCAs, leading to high risks of recanalization.
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Affiliation(s)
- Katsuhiro Tanaka
- Department of Neurosurgery, Kuwana City Medical Center, 3-11, Kotobuki-Cho, Kuwana, Mie, 511-0061, Japan.
| | - Kazuhiro Furukawa
- Department of Neurosurgery, NHO Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Fujimaro Ishida
- Department of Neurosurgery, NHO Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Chen L, Leng X, Zheng C, Shan Y, Wang M, Bao X, Wu J, Zou R, Liu X, Xu S, Xiang J, Wan S. Computational fluid dynamics (CFD) analysis in a ruptured vertebral artery dissecting aneurysm implanted by Pipeline when recurrent after LVIS-assisted coiling treatment: Case report and review of the literatures. Interv Neuroradiol 2023; 29:442-449. [PMID: 35484808 PMCID: PMC10399494 DOI: 10.1177/15910199221097766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUNDS Hemodynamics plays an important role in the natural history of the process of rupture and recurrence of intracranial aneurysms. This study aimed to investigate the role of hemodynamics for recurrence in a vertebral artery dissecting aneurysm (VADA). METHODS A patient with a ruptured VADA firstly treated by low-profile visualized intraluminal support (LVIS)-assisted coiling, and was implanted with a Pipeline Embolization Device (PED) after aneurysm recurrence. Finite element analysis and computational fluid dynamics simulations were conducted in 6 serial imaging procedures, and the calculated hemodynamics was correlated with aneurysm recurrence. RESULTS Wall shear stress (WSS) was not effectively suppressed, resulting in aneurysm recurrence with initial entry tear to occur above the protuberance after 7 months of LVIS stent-assisted coiling. With the implantation of PED, WSS, inflow stream and velocity at the aneurysm neck significantly decreased. During the 3-month follow-up after PED deployment, there was significant shrinkage of the sac and the blood flow in the sac was reduced considerably. The 27-month follow-up after PED deployment indicated the aneurysm was stable. CONCLUSIONS The present case study suggests that insufficient suppression of high WSS and high inflow velocity at the neck of the parent artery, especially near the posterior inferior cerebellar artery, might be associated with aneurysm recurrence.
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Affiliation(s)
- Linhui Chen
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Chaobo Zheng
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yejie Shan
- ArteryFlow Technology Co., Ltd. Hangzhou, China
| | - Ming Wang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Bao
- Department of Neurosurgery, Jinhua Central Hospital, Jinhua, China
| | - Jiong Wu
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd. Hangzhou, China
| | - Xiaobo Liu
- Department of Neurosurgery, Jinhua Central Hospital, Jinhua, China
| | - Shanhu Xu
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Shu Wan
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Cheng L, Huang Y, Yao H, Luo J, Zhang L, Fu R, Lv J, Yang B, Yan L. Wall Shear Stress Reduction Activates Angiotensin II to Facilitate Aneurysmal Subarachnoid Hemorrhage in Intracranial Aneurysms Through MicroRNA-29/The Growth Factor-Beta Receptor Type II/Smad3 Axis. World Neurosurg 2023; 176:e314-e326. [PMID: 37230243 DOI: 10.1016/j.wneu.2023.05.056] [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: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE We tried to broaden our knowledge of the possible role of wall shear stress (WSS) in the occurrence of intracranial aneurysms (IAs). METHODS Genes implicated in IAs and genes related to WSS were predicted through in silico analysis. Rat models of IAs were established, in which the expression patterns of angiotensin II (Ang II) were characterized, and WSS was assessed. Vascular endothelial cells isolated from rats bearing IAs were treated with microRNA-29 (miR-29) mimic/inhibitor, small interfering RNA-TGF-β receptor type II (TGFBR2)/overexpressed TGFBR2, Ang II, or angiotensin-converting enzyme (ACE) inhibitor. Then, the endothelial-to-mesenchymal transition (EndMT) was evaluated by flow cytometry. Finally, the volume of IAs and risk of subarachnoid hemorrhage were analyzed in vivo in response to miR-29 gain of function. RESULTS WSS was decreased in the IA bearing arteries, which showed a positive correlation with ACE and Ang II in the vascular tissues of IA rats. Reduced miR-29 and increased ACE, Ang II, and TGFBR2 were detected in the vascular tissues of IA rats. Ang II inhibited miR-29, which targeted TGFBR2. Downregulated TGFBR2 was accompanied by suppression of Smad3 phosphorylation. Through impairing miR-29-dependent inhibition of TGFBR2, Ang II enhanced EndMT. In vivo data confirmed that treatment of miR-29 agomir delayed the formation of IA and decreased the risk of subarachnoid hemorrhage. CONCLUSIONS The current study provided evidence that WSS reduction could activate Ang II, reduce miR-29 expression, and activate the TGFBR2/Smad3 axis, thus promoting EndMT and accelerating the progression of IAs.
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Affiliation(s)
- Longhai Cheng
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Yan Huang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Hong Yao
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Jie Luo
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Li Zhang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Rui Fu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Junti Lv
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China.
| | - Bowen Yang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Lidong Yan
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
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Fillingham P, Romero Bhathal J, Marsh LMM, Barbour MC, Kurt M, Ionita CN, Davies JM, Aliseda A, Levitt MR. Improving the accuracy of computational fluid dynamics simulations of coiled cerebral aneurysms using finite element modeling. J Biomech 2023; 157:111733. [PMID: 37527606 PMCID: PMC10528313 DOI: 10.1016/j.jbiomech.2023.111733] [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: 02/06/2023] [Revised: 05/26/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
Cerebral aneurysms are a serious clinical challenge, with ∼half resulting in death or disability. Treatment via endovascular coiling significantly reduces the chances of rupture, but the techniquehas failure rates of ∼20 %. This presents a pressing need to develop a method fordetermining optimal coildeploymentstrategies. Quantification of the hemodynamics of coiled aneurysms using computational fluid dynamics (CFD) has the potential to predict post-treatment outcomes, but representing the coil mass in CFD simulations remains a challenge. We use the Finite Element Method (FEM) for simulating patient-specific coil deployment for n = 4 ICA aneurysms for which 3D printed in vitro models were also generated, coiled, and scanned using ultra-high resolution synchrotron micro-CT. The physical and virtual coil geometries were voxelized onto a binary structured grid and porosity maps were generated for geometric comparison. The average binary accuracy score is 0.8623 and the average error in porosity map is 4.94 %. We then conduct patient-specific CFD simulations of the aneurysm hemodynamics using virtual coils geometries, micro-CT generated oil geometries, and using the porous medium method to represent the coil mass. Hemodynamic parameters including Neck Inflow Rate (Qneck) and Wall Shear Stress (WSS) were calculated for each of the CFD simulations. The average relative error in Qneck and WSS from CFD using FEM geometry were 6.6 % and 21.8 % respectively, while the error from CFD using a porous media approximation resulted in errors of 55.1 % and 36.3 % respectively; demonstrating a marked improvement in the accuracy of CFD simulations using FEM generated coil geometries.
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Affiliation(s)
- Patrick Fillingham
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States.
| | | | - Laurel M M Marsh
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Michael C Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Mehmet Kurt
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Jason M Davies
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, United States
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States; Department of Radiology, University of Washington, Seattle, WA, United States
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Bass DI, Marsh LMM, Fillingham P, Lim D, Chivukula VK, Kim LJ, Aliseda A, Levitt MR. Modeling the Mechanical Microenvironment of Coiled Cerebral Aneurysms. J Biomech Eng 2023; 145:041005. [PMID: 36193892 PMCID: PMC9791668 DOI: 10.1115/1.4055857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/09/2022] [Indexed: 12/30/2022]
Abstract
Successful occlusion of cerebral aneurysms using coil embolization is contingent upon stable thrombus formation, and the quality of the thrombus depends upon the biomechanical environment. The goal of this study was to investigate how coil embolization alters the mechanical micro-environment within the aneurysm dome. Inertialess particles were injected in three-dimensional, computational simulations of flow inside patient aneurysms using patient-specific boundary conditions. Coil embolization was simulated as a homogenous porous medium of known permeability and inertial constant. Lagrangian particle tracking was used to calculate the residence time and shear stress history for particles in the flow before and after treatment. The percentage of particles entering the aneurysm dome correlated with the neck surface area before and after treatment (pretreatment: R2 = 0.831, P < 0.001; post-treatment: R2 = 0.638, P < 0.001). There was an inverse relationship between the change in particles entering the dome and coil packing density (R2 = 0.600, P < 0.001). Following treatment, the particles with the longest residence times tended to remain within the dome even longer while accumulating lower shear stress. A significant correlation was observed between the treatment effect on residence time and the ratio of the neck surface area to porosity (R2 = 0.390, P = 0.007). The results of this study suggest that coil embolization triggers clot formation within the aneurysm dome via a low shear stress-mediated pathway. This hypothesis links independently observed findings from several benchtop and clinical studies, furthering our understanding of this treatment strategy.
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Affiliation(s)
- David I. Bass
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104
| | - Laurel M. M. Marsh
- Department of Mechanical Engineering, University of Washington, 3900 East Stevens Way NE, Box 352600, Seattle, WA 98195
| | - Patrick Fillingham
- Department of Neurological Surgery, Stroke & Applied Neuroscience Center, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104
| | - Do Lim
- Department of Neurological Surgery, Stroke & Applied Neuroscience Center, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104
| | - V. Keshav Chivukula
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, 150 West University Building, Melbourne, FL 32901
| | - Louis J. Kim
- Department of Neurological Surgery, Stroke & Applied Neuroscience Center, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104; Department of Radiology, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104
| | - Alberto Aliseda
- Department of Mechanical Engineering, Stroke & Applied Neuroscience Center, University of Washington, 3900 East Stevens Way NE, Box 352600, Seattle, WA 98195; Department of Neurological Surgery, Stroke & Applied Neuroscience Center, University of Washington, 3900 East Stevens Way NE, Box 352600, Seattle, WA 98195
| | - Michael R. Levitt
- Department of Neurological Surgery, Stroke & Applied Neuroscience Center, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104; Department of Radiology, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104; Department of Mechanical Engineering, University of Washington, 325 9th Avenue, Box 359924, Seattle, WA 98104
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Romero Bhathal J, Chassagne F, Marsh L, Levitt MR, Geindreau C, Aliseda A. Modeling Flow in Cerebral Aneurysm After Coils Embolization Treatment: A Realistic Patient-Specific Porous Model Approach. Cardiovasc Eng Technol 2023; 14:115-128. [PMID: 35879587 PMCID: PMC9873836 DOI: 10.1007/s13239-022-00639-x] [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: 08/03/2021] [Accepted: 06/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Computational fluid dynamics (CFD) has been used to evaluate the efficiency of endovascular treatment in coiled cerebral aneurysms. The explicit geometry of the coil mass cannot typically be incorporated into CFD simulations since the coil mass cannot be reconstructed from clinical images due to its small size and beam hardening artifacts. The existing methods use imprecise porous medium representations. We propose a new porous model taking into account the porosity heterogeneity of the coils deployed in the aneurysm. METHODS The porosity heterogeneity of the coil mass deployed inside two patients' cerebral aneurysm phantoms is first quantified based on 3D X-ray synchrotron images. These images are also used to compute the permeability and the inertial factor arising in porous models. A new homogeneous porous model (porous crowns model), considering the coil's heterogeneity, is proposed to recreate the flow within the coiled aneurysm. Finally, the validity of the model is assessed through comparisons with coil-resolved simulations. RESULTS The strong porosity gradient of the coil measured close to the aneurysmal wall is well captured by the porous crowns model. The permeability and the inertial factor values involved in this model are closed to the ideal homogeneous porous model leading to a mean velocity in the aneurysmal sac similar as in the coil-resolved model. CONCLUSION The porous crowns model allows for an accurate description of the mean flow within the coiled cerebral aneurysm.
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Affiliation(s)
| | - Fanette Chassagne
- Mines Saint-Etienne, INSERM, UMR1059, SAINBIOSE, CIS-EMSE, Saint-Etienne, France
| | - Laurel Marsh
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
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Jiang Y, Lu G, Ge L, Zou R, Li G, Wan H, Leng X, Xiang J, Zhang X. Hemodynamic Comparison of Treatment Strategies for Intracranial Vertebral Artery Fusiform Aneurysms. Front Neurol 2022; 13:927135. [PMID: 35873788 PMCID: PMC9296783 DOI: 10.3389/fneur.2022.927135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study comparatively analyzed the hemodynamic changes resulting from various simulated stent-assisted embolization treatments to explore an optimal treatment strategy for intracranial vertebral artery fusiform aneurysms. An actual vertebral fusiform aneurysm case treated by large coil post-stenting (PLCS) was used as a control. Materials and Methods A single case of an intracranial vertebral artery fusiform aneurysm underwent a preoperative and eight postoperative finite element treatment simulations: PLCS [single and dual Low-profile Visualized Intraluminal Support (LVIS)], Jailing technique (single and dual LVIS both simulated twice, Pipeline Embolization Device (PED) with or without large coils (LCs). Qualitative and quantitative assessments were performed to analyze the most common hemodynamic risk factors for recurrence. Results Jailing technique and PED-only had a high residual flow volume (RFV) and wall shear stress (WSS) on the large curvature of the blood flow impingement region. Quantitative analysis determined that PLSC and PED had a lower RFV compared to preoperative than did the jailing technique [PED+LC 2.46% < PLCS 1.2 (dual LVIS) 4.75% < PLCS 1.1 (single LVIS) 6.34% < PED 6.58% < Jailing 2.2 12.45% < Jailing 1.2 12.71% < Jailing 1.1 14.28% < Jailing 2.1 16.44%]. The sac-averaged flow velocity treated by PLCS, PED and PED+LC compared to preoperatively was significantly lower than the jailing technique [PED+LC = PLCS 1.2 (dual LVIS) 17.5% < PLCS 1.1 (single LVIS) = PED 27.5% < Jailing 1.2 = Jailing 2.2 32.5% < Jailing 1.1 37.5% < Jailing 2.1 40%]. The sac-averaged WSS for the PLCS 1.2 (dual LVIS) model was lower than the PED+LC, while the high WSS area of the Jailing 1 model was larger than for Jailing 2 [PLCS 1.2 38.94% (dual LVIS) < PED+LC 41% < PLCS 1.1 43.36% (single LVIS) < PED 45.23% < Jailing 2.1 47.49% < Jailing 2.2 47.79% < Jailing 1.1 48.97% < Jailing 1.2 49.85%]. Conclusions For fusiform aneurysms, post large coil stenting can provide a uniform coil configuration potentially reducing the hemodynamic risk factors of recurrence. Flow diverters also may reduce the recurrence risk, with long-term follow-up required, especially to monitor branch blood flow to prevent postoperative ischemia.
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Affiliation(s)
- Yeqing Jiang
- Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Lu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Ge
- Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | - Gaohui Li
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | - Hailin Wan
- Huashan Hospital, Fudan University, Shanghai, China
| | | | - Jianping Xiang
- ArteryFlow Technology Co., Ltd, Hangzhou, China
- *Correspondence: Jianping Xiang
| | - Xiaolong Zhang
- Huashan Hospital, Fudan University, Shanghai, China
- Xiaolong Zhang
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Effect of proximal parent artery stenosis on the outcomes of posterior communicating artery aneurysms: A preliminary study based on case-specific hemodynamic analysis. World Neurosurg 2022; 164:e349-e357. [DOI: 10.1016/j.wneu.2022.04.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
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16
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Mu L, Liu X, Liu M, Long L, Chi Q, He Y, Pan Y, Ji C, Gao G, Li X. In Vitro Study of Endothelial Cell Morphology and Gene Expression in Response to Wall Shear Stress Induced by Arterial Stenosis. Front Bioeng Biotechnol 2022; 10:854109. [PMID: 35497360 PMCID: PMC9043283 DOI: 10.3389/fbioe.2022.854109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: We examined the correlation between changes in hemodynamic characteristics induced by arterial stenosis and vascular endothelial cell (EC) morphology and gene expression in straight silicone arteries. Materials and methods: Transparent silicone straight artery models with four degrees of stenosis (0, 30, 50, and 70%) were fabricated. Particle image velocimetry was performed to screen silicone vessel structures with good symmetry and to match the numerical simulations. After the inner surface of a symmetric model was populated with ECs, it was perfusion-cultured at a steady flow rate. A computational fluid dynamics (CFD) study was conducted under the same perfusion conditions as in the flow experiment. The high-WSS region was then identified by CFD simulation. EC morphology in the high-WSS regions was characterized by confocal microscopy. ECs were antibody-stained to analyze the expression of inflammatory factors, including matrix metalloproteinase (MMP)-9 and nuclear factor (NF)-κB, which were then correlated with the CFD simulations. Results: As the degree of vascular stenosis increases, more evident jet flow occurs, and the maximum WSS position moves away first and then back. ECs were irregularly shaped at vortex flow regions. The number of gaps between the cells in high-WSS regions increased. The MMP-9 and NF-κB expression did not differ between vessels with 30 and 0% stenosis. When arterial stenosis was 70%, the MMP-9 and NF-κB expression increased significantly, which correlated with the regions of substantially high WSS in the CFD simulations. Conclusion: Stenotic arteries induce hemodynamic stress variations, which contribute to differences in EC morphology and gene expression. A high degree of vascular stenosis can directly increase inflammatory factor expression.
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Affiliation(s)
- Lizhong Mu
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Xiaolong Liu
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Mengmeng Liu
- Schood of Chemical Engineering, Dalian University of Technology, Dalian, China
| | - Lili Long
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Qingzhuo Chi
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Ying He
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Yue Pan
- Schood of Chemical Engineering, Dalian University of Technology, Dalian, China
- Ningbo Institute, Dalian University of Technology, Ningbo, China
- *Correspondence: Yue Pan,
| | - Changjin Ji
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Ge Gao
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xiaona Li
- Key Laboratory of Industrial Ecology and Environmental Engineering (MOE), School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
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Jiang Y, Ge L, Huang L, Wan H, Lu G, Zhang X. Large postoperative inflow area predictive of recurrence for paraclinoid aneurysms treated by simple coiling. J Clin Neurosci 2022; 98:53-59. [DOI: 10.1016/j.jocn.2022.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/13/2021] [Accepted: 01/22/2022] [Indexed: 11/17/2022]
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18
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Assessing the aneurysm occlusion efficacy of a shear-thinning biomaterial in a 3D-printed model. J Mech Behav Biomed Mater 2022; 130:105156. [DOI: 10.1016/j.jmbbm.2022.105156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 12/26/2022]
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Yuan J, Huang C, Li Z, Jiang X, Zhao X, Lai N, Xia D, Wu D, Zhang B, Wang X, Fang X. Hemodynamic Characteristics Associated with Recurrence of Middle Cerebral Artery Bifurcation Aneurysms After Total Embolization. Clin Interv Aging 2021; 16:2023-2032. [PMID: 34908831 PMCID: PMC8665268 DOI: 10.2147/cia.s326635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Hemodynamic parameters are associated with the recurrence of intracranial aneurysms (IAs). Studies showed that high velocity and wall shear stress (WSS) were associated with IAs recurrence after endovascular treatment; nevertheless, factors such as small sample size, locations of IAs, and types of IAs (ie, sidewall or bifurcation) were neglected. The purpose of this study was to identify the hemodynamic characteristics associated with recurrence of middle cerebral artery bifurcation aneurysms (MCABAs) after total embolization by the method of computer fluid dynamics (CFD). Methods Following inclusion criteria, we included 92 MCABAs treated with coils only after total embolization from January 2014 to January 2019. We segmented into recurrent and non-recurrent groups according to follow-up digital subtraction angiography (DSA). The MCABA models, including pre-operatively and immediate post-operatively, were reconstructed using 3D-DSAs. The hemodynamic parameters pre-operatively and immediately post-operatively between the groups were calculated and analyzed. Results There were no significant differences between the recurrent and non-recurrent groups for spatially averaged wall shear stress (SAWSS), maximum wall shear stress (MWSS), velocity, or oscillatory shear index (OSI) at the neck pre-operatively. In the recurrent group, the WSS (22.02±5.11 vs 37.43±8.27 pa, p < 0.001), MWSS (42.59±17.02 vs 66.98±18.61 pa, p=0.014), velocity (0.86±0.19 vs 1.44±0.61 m/s, p=0.01) preoperatively were significantly higher than postoperative values. By contrast, in the non-recurrent group, the WSS (26.53±8.18 vs 22.29±8.64pa, p=0.002), MWSS (42.71±14.01 vs 37.15±15.56 pa, p=0.013), velocity (1.08±0.43 vs 0.23 (0.52, 0.57) m/s, p < 0.001) postoperatively were significantly lower than preoperative values. The OSI, whether in the recurrent group or the non-recurrent group, did not differ significantly between groups (p=0.79 and p=0.19). Conclusion Higher WSS (SAWSS, MWSS) and flow velocity at the aneurysm neck after embolization might be related to recurrence of bifurcation IAs. These might be applied to clinical post-embolization management for the evaluation of bifurcation IAs recanalization.
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Affiliation(s)
- Jinlong Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Chenlei Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Xiaochun Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Xintong Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Niansheng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Dayong Xia
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Bingbing Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
| | - Xuanzhi Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, People's Republic of China
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Liu J, Li W, Zhang Y, Wang K, Yang X, Zhang Y. Hemodynamic analysis for endovascular treatment in small unruptured intracranial aneurysms: a matched comparison study of flow diverter versus LVIS. Chin Neurosurg J 2021; 7:49. [PMID: 34852851 PMCID: PMC8638548 DOI: 10.1186/s41016-021-00266-w] [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: 01/10/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment. METHODS Fifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent, which were defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match. RESULTS There was no difference in procedural complications between the two groups (P = 0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs. 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in the PED group achieved 100%, which was higher than that in the LVIS group (98.0%). Compared with the LVIS group after treatment, cases in the PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs. 0.01 ± 0.01, P = 0.037) and WSS on the aneurysm (2.32 ± 5.40 vs. 0.33 ± 0.47, P = 0.011). Consequently, the reduction ratios of these two parameters also showed statistical differences. These parameters in the LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. CONCLUSIONS Both LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.
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Affiliation(s)
- Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, China.
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, China.
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Fuga M, Tanaka T, Irie K, Kajiwara I, Tachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Proposed predictors of the need for retreatment after coil embolization of unruptured cerebral aneurysms with major or minor recanalization: Analysis of a single center’s experience. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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22
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Pandey PK, Das MK. Effect of foam insertion in aneurysm sac on flow structures in parent lumen: relating vortex structures with disturbed shear. Phys Eng Sci Med 2021; 44:1231-1248. [PMID: 34581959 DOI: 10.1007/s13246-021-01058-3] [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: 11/06/2020] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
Numerous studies suggest that disturbed shear, causing endothelium dysfunction, can be related to neighboring vortex structures. With this motivation, this study presents a methodology to characterize the vortex structures. Precisely, we use mapping and characterization of vortex structures' changes to relate it with the hemodynamic indicators of disturbed shear. Topological features of vortex core lines (VCLs) are used to quantify the changes in vortex structures. We use the Sujudi-Haimes algorithm to extract the VCLs from the flow simulation results. The idea of relating vortex structures with disturbed shear is demonstrated for cerebral arteries with aneurysms virtually treated by inserting foam in the sac. To get physiologically realistic flow fields, we simulate blood flow in two patient-specific geometries before and after foam insertion, with realistic velocity waveform imposed at the inlet, using the Carreau-Yasuda model to mimic the shear-thinning behavior. With homogenous porous medium assumption, flow through the foam is modeled using the Forchheimer-Brinkman extended Darcy model. Results show that foam insertion increases the number of VCLs in the parent lumen. The average length of VCL increases by 168.9% and 55.6% in both geometries. For both geometries under consideration, results demonstrate that the region with increased disturbed shear lies in the same arterial segment exhibiting an increase in the number of oblique VCLs. Based on the findings, we conjecture that an increase in oblique VCLs is related to increased disturbed shear at the neighboring portion of the arterial wall.
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Affiliation(s)
- Pawan Kumar Pandey
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, 208016, Uttar Pradesh, India
| | - Malay Kumar Das
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, 208016, Uttar Pradesh, India.
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Chivukula VK, Marsh L, Chassagne F, Barbour MC, Kelly CM, Levy S, Geindreau C, du Roscoat SR, Kim LJ, Levitt MR, Aliseda A. Lagrangian Trajectory Simulation of Platelets and Synchrotron Microtomography Augment Hemodynamic Analysis of Intracranial Aneurysms Treated With Embolic Coils. J Biomech Eng 2021; 143:071002. [PMID: 33665669 PMCID: PMC8086186 DOI: 10.1115/1.4050375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/25/2021] [Indexed: 11/08/2022]
Abstract
As frequency of endovascular treatments for intracranial aneurysms increases, there is a growing need to understand the mechanisms for coil embolization failure. Computational fluid dynamics (CFD) modeling often simplifies modeling the endovascular coils as a homogeneous porous medium (PM), and focuses on the vascular wall endothelium, not considering the biomechanical environment of platelets. These assumptions limit the accuracy of computations for treatment predictions. We present a rigorous analysis using X-ray microtomographic imaging of the coils and a combination of Lagrangian (platelet) and Eulerian (endothelium) metrics. Four patient-specific, anatomically accurate in vitro flow phantoms of aneurysms are treated with the same patient-specific endovascular coils. Synchrotron tomography scans of the coil mass morphology are obtained. Aneurysmal hemodynamics are computationally simulated before and after coiling, using patient-specific velocity/pressure measurements. For each patient, we analyze the trajectories of thousands of platelets during several cardiac cycles, and calculate residence times (RTs) and shear exposure, relevant to thrombus formation. We quantify the inconsistencies of the PM approach, comparing them with coil-resolved (CR) simulations, showing the under- or overestimation of key hemodynamic metrics used to predict treatment outcomes. We fully characterize aneurysmal hemodynamics with converged statistics of platelet RT and shear stress history (SH), to augment the traditional wall shear stress (WSS) on the vascular endothelium. Incorporating microtomographic scans of coil morphology into hemodynamic analysis of coiled intracranial aneurysms, and augmenting traditional analysis with Lagrangian platelet metrics improves CFD predictions, and raises the potential for understanding and clinical translation of computational hemodynamics for intracranial aneurysm treatment outcomes.
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Affiliation(s)
| | - Laurel Marsh
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Fanette Chassagne
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Michael C. Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Cory M. Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195
| | - Samuel Levy
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195
| | - Christian Geindreau
- Laboratoire 3SR, Université Grenoble Alpes, 1270 Rue de la Piscine, Gières 38610, France
| | | | - Louis J. Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195; Department of Radiology, University of Washington, Seattle, WA 98195
| | - Michael R. Levitt
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195; Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195; Department of Radiology, University of Washington, Seattle, WA 98195
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195; Department of Neurological Surgery, University of Washington, Seattle, WA 98195; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA 98195
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Fukuta S, Hikita C, Iwasaki M, Maeda M, Inaka Y, Yamazaki H, Sato H, Morimoto M, Oishi H. Risk factors for recurrence after coil embolization for internal carotid artery-posterior communicating artery aneurysms. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pandey PK, Paul C, Das MK, Muralidhar K. Assessment and visualization of hemodynamic loading in aneurysm sac and neck: Effect of foam insertion. Proc Inst Mech Eng H 2021; 235:927-939. [PMID: 33971763 DOI: 10.1177/09544119211015569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shape memory polymer (SMP) foam is often proposed as the future alternative of coils in aneurysm treatment devices. Present work numerically investigates the unsteady, three-dimensional simulation of blood flow in a cerebral aneurysm filled with SMP foam. Simulations are conducted on patient-specific geometries with realistic blood velocity waveform imposed at the inlet while SMP foam is treated as a porous medium. The present study introduces a "loading risk map" that helps to visualize the hemodynamic effect of foam insertion on the aneurysm sac and neck. The loading risk maps suggest that while the SMP foam subdues the flow and wall shear pulsations in the aneurysm sac, the pressure distribution is minimally affected. The maps suggest that while the downstream lip is the most risk-prone site for both geometries, downstream vascular anatomy significantly influences foam efficiency in reducing pressure and wall shear stress loading.
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Affiliation(s)
- Pawan Kumar Pandey
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, UP, India
| | - Chandan Paul
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, UP, India
| | - Malay K Das
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur, UP, India
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Wiśniewski K, Tomasik B, Tyfa Z, Reorowicz P, Bobeff EJ, Stefańczyk L, Posmyk BJ, Jóźwik K, Jaskólski DJ. Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms. J Clin Med 2021; 10:jcm10071348. [PMID: 33805169 PMCID: PMC8037793 DOI: 10.3390/jcm10071348] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/28/2021] [Accepted: 03/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.
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Affiliation(s)
- Karol Wiśniewski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (D.J.J.)
- Correspondence: ; Tel.: +48-(042)-677-6770
| | - Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 15 Mazowiecka St., 92-215 Lodz, Poland; or
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Zbigniew Tyfa
- Institute of Turbomachinery, Lodz University of Technology, Medical Apparatus Division, Wolczanska 219/223, 90-924 Lodz, Poland; (Z.T.); (P.R.); (K.J.)
| | - Piotr Reorowicz
- Institute of Turbomachinery, Lodz University of Technology, Medical Apparatus Division, 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, Barlicki University Hospital, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (D.J.J.)
| | - Ludomir Stefańczyk
- Department of Radiology—Diagnostic Imaging, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland;
| | - Bartłomiej J. Posmyk
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (D.J.J.)
| | - Krzysztof Jóźwik
- Institute of Turbomachinery, Lodz University of Technology, Medical Apparatus Division, 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, Barlicki University Hospital, Kopcińskiego 22, 90-153 Lodz, Poland; (E.J.B.); (B.J.P.); (D.J.J.)
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Tian Z, Liu J, Kumar J, Li W, Zhang Y, Zhang Y, Wang K, Wang S, Ren Z, Yang X. Significant flow velocity reduction at the intracranial aneurysm neck after endovascular treatment leads to favourable angiographic outcome: a prospective study. Stroke Vasc Neurol 2021; 6:366-375. [PMID: 33526635 PMCID: PMC8485238 DOI: 10.1136/svn-2020-000413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND With widely usage of flow diverter in intracranial aneurysm treatment, some previously used predictors may not be effective in evaluating the recurrence risk. We aimed to comprehensively re-evaluate the predictors of intracranial aneurysm outcome with various endovascular treatment methods and devices. METHODS This is a prospective registered study. We analysed 6-month and 18-month follow-up angiographic data from the prospective study. Data on patient demographics, aneurysm morphology and type of treatment were recorded. Patient-specific haemodynamic simulations were performed. An unfavourable angiographic outcome was defined as recurrence of aneurysm in cases with coiling or stent-assisted coiling, patency of aneurysm in cases with flow diverters or retreatment during follow-up. RESULTS In total, 165 patients (177 intracranial aneurysms) with at least one angiographic follow-up data were analysed. For the short-term (6-month) results, after univariate analysis, the demographic, morphological and treatment-related factors did not achieve significantly statistical differences. The reduction ratio (RR) of velocity at aneurysm neck after embolisation was significantly lower in the unfavourable angiographic group than the favourable angiographic outcome group (p=0.002). After the Cox regression analysis, the RR of velocity at aneurysm neck was the only independent factor associated with favourable angiographic outcome (OR 0.028; p=0.001) and had an acceptable area under the curve (0.714) with a clear cut-off value (46.14%). Similarly, for the analysis of midterm (18-month) results, the RR of velocity at the aneurysm neck was the only independent significant factor for the unfavourable angiographic outcome (OR 0.050; p=0.017). The area under the curve was 0.754 and the cut-off value was 48.20%. CONCLUSIONS The haemodynamics showed an independent effect on angiographic follow-up results and may provide helpful suggestions for clinical practice in the future.
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Affiliation(s)
- Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jay Kumar
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Shengzhang Wang
- Department of Mechanics and Engineering Science, Fudan University, Shanghai, China
| | - Zeguang Ren
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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Suzuki T, Hasegawa H, Ando K, Shibuya K, Takahashi H, Saito S, Oishi M, Fujii Y. Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms. Front Neurol 2021; 11:611124. [PMID: 33384657 PMCID: PMC7770215 DOI: 10.3389/fneur.2020.611124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery. Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated. Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery. Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Kazuhiro Ando
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Kouhei Shibuya
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Haruhiko Takahashi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Shoji Saito
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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Ishida F, Tsuji M, Tanioka S, Tanaka K, Yoshimura S, Suzuki H. Computational Fluid Dynamics for Cerebral Aneurysms in Clinical Settings. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 132:27-32. [PMID: 33973025 DOI: 10.1007/978-3-030-63453-7_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hemodynamics is thought to play an important role in the pathogenesis of cerebral aneurysms and recent development of computer technology makes it possible to simulate blood flow using high-resolution 3D images within several hours. A lot of studies of computational fluid dynamics (CFD) for cerebral aneurysms were reported; therefore, application of CFD for cerebral aneurysms in clinical settings is reviewed in this article.CFD for cerebral aneurysms using a patient-specific geometry model was first reported in 2003 and it has been revealing that hemodynamics brings a certain contribution to understanding aneurysm pathology, including initiation, growth and rupture. Based on the knowledge of the state-of-the-art techniques, this review treats the decision-making process for using CFD in several clinical settings. We introduce our CFD procedure using digital imaging and communication in medicine (DICOM) datasets of 3D CT angiography or 3D rotational angiography. In addition, we review rupture status, hyperplastic remodeling of aneurysm wall, and recurrence of coiled aneurysms using the hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI), aneurysmal inflow rate coefficient (AIRC), and residual flow volume (RFV).
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Affiliation(s)
- Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan.
| | - Masanori Tsuji
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan
| | - Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan
| | - Katsuhiro Tanaka
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan
| | | | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Futami K, Misaki K, Uno T, Kamide T, Nakada M. Effect of Neck Size on the Inflow Magnitude Evaluated on 4D Flow MRI in Unruptured Internal Carotid Artery Aneurysms. J Stroke Cerebrovasc Dis 2020; 29:105116. [PMID: 32912568 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND A neck size >4.0 mm is a risk factor for recanalization after coil embolization. The high inflow magnitude of pretreatment wide-neck aneurysms may be correlated to recanalization. We aimed to elucidate the effect of the neck size on the inflow magnitude evaluated on four-dimensional (4D) flow magnetic resonance imaging (MRI) in pretreatment unruptured internal carotid artery (ICA) aneurysms. METHODS Thirty-three untreated ICA aneurysms were subjected to 4D flow MRI to evaluate the inflow magnitude parameters including the maximum spatially-averaged inflow velocity (MSAIV), maximum inflow velocity, maximum inflow rate (MIR), and their ratios to each corresponding flow parameter in the parent artery. RESULTS The neck size was linearly correlated to all inflow parameters investigated in this study. A strong correlation was observed between the neck size and the following: MSAIV (r = .755, p < .0001), MIR (r = .715, p < .0001), MSAIV ratio (r = .724, p < .0001), and MIR ratio (r = .741, p < .0001). The predicted value of MIR ratio of an aneurysm with the neck size of 4.0 mm was 23.0% and 20.6%, based on the linear regression equation of all aneurysms and on that of aneurysms with the neck size >4.0 mm, respectively. CONCLUSIONS The neck size was linearly correlated with the inflow magnitude of unruptured ICA aneurysms. Inflow magnitude evaluation using 4D flow MRI may help to hemodynamically identify aneurysms with a high risk of recanalization after endovascular coil embolization.
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Affiliation(s)
- Kazuya Futami
- Department of Neurosurgery, Hokuriku Central Hospital, 123 Nodera, Oyabe, 932-8503 Toyama, Japan.
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
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Suzuki T, Genkai N, Nomura T, Abe H. Assessing the Hemodynamics in Residual Cavities of Intracranial Aneurysm after Coil Embolization with Combined Computational Flow Dynamics and Silent Magnetic Resonance Angiography. J Stroke Cerebrovasc Dis 2020; 29:105290. [PMID: 32992205 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Metal artifacts limit computational fluid dynamics analysis after coil embolization. Silent magnetic resonance angiography reduces metal artifacts and improves visualization of the residual cavity of coil-embolized aneurysms. This study investigated the flow dynamics of the residual cavity after coil embolization using silent magnetic resonance angiography and computational fluid dynamics to elucidate the hemodynamic characteristics of recanalization. METHODS Twenty internal carotid-posterior communicating aneurysm cases treated with coil embolization and without stent assistance were followed up (mean±standard deviation, 13.0±6.1 months) and assessed using silent magnetic resonance angiography. The hemodynamic characteristics of the residual cavities in both types of aneurysms were compared between neck remnants, which persisted for >12 months (NR group), and those treated with coil compaction-induced body filling (BF group). Computational fluid dynamics analysis of each aneurysm was performed using morphological data obtained from silent magnetic resonance angiography. Pressure, pressure difference, normalized wall shear stress, and flow velocity were measured. RESULTS The residual cavity was well-visualized using silent magnetic resonance angiography and compared with those imaged using conventional time-of-flight magnetic resonance angiography, and eight internal carotid-posterior communicating aneurysms with neck remnants and body filling were investigated. The maximum pressure area was localized to the aneurysm wall in the NR group (n=4) and to sides of the coil surface in the BF group (n=4). No significant differences were observed for each hemodynamic parameter. CONCLUSIONS Combination of silent magnetic resonance angiography and computational fluid dynamics helps to understand the hemodynamic characteristics of residual cavity in coil- embolized aneurysms. The flow-impingement zone at the coil surface (maximum pressure area) may influence the risk for future coil compaction.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan; Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata 951-8585, Japan.
| | - Nobuyuki Genkai
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan
| | - Toshiharu Nomura
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan
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Ki HJ, Lee KS, Kim BS, Choi JH, Shin YS. Clinical and morphological risk factors for the recurrence of anterior communicating artery aneurysms after clipping or coiling. Acta Neurochir (Wien) 2020; 162:2245-2250. [PMID: 32556525 DOI: 10.1007/s00701-020-04450-2] [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: 04/19/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate clinical and morphological factors associated with recurrence in anterior communicating artery (AcomA) aneurysms after clipping or coiling. METHODS We retrospectively reviewed the clinical and radiologic features of consecutive 214 patients with AcomA aneurysms treated between January 2012 and December 2016 in a single tertiary institute. Univariate and multivariate analyses were performed to identify the relationship between clinical and morphological variables and recurrence. RESULTS Of 214 patients, 166 were unruptured aneurysms and 109 were treated with coiling. Overall recurrence rate was 13% (28 out of 214 aneurysms) during mean 36.9 ± 18.4-month follow-up. Multivariate logistic regression analysis showed that size greater than 10 mm (OR = 5.651; 95% CI, 1.317-24.242; p = 0.020), smoking (OR = 3.474; 95% CI, 1.342-8.996; p = 0.010), coiling (OR = 2.98; 95% CI, 1.005-8.832; p = 0.049), and anterior direction of aneurysm (OR = 3.77; 95% CI, 1.12-12.66; p = 0.032) were significantly associated with recurrence of AcomA aneurysms after treatment. CONCLUSIONS The results of this study demonstrated that coiling, large aneurysm, anterior direction, and smoking history may be independent risk factors for the recurrence of AcomA aneurysms. Therefore, careful follow-up should be needed especially in large AcomA aneurysms with anterior direction after coiling.
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Nawka MT, Lohse A, Bester M, Fiehler J, Buhk JH. Residual Flow Inside the Woven EndoBridge Device at Follow-Up: Potential Predictors of the Bicêtre Occlusion Scale Score 1 Phenomenon. AJNR Am J Neuroradiol 2020; 41:1232-1237. [PMID: 32586965 DOI: 10.3174/ajnr.a6605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) device is an established technique for the treatment of intracranial aneurysms. Occasionally, persistent opacification inside the WEB lumen can be observed at follow-up (previously described as Bicêtre Occlusion Scale Score 1). We evaluated potential risk factors of this phenomenon, hypothesizing that initial deviation of the WEB device from the aneurysm axis, size of the aneurysmal neck surface, or inappropriate WEB sizing correlates with Bicêtre Occlusion Scale Score 1 findings. MATERIALS AND METHODS We systematically reviewed all patients treated with the WEB device between February 2014 and December 2018 in our neurointerventional center. Patients with midterm follow-up DSA available were considered for aneurysm evaluation applying the Bicêtre Occlusion Scale Score. WEB angle deviation from the aneurysm axis, neck widths, and WEB sizes were collected. RESULTS We included 65 patients with 67 intracranial aneurysms. Eleven of 67 (16.4%) intracranial aneurysms showed the Bicêtre Occlusion Scale Score 1 phenomenon at follow-up. Anterior-posterior projections of WEB axis deviation (angles measured in degrees) were significantly different between the Bicêtre Occlusion Scale Score 1 cohort (median ± interquartile range, 17 ± 17) and all other Bicêtre Occlusion Scale Scores (median ± interquartile range, 7 ± 11; P = .023), whereas in lateral projections, no significant difference was observed (median ± interquartile range, 10 ± 10 versus 8 ± 9; P = .169). Neck or aneurysm recurrence, but not the Bicêtre Occlusion Scale Score 1 phenomenon, occurred significantly more often in patients with inappropriate WEB sizing compared with appropriate WEB sizing (median ± interquartile range, 1 ± 1.3 versus 0 ± 0; P < .001/P = .664). CONCLUSIONS The Bicêtre Occlusion Scale Score 1 phenomenon is associated with an initial deviation of the WEB device from the aneurysm axis but does not correlate with aneurysmal neck surface measurements or WEB sizing.
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Affiliation(s)
- M T Nawka
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - A Lohse
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Bester
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J-H Buhk
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Li W, Wang S, Tian Z, Zhu W, Zhang Y, Zhang Y, Wang Y, Wang K, Yang X, Liu J. Discrimination of intracranial aneurysm rupture status: patient-specific inflow boundary may not be a must-have condition in hemodynamic simulations. Neuroradiology 2020; 62:1485-1495. [PMID: 32588092 DOI: 10.1007/s00234-020-02473-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Computational fluid dynamics (CFD) are important in evaluating the hemodynamics of intracranial aneurysm rupture, and the setting of inflow boundary conditions is critical. We evaluated intracranial aneurysm hemodynamics based on generalized versus patient-specific inflow boundary conditions to examine the effect of different hemodynamic results on the discrimination of intracranial aneurysm rupture status. METHODS We enrolled 148 patients with 156 intracranial aneurysms. For each included aneurysm, we performed CFD simulation once based on patient-specific and once based on generalized inflow boundary conditions. First, we compared the hemodynamics of intracranial aneurysms based on different inflow boundary conditions. Then, we divided the included aneurysms into a ruptured and unruptured group and compared the hemodynamics between the two groups under patient-specific and generalized inflow boundary conditions. RESULTS For the hemodynamic parameters using specific inflow boundary conditions, more complex flow (p = 0.002), larger minimum WSS (p = 0.024), lower maximum low WSS area (LSA) (p = 0.038), and oscillatory shear index (p = 0.002) were found. Furthermore, we compared the hemodynamics between ruptured and unruptured groups based on different inflow boundary conditions. We found that the significant hemodynamic parameters associated with rupture status were the same, including the proportion of aneurysms with flow complex and unstable flow and the minimum and maximum of LSA (p = 0.011, p = 0.003, p = 0.001 and p = 0.004, respectively). CONCLUSION Patient-specific and generalized inflow boundary conditions of aneurysmal hemodynamics resulted in significant differences. However, the significant parameters associated with rupture status were the same in both conditions, indicating that patient-specific inflow boundary conditions may not be necessary for predicting rupture risk.
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Affiliation(s)
- Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Shengzhang Wang
- Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China.
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Morga R, Moskała M, Popiela T, Rajzer M, Wilk A, Kłosiński M, Muszyński T, Trystuła M. Recanalization of Embolized Endovascular Intracranial Aneurysms and Changes in the Blood Viscosity: A Pilot Study. Med Sci Monit 2020; 26:e919059. [PMID: 32231175 PMCID: PMC7146064 DOI: 10.12659/msm.919059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The purpose of our research was to evaluate the relationships between blood viscosity and recanalization of coiled intracranial aneurysms. Material/Methods The study included consecutives patients treated endovascularly by a team of experienced neurosurgeons and neuroradiologists due to brain aneurysm. A total of 50 patients (the average age was 57.48 years, SD=13.71) were assigned to 2 groups: group A with recanalization (4 male and 8 female patients) and group B without recanalization (10 male and 28 female patients) were examined. All patients underwent a 6-month follow-up of the whole-blood viscosity test with a Brookfield DV III+pro cone-plate viscometer using the Rheocalc program. Differences between groups were assessed using the Statistica 12 computer program (StatSoft Inc., Tulsa, OK, USA). Results Studies have shown no significant difference in the age range between group A and B (P=0.31). In group A, higher viscosity values were found for whole blood [median: 4.14 dyn×sec/cm2 (mPa×sec) quartile range 0.42], compared to group B [median: 3.92 dyn×sec/cm2 (mPa×sec); quartile range 0.40; (P=0.04)]. This difference was significant (P=0.04). Additionally, the level of hematocrit was positively related with recanalization, the higher the hematocrit, the more frequent recanalization. A very strong and statistically significant relationship occurred between the frequency of recanalization and smoking (P<0.001). Conclusions The occurrence of higher values of whole blood viscosity which increase turbulent flow through the vessels may be a risk for recanalization of the coiled intracranial aneurysm.
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Affiliation(s)
- Rafał Morga
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Cracow, Poland
| | - Marek Moskała
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Cracow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Cracow, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Invasive Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Cracow, Poland
| | - Aleksander Wilk
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Kłosiński
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Muszyński
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Cracow, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Cracow, Poland
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Fukuda M, Fukuda S, Ando J, Yamamoto K, Yonemoto N, Suzuki T, Niwa Y, Inoue T, Satoh-Asahara N, Hasegawa K, Shimatsu A, Tsukahara T. Disruption of P2X4 purinoceptor and suppression of the inflammation associated with cerebral aneurysm formation. J Neurosurg 2019; 134:102-114. [PMID: 31860812 DOI: 10.3171/2019.9.jns19270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are no effective therapeutic drugs for cerebral aneurysms, partly because the pathogenesis remains unresolved. Chronic inflammation of the cerebral arterial wall plays an important role in aneurysm formation, but it is not clear what triggers the inflammation. The authors have observed that vascular endothelial P2X4 purinoceptor is involved in flow-sensitive mechanisms that regulate vascular remodeling. They have thus hypothesized that shear stress-associated hemodynamic stress on the endothelium causes the inflammatory process in the cerebral aneurysm development. METHODS To test their hypothesis, the authors examined the role of P2X4 in cerebral aneurysm development by using P2X4-/- mice and rats that were treated with a P2X4 inhibitor, paroxetine, and subjected to aneurysm-inducing surgery. Cerebral aneurysms were induced by unilateral carotid artery ligation and renovascular hypertension. RESULTS The frequency of aneurysm induction evaluated by light microscopy was significantly lower in the P2X4-/- mice (p = 0.0488) and in the paroxetine-treated male (p = 0.0253) and female (p = 0.0204) rats compared to control mice and rats, respectively. In addition, application of paroxetine from 2 weeks after surgery led to a significant reduction in aneurysm size in the rats euthanized 3 weeks after aneurysm-inducing surgery (p = 0.0145), indicating that paroxetine suppressed enlargement of formed aneurysms. The mRNA and protein expression levels of known inflammatory contributors to aneurysm formation (monocyte chemoattractant protein-1 [MCP-1], interleukin-1β [IL-1β], tumor necrosis factor-α [TNFα], inducible nitric oxide synthase [iNOS], and cyclooxygenase-2 [COX-2]) were all significantly elevated in the rats that underwent the aneurysm-inducing surgery compared to the nonsurgical group, and the values in the surgical group were all significantly decreased by paroxetine administration according to quantitative polymerase chain reaction techniques and Western blotting. Although immunolabeling densities for COX-2, iNOS, and MCP-1 were not readily observed in the nonsurgical mouse groups, such densities were clearly seen in the arterial wall of P2X4+/+ mice after aneurysm-inducing surgery. In contrast, in the P2X4-/- mice after the surgery, immunolabeling of COX-2 and iNOS was not observed in the arterial wall, whereas that of MCP-1 was readily observed in the adventitia, but not the intima. CONCLUSIONS These data suggest that P2X4 is required for the inflammation that contributes to both cerebral aneurysm formation and growth. Enhanced shear stress-associated hemodynamic stress on the vascular endothelium may trigger cerebral aneurysm development. Paroxetine may have potential for the clinical treatment of cerebral aneurysms, given that this agent exhibits efficacy as a clinical antidepressant.
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Affiliation(s)
- Miyuki Fukuda
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
- 2Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shunichi Fukuda
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
| | - Joji Ando
- 3Laboratory of Biomedical Engineering, School of Medicine, Dokkyo Medical University, Mibu City, Tochigi
| | - Kimiko Yamamoto
- 4Department of Biomedical Engineering, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo
| | | | - Takashi Suzuki
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
- 6Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto; and
| | - Youko Niwa
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
| | - Takayuki Inoue
- 7Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute
| | - Noriko Satoh-Asahara
- 7Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute
| | | | - Akira Shimatsu
- 9Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tetsuya Tsukahara
- 1Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto
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Damiano RJ, Tutino VM, Paliwal N, Patel TR, Waqas M, Levy EI, Davies JM, Siddiqui AH, Meng H. Aneurysm characteristics, coil packing, and post-coiling hemodynamics affect long-term treatment outcome. J Neurointerv Surg 2019; 12:706-713. [PMID: 31848217 DOI: 10.1136/neurintsurg-2019-015422] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Recurrence of intracranial aneurysms after endovascular coiling is a serious clinical concern. OBJECTIVE We hypothesized that recurrence is associated with aneurysm morphology and flow, as well as the coil intervention and the induced flow modifications. METHODS We collected 52 primary-coiling aneurysm cases that were either occluded (n=34) or recurrent (n=18) at >1 year follow-up. We created aneurysm models from pre-coiling digital subtraction angiographic images, calculated aneurysm morphology, simulated pre-coiling hemodynamics, modeled coil deployment, and obtained post-coiling hemodynamics for each case. We performed univariable analysis on 26 morphologic, treatment-specific, and hemodynamic parameters to distinguish between recurrent and occluded groups, and multivariable analysis to identify independently significant parameters associated with recurrence. Univariable analysis was also performed on ruptured and unruptured aneurysm subcohorts separately to investigate if they shared specific significant parameters. RESULTS Recurrence was associated with pre-coiling aneurysm morphologic and flow parameters including larger size (maximum dimension and volume), larger neck (diameter, area, and neck-to-parent-artery ratio), and higher flow momentum and kinetic energy. Recurrence was also associated with lower coil packing (packing density and uncoiled volume), higher post-treatment flow (velocity, momentum, and kinetic energy), lower post-treatment washout time, and higher post-treatment impingement force at the neck. Multivariable analysis identified two aneurysmal characteristics (neck diameter and pre-coiling flow kinetic energy), one coil packing parameter (uncoiled volume), and one post-treatment hemodynamic parameter (flow momentum) that were independently associated with recurrence. In ruptured aneurysms, recurrence was associated with larger neck (diameter and area), whereas in unruptured aneurysms, recurrence was associated with larger size (maximum dimension and volume). In both subcohorts, recurrence was associated with higher post-coiling flow momentum and kinetic energy. CONCLUSION Recurrence at >1 year after coil treatment is associated with intrinsic aneurysm characteristics, coiling itself, and flow changes induced by coiling. Larger aneurysm size and neck, less coil packing, and higher intra-aneurysmal flow before and after coiling predict recurrence.
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Affiliation(s)
- Robert J Damiano
- Mechanical and Aerospace Engineering, Canon Stroke & Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Vincent M Tutino
- Canon Stroke & Vascular Research Center, Neurosurgery, Biomedical Engineering, Pathology and Anatomical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Nikhil Paliwal
- Mechanical and Aerospace Engineering, Canon Stroke & Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Tatsat R Patel
- Mechanical and Aerospace Engineering, Canon Stroke & Vascular Research Center, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Jason M Davies
- Neurosurgery, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Canon Stroke & Vascular Research Center, Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Hui Meng
- Mechanical and Aerospace Engineering, Canon Stroke & Vascular Research Center, Neurosurgery, Biomedical Engineering, University at Buffalo - The State University of New York, Buffalo, New York, USA
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Yu H, Huang GP, Yang Z, Ludwig BR. Numerical studies of hemodynamic alterations in pre- and post-stenting cerebral aneurysms using a multiscale modeling. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3256. [PMID: 31483953 DOI: 10.1002/cnm.3256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
The aim of this work was to use a multiscale modeling to study the influence of stent deployment, with generic stents, on flow distributions within the vascular network and the hemodynamic alterations within the cerebral aneurysms pre- and post-stenting. To achieve this goal, two image-based anatomical cerebral aneurysm models were reconstructed along with the respective aneurysms post-stenting models after deploying a 16- or 24-wire stent. The investigation results revealed that the stent may increase the local pressure resistance resulting in flow alterations. The hemodynamic parameters demonstrated stent placement can reduce the intra-aneurysmal pressure, decrease wall shear stress (WSS) at the neck region, and increase blood turnover time for aneurysm case I (sidewall aneurysm). These findings are consistent with the trends of hemodynamic changes reported previously. However, aneurysm case II (bifurcation aneurysm) showed gradually increased intra-aneurysmal pressure and the pressure at the neck region, decreased WSS over the sac surface, and enhanced flow vortices within the aneurysm. When simulating the hemodynamics of pre- and post-stenting aneurysms for a patient using measured flow waveforms, the flow alteration induced by the stent deployment may affect the hemodynamic predictions for the post-stenting aneurysm. Thus, the remeasurement of boundary conditions once the morphology of the aneurysm is deformed is needed in follow-up studies with a focus on aneurysm growth and stent deployment.
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Affiliation(s)
- Hongtao Yu
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, 45435
| | - George P Huang
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, 45435
| | - Zifeng Yang
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, 45435
| | - Bryan R Ludwig
- Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435
- Department of Neurology, Division of NeuroInterventional Surgery, Wright State University/Premier Health, Clinical Neuroscience Institute, 30 E. Apple St, Dayton, OH, 45409
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Lee SH, Cho YD, Mun JH, Yoo DH, Yeon EK, Kang HS, Kim JE, Cho WS, Han MH. Does Systemic Hypertension Impact Recanalization of Coiled Aneurysms? Clin Neuroradiol 2019; 31:117-124. [PMID: 31468079 DOI: 10.1007/s00062-019-00830-z] [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: 06/12/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE It is well known that hypertension is a significant factor in the formation, growth, and rupture of aneurysms and recanalization of coiled aneurysms is affected by hemodynamic stress. At present, however, the impact of hypertension on recanalization of coiled aneurysms has not been adequately investigated. This study examined the relation between hypertension and subsequent outcomes of coiled aneurysms, using a matched patient analysis. METHODS A total of 715 subjects undergoing coil embolization of intracranial aneurysms between 2011 and 2013 were selected for study. Time-of-flight magnetic resonance or conventional angiography was used (singly or together) to gauge degrees of occlusion after coiling, applying the Raymond classification in grading recanalization. Patients with hypertension were grouped as controlled or uncontrolled, based on blood pressure readings at outpatient clinics. Hypertensive and non-hypertensive subjects were matched (1:1) for several relevant variables. RESULTS Overall, 484 patients (67.7%) were hypertensive (controlled 338; uncontrolled 146). During the follow-up period (28.6 ± 9.7 months), 129 aneurysms (18.0%) displayed recanalization (minor 58; major 71). Patient age, concomitant diabetes, hyperlipidemia, aneurysm size, neck size, depth-to-neck ratio, and aneurysm type differed significantly in hypertensive and non-hypertensive groups; however, group incidences of cumulative recanalization were similar (p = 0.297). After 1:1 matching the cumulative recanalization rate (13.5%) in hypertensive and non-hypertensive counterparts (14.3%) again proved similar (p = 0.578). In the hypertensive group, in addition, recanalization showed no relation to controlled and uncontrolled subgroup (odds ratio, OR = 1.000, p > 0.999). CONCLUSION Unlike other aspects of evolving aneurysms (e.g. formation, growth, or rupture), recanalization of coiled aneurysms seems to be unaffected by systemic hypertension.
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Affiliation(s)
- Su Hwan Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea (Republic of)
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 110-744, Seoul, Korea (Republic of).
| | - Jong Hyeon Mun
- Department of Neurosurgery, Kwangju Christian Hospital, Gwangju, Korea (Republic of)
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 110-744, Seoul, Korea (Republic of)
| | - Eung Koo Yeon
- Department of Radiology, KyungHee University Medical Center, KyungHee University College of Medicine, Seoul, Korea (Republic of)
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - Moon Hee Han
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Korea (Republic of)
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Wu X, Tian Z, Liu J, Zhang Y, Li W, Zhang Y, Chen J, Zhou Y, Yang X, Mu S. Patency of Posterior Circulation Branches Covered by Flow Diverter Device: A Hemodynamic Study. Front Neurol 2019; 10:658. [PMID: 31275237 PMCID: PMC6593048 DOI: 10.3389/fneur.2019.00658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Flow diverter devices are increasingly used in the treatment of posterior circulation aneurysms, sometimes necessarily involving ostia of side branches and perforators. The aim of this study was to identify the hemodynamic influence of flow diverters on side branches and perforators of the posterior circulation. Methods: We performed a retrospective study of consecutive patients treated by a flow diverter device for posterior circulation aneurysms with anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA) involvement. Computational fluid dynamics (CFD) were used to discern hemodynamic changes of branches after deployment of the flow diverter. Results: We studied 18 branches from 17 patients (mean age, 50.72 ± 8.17 years). No branches were occluded on immediate angiography and later follow-up. Average flow velocity in aneurysms decreased from 0.077 ± 0.065 m/s to 0.025 ± 0.025 m/s (p < 0.01). Average flow velocity in branch ostia decreased from 0.29 ± 0.14 m/s to 0.27 ± 0.16 m/s (p = 0.189). The difference in flow velocity reduction ratio between aneurysms and branches was statistically significant (68.8 vs. 9.5%; p < 0.001). The mean pressure in branch ostia increased from 10,717.4 ± 489.0 to 10,859.0 ± 643.4 Pa (p < 0.01). Conclusion: While a flow diverter device is capable of slowing down aneurysmal inflow, it is unable to block the flow into branches and perforators when used in the treatment of posterior circulation aneurysms; flow velocity in branches even increased in some cases. With a low branch occlusion ratio, it may be acceptable to cover posterior circulation branches and perforators if unavoidable.
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Affiliation(s)
- Xinzhi Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junfan Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yangyang Zhou
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Tian Z, Mu S, Li W, Zhu W, Zhang Y, Yang X, Liu J. Recurrence of an internal carotid artery aneurysm after complete exclusion by a Willis covered stent. Interv Neuroradiol 2019; 25:688-691. [PMID: 31159630 DOI: 10.1177/1591019919854184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Treatment of selective intracranial aneurysms treated with a Willis covered stent is safe and effective. We describe a previously unreported case of a large, irregular, carotid-ophthalmic aneurysm that was treated with a Willis covered stent. An immediate angiogram after the procedure showed complete occlusion of the aneurysm. However, a six-month follow-up angiogram demonstrated contrast media filling of the aneurysm neck. To the best of our knowledge, this is the first report of a recurrent aneurysm treated with a Willis covered stent because of a membrane partially isolated with the stent. This case suggests that an aneurysm that is treated with a Willis covered stent might recanalise, and the risk of aneurysm rupture persists when the membrane of the stent is isolated with the stent. Therefore, follow-up angiography is necessary, even if an immediate angiogram shows complete aneurysm occlusion. Long-term follow-up is required, and the final outcome of such a case is still unknown.
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Affiliation(s)
- Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
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Li W, Wang Y, Zhang Y, Wang K, Zhang Y, Tian Z, Yang X, Liu J. Efficacy of LVIS vs. Enterprise Stent for Endovascular Treatment of Medium-Sized Intracranial Aneurysms: A Hemodynamic Comparison Study. Front Neurol 2019; 10:522. [PMID: 31191428 PMCID: PMC6546800 DOI: 10.3389/fneur.2019.00522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background: We conducted a computational fluid dynamics (CFD) study and compared the treatment of medium-sized intracranial aneurysms with LVIS and Enterprise stent-assisted coil embolization (SACE) to determine the effects of hemodynamic changes caused by different stent and coil packing densities (PDs) in endovascular treatment. Methods: We enrolled 87 consecutive patients, with 87 medium-sized intracranial aneurysms (≥7, ≤ 12 mm), who underwent LVIS or Enterprise SACE. Aneurysms treated with LVIS SACE were allocated to the LVIS group, and the remainder were allocated to the Enterprise group. CFD were performed to assess hemodynamic alterations between before treatment, after stent deployment, and after SACE. Results: One aneurysm recanalized in the LVIS group (n = 42), and five recanalized in the Enterprise group (n = 45) (recanalization rate: 2.4 vs. 11.1%, respectively; P = 0.108). Higher complete obliteration rate (P = 0.069) was found in the LVIS group. Velocity at the neck plane showed a greater reduction ratio than velocity and WSS of the aneurysm in both groups after stent deployment, while velocity and WSS of the aneurysm showed a greater reduction ratio after coil placement. Further, there was a greater reduction in velocity at the neck plane (59.52 vs. 39.81%), aneurysmal velocity (88.46 vs. 69.45%), and wall shear stress (WSS) (85.45 vs. 69.49%) on the aneurysm in the LVIS group (P < 0.001 for all). Specifically, the reduction ratio of velocity at the neck plane showed significant difference between the groups in the multivariate analysis (P = 0.013). Conclusions : LVIS SACE showed a lower recanalization for endovascular treatment of medium-sized intracranial aneurysms, and the greater hemodynamic alterations might be the key factors.
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Affiliation(s)
- Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wu X, Tian Z, Liu J, Li W, Chen J, Zhou Y, Yang X, Mu S. Hemodynamic impacts of flow diverter devices on the ophthalmic artery. J Transl Med 2019; 17:160. [PMID: 31096981 PMCID: PMC6524319 DOI: 10.1186/s12967-019-1913-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/08/2019] [Indexed: 01/20/2023] Open
Abstract
Background Flow diverter devices are increasingly used for endovascular treatment of internal carotid artery aneurysms. Treatment of ophthalmic segment aneurysms with flow diverter devices also includes coverage of the ophthalmic artery but may result in complications. It is unclear, however, whether these devices mechanically block blood flow in the ophthalmic artery. Also unclear is the relationship between deployment of a flow diverter device and post-treatment occlusion. We studied hemodynamic changes in the ophthalmic artery after deployment of a flow diverter device to determine the relationship between those changes and post-stent occlusion of the artery. Methods We analyzed hemodynamic modifications in the ophthalmic artery in 21 patients (19 women, 2 men; mean age 53.43 ± 7.32 years) treated by a single pipeline embolization device. Patient-specific geometries were determined from three-dimensional digital subtraction angiography and the stenting process was simulated. Computational fluid dynamics technology was used to analyze the change in ophthalmic artery hemodynamics. We compared pre-treatment and post-treatment flow velocity of the ophthalmic artery. Results Among the 21 patients with aneurysms located in the ophthalmic segment, no ophthalmic artery occlusion was found during immediate or follow-up angiography. Post-stent flow velocity in the ophthalmic artery decreased from 0.35 ± 0.19 to 0.33 ± 0.20 m/s, with the difference not being statistically significant (P = 0.106). Conclusion Our results showed no significant change in ophthalmic artery blood flow after pipeline embolization device deployment. Hence, post-stent occlusion of the ophthalmic artery could not be explained by reduced blood flow. Delayed thrombosis and neointimal formation maybe the keys to ophthalmic artery occlusion and need further investigation. Electronic supplementary material The online version of this article (10.1186/s12967-019-1913-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinzhi Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Junfan Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yangyang Zhou
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Sheng B, Wu D, Yuan J, Xu S, Li Z, Dong J, Lai N, Fang X. Hemodynamic Characteristics Associated With Paraclinoid Aneurysm Recurrence in Patients After Embolization. Front Neurol 2019; 10:429. [PMID: 31105640 PMCID: PMC6494928 DOI: 10.3389/fneur.2019.00429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: To investigate the hemodynamic features before and after embolization of paraclinoidal aneurysms using hemodynamic numerical simulation and the influence of embolization on recurrence after embolization. Methods: From January 2016 to December 2017, we enrolled a total of 113 paraclinoidal aneurysms treated with embolization. They were divided into recurrent group and stable group depending on follow-up results. An aneurysm model was generated based on 3D-DSA before and after embolization. The hemodynamic characteristics were analyzed between two groups using Computational fluid dynamic (CFD). Results: In the recurrent group, the peak systolic WSS, OSI and velocity around the aneurysm neck areas prior to embolization were 20.47 ± 3.04 Pa, 0.06 ± 0.02 and 0.07 ± 0.03 m/s, respectively. These values were 23.50 ± 4.11 Pa, 0.06 ± 0.01 and 0.11 ± 0.02 m/s, respectively in the stable group (P > 0.05). The WSS, OSI, velocity around the same areas in the recurrent group after embolization were 35.59 ± 8.75 Pa, 0.07 ± 0.02 and 0.12 ± 0.03 m/s, respectively (P < 0.01). In the stable group, the WSS, OSI and velocity were 13.08 ± 2.89 Pa, 0.04 ± 0.01 and 0.07 ± 0.02 m/s, respectively (P < 0.01). After embolization, the WSS, OSI and velocity around the aneurysm neck areas in the recurrent group were significantly higher than those in the stable group. Conclusions: High peak systolic WSS, OSI and velocity around aneurysm neck areas after embolization of paraclinoidal aneurysms may be important factors leading to recurrence.
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Affiliation(s)
- Bin Sheng
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jinlong Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shanshui Xu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jin Dong
- Department of Nursing, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Niansheng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Schönfeld MH, Forkert ND, Fiehler J, Cho YD, Han MH, Kang HS, Peach TW, Byrne JV. Hemodynamic Differences Between Recurrent and Nonrecurrent Intracranial Aneurysms: Fluid Dynamics Simulations Based on MR Angiography. J Neuroimaging 2019; 29:447-453. [PMID: 30891876 DOI: 10.1111/jon.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Although the role of wall shear stress (WSS) in the initiation, growth, and rupture of intracranial aneurysms has been well studied, its influence on aneurysm recurrence after endovascular treatment requires further investigation. We aimed to compare WSS at necks of recurrent and nonrecurrent aneurysms. METHODS Nine recurrent coil-embolized aneurysms were identified and matched with nine nonrecurrent aneurysms. Patient-specific vessel geometries reconstructed from follow-up 3-D time-of-flight magnetic resonance angiography were analyzed using computational fluid dynamics (CFD) simulations. Absolute WSS and the percentage of abnormally low and high WSS at the aneurysm neck compared to the near artery were measured. RESULTS The median percentage of abnormal WSS at the aneurysm neck was 49.3% for recurrent and 34.7% for nonrecurrent aneurysms (P = .011). The area under the receiver-operating-characteristic curve for distinguishing these aneurysms according to the percentage of abnormal WSS was .86 (95% CI .62 to .98). The optimal cut-off value of 45.1% resulted in a sensitivity and a specificity of 88.89% (95% CI 51.8% to 99.7%). CONCLUSION Our findings indicate that necks of recurrent aneurysms are exposed to abnormal WSS to a larger extent. Abnormal WSS may serve as a metric to distinguish them from nonrecurrent aneurysms with CFD simulations a priori.
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Affiliation(s)
- Michael Hinrich Schönfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils Daniel Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Thomas William Peach
- Department of Mechanical Engineering, University College London, London, UK.,Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - James Vincent Byrne
- Oxford Neurovascular & Neuroradiology Research Unit, Oxford Radcliffe Hospital, Oxford, UK
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Choi HH, Cho YD, Yoo DH, Lee SH, Yeon EK, Kang HS, Cho WS, Kim JE, Han MH. Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms. J Neurosurg 2019; 132:1068-1076. [PMID: 30835696 DOI: 10.3171/2018.11.jns181929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the presence of symmetric A1 flow, the safety and efficacy of compromising the anterior communicating artery (ACoA) during coil embolization of ACoA aneurysms has yet to be evaluated. Herein, the authors describe their experience, focusing on procedural safety. METHODS Between October 2012 and July 2017, 285 ACoA aneurysms with symmetric A1 flows were treated at the authors' institution by endovascular coil embolization. Clinical and angiographic outcome data were subjected to binary logistic regression analysis. RESULTS ACoA compromise was chosen in the treatment of 71 aneurysms (24.9%), which were completely (n = 15) or incompletely (n = 56) compromised. In the remaining 214 lesions, the ACoA was preserved. Although 9 patients (3.2%) experienced procedure-related thromboembolisms (compromised, 4; preserved, 5), all but 1 patient (with ACoA compromise) were asymptomatic. In multivariate analysis, subarachnoid hemorrhage at presentation was the sole independent risk factor for thromboembolism (OR 15.98, p < 0.01), with ACoA compromise being statistically unrelated. In 276 aneurysms (96.8%) with follow-up of > 6 months (mean 20.9 ± 13.1 months, range 6-54 months), recanalization was confirmed in 21 (minor, 15; major, 6). A narrow (≤ 4 mm) saccular neck (p < 0.01) and ACoA compromise (p = 0.04) were independently linked to prevention of recanalization. CONCLUSIONS During coil embolization of ACoA aneurysms, the ACoA may be compromised without serious complications if A1 flows are symmetric. This approach may also confer some long-term protection from recanalization, serving as a valid treatment option for such lesions.
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Affiliation(s)
- Hyun Ho Choi
- 1Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul
| | - Young Dae Cho
- 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and
| | - Dong Hyun Yoo
- 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and
| | - Su Hwan Lee
- 3Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eung Koo Yeon
- 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and
| | - Hyun-Seung Kang
- 3Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- 3Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and.,3Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Hemodynamic differences between Pipeline and coil-adjunctive intracranial stents. J Neurointerv Surg 2019; 11:908-911. [DOI: 10.1136/neurintsurg-2018-014439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 12/15/2022]
Abstract
IntroductionModern coil-adjunctive intracranial stent designs have increased metal surface coverage to construct putative ‘flow diverter lights.’ This is rooted in the assumption that flow diversion is linearly correlated with metal surface coverage rather than being a threshold to be reached by device porosity and design.ObjectiveTo evaluate this assumption, by performing computational flow analysis on three aneurysm models treated with low metal surface coverage stents (ATLAS and Enterprise), a Pipeline flow diverter, and the LVIS Blue stent.MethodsComputational flow analysis was performed on virtual deployment models entailing deployment of an ATLAS, Enterprise, LVIS Blue, or Pipeline. The impact of device deployment on velocity vectors at the neck, maximum wall shear stress, inflow rate into the aneurysm, and turnover time was determined.ResultsVelocity vector plots demonstrated low magnitude, localized inflow jets for Pipeline only; asymmetric, selectively high inflow jets were seen for LVIS Blue, and broader velocity vector clusters were seen for Atlas and Enterprise. Reduction in wall shear stress as compared with baseline was significant for all devices and greatest for the Pipeline. Mean peak wall shear stress was significantly lower for LVIS Blue in comparison with ATLAS or Enterprise but significantly lower for Pipeline than for LVIS Blue. Reduction of inflow rate into the aneurysm was significant for LVIS Blue and Pipeline but significantly lower for Pipeline than for LVIS Blue. Turnover time was statistically similar for ATLAS, Enterprise, and LVIS Blue, but significantly increased for Pipeline.ConclusionConsiderable differences in peak wall shear stress, inflow rates, and turnover time between flow diverters, moderate- and low-porosity stents reinforce the assumption that effective flow diversion represents a threshold in device design, encompassing metal surface coverage only in part.
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Reconstructing patient-specific cerebral aneurysm vasculature for in vitro investigations and treatment efficacy assessments. J Clin Neurosci 2018; 61:153-159. [PMID: 30470652 DOI: 10.1016/j.jocn.2018.10.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/27/2018] [Indexed: 11/27/2022]
Abstract
Perianeurysmal hemodynamics play a vital role in the initiation, growth and rupture of intracranial aneurysms. In vitro investigations of aneurysmal hemodynamics are helpful to visualize and measure blood flow, and aiding surgical planning approaches. Improving in vitro model creation can improve the feasibility and accuracy of hemodynamic investigations and surgical planning, improving clinical value. In this study, in vitro models were created from three-dimensional rotational angiography (3DRA) of six patients harboring intracranial aneurysms using a multi-step process involving 3D printing, index of refraction matching and silicone casting that renders the models transparent for flow visualization. Each model was treated with the same commercially-available, patient-specific, endovascular devices (coils and/or stents). All models were scanned by synchrotron X-ray microtomography to obtain high-resolution imaging of the vessel lumen, aneurysmal sac and endovascular devices. Dimensional accuracy was compared by quantifying the differences between the microtomographic reconstructions of the fabricated phantoms and the original 3DRA obtained during patient treatment. True-scale in vitro flow phantoms were successfully created for all six patients. Optical transparency was verified by using an index of refraction matched working fluid that replicated the mechanical behavior of blood. Synchrotron imaging of vessel lumen, aneurysmal sac and endovascular devices was successfully obtained, and dimensional errors were found to be O(100 μm). The creation of dimensionally-accurate, optically-transparent flow phantoms of patient-specific intracranial aneurysms is feasible using 3D printing technology. Such models may enable in vitro investigations of aneurysmal hemodynamics to aid in treatment planning and outcome prediction to devise optimal patient-specific neurointerventional strategies.
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Chen J, Liu J, Zhang Y, Tian Z, Wang K, Zhang Y, Mu S, Lv M, Jiang P, Duan C, Zhang H, Qu Y, He M, Yang X. China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms. J Transl Med 2018; 16:263. [PMID: 30257699 PMCID: PMC6158879 DOI: 10.1186/s12967-018-1641-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ruptured aneurysms, the commonest cause of nontraumatic subarachnoid hemorrhage, can be catastrophic; the mortality and morbidity of affected patients being very high. Some risk factors, such as smoking, hypertension and female sex have been identified, whereas others, such as hemodynamics, imaging, and genomics, remain unclear. Currently, no accurate model that includes all factors for predicting such rupture is available. We plan to use data from a large cohort of Chinese individuals to set up a multidimensional model for predicting risk of rupture of unruptured intracranial aneurysms (UIAs). METHODS The China Intracranial Aneurysm Project-2 (CIAP-2) will comprise screening of a cohort of 500 patients with UIA (From CIAP-1) and focus on hemodynamic factors, high resolution magnetic resonance imaging (HRMRI) findings, genetic factors, and biomarkers. Possible risk factors for rupture of UIA, including genetic factors, biomarkers, HRMRI, and hemodynamic factors, will be analyzed. The first project of the China Intracranial Aneurysm Project (CIAP-1; chaired by the Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China) will prospectively collect a cohort of 5000 patients with UIA from 20 centers in China, and collect baseline information for each patient. Multidimensional data will be acquired in follow-up assessments. Statistically significant clinical features in the UIA cohort will also be analyzed and integrated into the model for predicting risk of UIA rupture. After the model has been set up, the resultant evidence-based prediction will provide a preliminary theoretical basis for treating aneurysms at high risk of rupture. DISCUSSION This study will explore the risk of rupture of aneurysms and develop a scientific multidimensional model for predicting rupture of unruptured intracranial aneurysms. Clinical Trials registration A Study on a Multidimensional Prediction Model for Rupture Risk of Unruptured Intracranial Aneurysms (CIAP-2), NCT03133624. Registered: 16 April 2017. https://clinicaltrials.gov/ct2/show/NCT03133624.
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Affiliation(s)
- Junfan Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - ChuanZhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Min He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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Acute Recanalization of a Partially Thrombosed Large Intracranial Aneurysm. World Neurosurg 2018; 115:73-78. [DOI: 10.1016/j.wneu.2018.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
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