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Hadad S, Karnam Y, Mut F, Lohner R, Robertson AM, Kaneko N, Cebral JR. Computational fluid dynamics-based virtual angiograms for the detection of flow stagnation in intracranial aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3740. [PMID: 37288602 PMCID: PMC10524728 DOI: 10.1002/cnm.3740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
The goal of this study was to test if CFD-based virtual angiograms could be used to automatically discriminate between intracranial aneurysms (IAs) with and without flow stagnation. Time density curves (TDC) were extracted from patient digital subtraction angiography (DSA) image sequences by computing the average gray level intensity inside the aneurysm region and used to define injection profiles for each subject. Subject-specific 3D models were reconstructed from 3D rotational angiography (3DRA) and computational fluid dynamics (CFD) simulations were performed to simulate the blood flow inside IAs. Transport equations were solved numerically to simulate the dynamics of contrast injection into the parent arteries and IAs and then the contrast retention time (RET) was calculated. The importance of gravitational pooling of contrast agent within the aneurysm was evaluated by modeling contrast agent and blood as a mixture of two fluids with different densities and viscosities. Virtual angiograms can reproduce DSA sequences if the correct injection profile is used. RET can identify aneurysms with significant flow stagnation even when the injection profile is not known. Using a small sample of 14 IAs of which seven were previously classified as having flow stagnation, it was found that a threshold RET value of 0.46 s can successfully identify flow stagnation. CFD-based prediction of stagnation was in more than 90% agreement with independent visual DSA assessment of stagnation in a second sample of 34 IAs. While gravitational pooling prolonged contrast retention time it did not affect the predictive capabilities of RET. CFD-based virtual angiograms can detect flow stagnation in IAs and can be used to automatically identify aneurysms with flow stagnation even without including gravitational effects on contrast agents.
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Affiliation(s)
- Sara Hadad
- Department of Bioengineering George Mason University, Fairfax, VA, USA
| | - Yogesh Karnam
- Department of Bioengineering George Mason University, Fairfax, VA, USA
| | - Fernando Mut
- Department of Bioengineering George Mason University, Fairfax, VA, USA
| | - Rainald Lohner
- Center for Computational Fluid Dynamics, College of Science, George Mason University, VA, Fairfax, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Naoki Kaneko
- Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
| | - Juan R Cebral
- Department of Bioengineering George Mason University, Fairfax, VA, USA
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Shen Y, Molenberg R, Bokkers RPH, Wei Y, Uyttenboogaart M, van Dijk JMC. The Role of Hemodynamics through the Circle of Willis in the Development of Intracranial Aneurysm: A Systematic Review of Numerical Models. J Pers Med 2022; 12:jpm12061008. [PMID: 35743791 PMCID: PMC9225067 DOI: 10.3390/jpm12061008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The role of regional hemodynamics in the intracranial aneurysmal formation, growth, and rupture has been widely discussed based on numerical models over the past decades. Variation of the circle of Willis (CoW), which results in hemodynamic changes, is associated with the aneurysmal formation and rupture. However, such correlation has not been further clarified yet. The aim of this systematic review is to investigate whether simulated hemodynamic indices of the CoW are relevant to the formation, growth, or rupture of intracranial aneurysm. Methods: We conducted a review of MEDLINE, Web of Science, and EMBASE for studies on the correlation between hemodynamics indices of the CoW derived from numerical models and intracranial aneurysm up to December 2020 in compliance with PRISMA guidelines. Results: Three case reports out of 1046 publications met our inclusion and exclusion criteria, reporting 13 aneurysms in six patients. Eleven aneurysms were unruptured, and the state of the other two aneurysms was unknown. Wall shear stress, oscillatory shear index, von-Mises tension, flow velocity, and flow rate were reported as hemodynamic indices. Due to limited cases and significant heterogeneity between study settings, meta-analysis could not be performed. Conclusion: Numerical models can provide comprehensive information on the cerebral blood flow as well as local flow characteristics in the intracranial aneurysm. Based on only three case reports, no firm conclusion can be drawn regarding the correlation between hemodynamic parameters in the CoW derived from numerical models and aneurysmal formation or rupture. Due to the inherent nature of numerical models, more sensitive analysis and rigorous validations are required to determine its measurement error and thus extend their application into clinical practice for personalized management. Prospero registration number: CRD42021125169.
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Affiliation(s)
- Yuanyuan Shen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (Y.S.); (R.M.)
| | - Rob Molenberg
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (Y.S.); (R.M.)
| | - Reinoud P. H. Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.P.H.B.); (M.U.)
| | - Yanji Wei
- Engineering and Technology Institute Groningen, Faculty of Science & Engineering, University of Groningen, 9747 AG Groningen, The Netherlands;
| | - Maarten Uyttenboogaart
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.P.H.B.); (M.U.)
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (Y.S.); (R.M.)
- Correspondence:
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Togashi S, Shimizu H. Complex Intracranial Aneurysms. Adv Tech Stand Neurosurg 2022; 44:225-238. [PMID: 35107682 DOI: 10.1007/978-3-030-87649-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complex intracranial aneurysms remain challenging to treat using standard microsurgical or endovascular techniques. These aneurysms often require a combination of deconstructive and reconstructive procedures, such as parent artery occlusion, flow alteration, and blind-alley formation with or without bypass surgery, for effective and enduring therapeutic effects. It is important to determine the type of bypass based on the site of occlusion of the patent artery, anatomical features of the distal vessels, and expected adequate blood flow. In this chapter, we describe the "Standards," "Advances," and "Controversies" in the context of a microsurgical treatment strategy for complex intracranial aneurysms. "Standards" include a combination of frequent and commonly used procedures that have been gathering a certain consensus on their effectiveness. "Advances" include infrequent, demanding, and/or uncertain surgical procedures that are currently under debate. Finally, "Controversies" discuss a number of unsolved issues.
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Affiliation(s)
- Shuntaro Togashi
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Akita, Japan.
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Akita, Japan
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Letter to Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk. Transl Stroke Res 2022; 13:507-508. [PMID: 35088372 DOI: 10.1007/s12975-021-00982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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Endo H, Mori N, Mugikura S, Niizuma K, Omodaka S, Takase K, Tominaga T. Quantitative assessment of microstructural evolution of intracranial aneurysm wall by vessel wall imaging. Neuroradiology 2022; 64:1343-1350. [PMID: 34997283 DOI: 10.1007/s00234-021-02877-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to evaluate new quantitative parameters of aneurysm wall enhancement (AWE) on magnetic resonance vessel wall imaging (VWI) in differentiating between the stable and evolving unruptured intracranial aneurysms (UIAs). METHODS Thirty-eight consecutive patients with UIAs (27 stable and 11 evolving) underwent VWI with contrast-enhanced 3D T1 volume isotropic turbo spin echo acquisition. The voxel-based enhancement maps were created using pre- and post-contrast images. The aneurysmal lumen with signal suppression by black-blood method was segmented. Then, one voxel outer and inner layers of the lumen contour were automatically segmented. The shape features of the aneurysms and AWE of the two layers were compared between stable and evolving groups. RESULTS The shape features, including aneurysm volume, surface, and compacity were significantly different between the stable and evolving groups (P = 0.024, 0.028, and 0.033, respectively). Stable and evolving groups also differed significantly in the AWE at the union of outer and inner layers of the aneurysm wall (P = 0.0082) but not in that of the outer or inner layer alone. Multivariate logistic regression analysis revealed significant differences in aneurysm volume, surface, and AWE at the union of outer and inner layers between the two groups (P = 0.0029, 0.0092, and 0.0033, respectively). Receiver operating characteristics curve analysis revealed that the area under the curve of the logistic regression model was 0.89. CONCLUSION Quantitative combined analysis of aneurysm shape features and AWE of the union of outer and inner layers were effective for differentiating between stable and evolving UIAs.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.,Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunsuke Omodaka
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Sunderland K, Jiang J, Zhao F. Disturbed flow's impact on cellular changes indicative of vascular aneurysm initiation, expansion, and rupture: A pathological and methodological review. J Cell Physiol 2022; 237:278-300. [PMID: 34486114 PMCID: PMC8810685 DOI: 10.1002/jcp.30569] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
Aneurysms are malformations within the arterial vasculature brought on by the structural breakdown of the microarchitecture of the vessel wall, with aneurysms posing serious health risks in the event of their rupture. Blood flow within vessels is generally laminar with high, unidirectional wall shear stressors that modulate vascular endothelial cell functionality and regulate vascular smooth muscle cells. However, altered vascular geometry induced by bifurcations, significant curvature, stenosis, or clinical interventions can alter the flow, generating low stressor disturbed flow patterns. Disturbed flow is associated with altered cellular morphology, upregulated expression of proteins modulating inflammation, decreased regulation of vascular permeability, degraded extracellular matrix, and heightened cellular apoptosis. The understanding of the effects disturbed flow has on the cellular cascades which initiate aneurysms and promote their subsequent growth can further elucidate the nature of this complex pathology. This review summarizes the current knowledge about the disturbed flow and its relation to aneurysm pathology, the methods used to investigate these relations, as well as how such knowledge has impacted clinical treatment methodologies. This information can contribute to the understanding of the development, growth, and rupture of aneurysms and help develop novel research and aneurysmal treatment techniques.
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Affiliation(s)
- Kevin Sunderland
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
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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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8
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Tanioka S, Ishida F, Yamamoto A, Shimizu S, Sakaida H, Toyoda M, Kashiwagi N, Suzuki H. Machine Learning Classification of Cerebral Aneurysm Rupture Status with Morphologic Variables and Hemodynamic Parameters. Radiol Artif Intell 2020; 2:e190077. [PMID: 33937812 DOI: 10.1148/ryai.2019190077] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022]
Abstract
Purpose To construct a classification model of rupture status and to clarify the importance of morphologic variables and hemodynamic parameters on rupture status by applying a machine learning (ML) algorithm to morphologic and hemodynamic data of cerebral aneurysms. Materials and Methods Between 2011 and 2019, 226 (112 ruptured and 114 unruptured) cerebral aneurysms in 188 consecutive patients were retrospectively analyzed with computational fluid dynamics (CFD). A random forest ML algorithm was applied to the results to create three classification models consisting of only morphologic variables (model 1), only hemodynamic parameters (model 2), and both morphologic variables and hemodynamic parameters (model 3). The accuracy of rupture status classification and the importance of each variable or parameter in the models were computed. Results The accuracy was 77.0% in model 1, 71.2% in model 2, and 78.3% in model 3. The three most important features were projection ratio, size ratio, and aspect ratio in model 1; low shear area ratio, oscillatory shear index, and oscillatory velocity index in model 2; and projection ratio, irregular shape, and size ratio in model 3. Conclusion Classification models of rupture status of cerebral aneurysms were constructed by applying an ML algorithm to morphologic variables and hemodynamic parameters. The model worked with relatively high accuracy, in which projection ratio, irregular shape, and size ratio were important for the discrimination of ruptured aneurysms.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Atsushi Yamamoto
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Shigetoshi Shimizu
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Hiroshi Sakaida
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Mitsuru Toyoda
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Nobuhisa Kashiwagi
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
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Tanioka S, Ishida F, Kishimoto T, Tanaka K, Shimosaka S, Suzuki H. Prediction of the extent of thrombus formation in the parent artery after endovascular occlusion of a distal anterior cerebral artery aneurysm using computational fluid dynamics. J Clin Neurosci 2019; 74:210-212. [PMID: 31420275 DOI: 10.1016/j.jocn.2019.08.042] [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: 06/02/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
Endovascular coiling of a cerebral aneurysm and coil occlusion of the parent artery have been occasionally performed to treat cerebral aneurysms; however, it is difficult to predict the accurate extent of thrombus formation in the parent artery proximal to the coiled aneurysm and the coil-occluded parent artery preoperatively, and unexpected occlusion of the arterial branches can occur by thrombus extension into or in the parent artery. The authors describe a case of a distal anterior cerebral artery (ACA) aneurysm treated by endovascular parent artery occlusion (PAO) with preoperative computational fluid dynamics (CFD) prediction of the extent of thrombus formation. A 73-year-old woman presented with subarachnoid hemorrhage and an aneurysm that was located on the right pericallosal artery distal to the paracentral artery bifurcation. Endovascular coiling of the aneurysm and the pericallosal artery was planned. In advance of the treatment, CFD was performed to predict the extent of thrombus formation with specific wall shear stress and shear rate thresholds. The hemodynamic results indicated that coiling of the aneurysm resulted in thrombus formation in the pericallosal artery up to just distal to the paracentral artery ostium; therefore, the treatment was implemented according to the CFD prediction. Postoperative digital subtraction angiography revealed that the extent of thrombus formation was consistent with the preoperative CFD prediction. This technique may prevent unexpected occlusion of arterial branches.
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Affiliation(s)
- Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan.
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan
| | - Tomoyuki Kishimoto
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan
| | - Katsuhiro Tanaka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan
| | - Shinichi Shimosaka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan.
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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10
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Tanioka S, Ishida F, Kishimoto T, Tsuji M, Tanaka K, Shimosaka S, Toyoda M, Kashiwagi N, Sano T, Suzuki H. Quantification of hemodynamic irregularity using oscillatory velocity index in the associations with the rupture status of cerebral aneurysms. J Neurointerv Surg 2019; 11:614-617. [PMID: 30670624 DOI: 10.1136/neurintsurg-2018-014489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/01/2018] [Accepted: 12/09/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Complex and unstable flow patterns are reported to be associated with the rupture status of cerebral aneurysms, while their evaluation depends on qualitative analysis of streamlines of bloodflow. Oscillatory velocity index (OVI) is a hemodynamic parameter to quantify flow patterns. The aim of this study is to elucidate the associations between OVI and the rupture status of cerebral aneurysms. METHODS One hundred and twenty-nine ruptured and unruptured cerebral aneurysms were analyzed with computational fluid dynamics under pulsatile flow conditions. With the use of median value of OVI, all aneurysms were divided into high and low OVI groups. Statistical analysis was performed to compare rupture status, and morphological and hemodynamic parameters between the two groups. RESULTS The median value of OVI was 0.006. High OVI was more likely observed in ruptured aneurysms (P=0.028) and associated with irregular shape, complex flow patterns, and unstable flow patterns (P<0.001, respectively). In morphological parameters, maximum size, aspect, projection, size, and volume-to-ostium area ratios were significantly higher in the high OVI group (P<0.001, respectively). In hemodynamic parameters, wall shear stress and wall shear stress gradient were significantly lower, and oscillatory shear index and gradient oscillatory number were significantly higher in the high OVI group (P<0.001, respectively). CONCLUSION High OVI was associated with rupture status, and morphological and hemodynamic characteristics of ruptured aneurysms. These results indicate that OVI may serve as a valuable hemodynamic parameter for diagnosing rupture status and risks of aneurysms.
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Affiliation(s)
- Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, Tsu, Japan
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, Tsu, Japan
| | - Tomoyuki Kishimoto
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masanori Tsuji
- Department of Neurosurgery, Mie Chuo Medical Center, Tsu, Japan
| | | | | | - Mitsuru Toyoda
- School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Nobuhisa Kashiwagi
- School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Takanori Sano
- Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan
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Shimano K, Serigano S, Ikeda N, Yuchi T, Shiratori S, Nagano H. Understanding of boundary conditions imposed at multiple outlets in computational haemodynamic analysis of cerebral aneurysm. ACTA ACUST UNITED AC 2019. [DOI: 10.17106/jbr.33.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kenjiro Shimano
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Shota Serigano
- Graduate School of Integrative Science and Engineering, Tokyo City University
| | - Naoki Ikeda
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Tomoki Yuchi
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Suguru Shiratori
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Hideaki Nagano
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
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Terashima M, Miura Y, Ishida F, Toma N, Araki T, Shimosaka S, Kanamaru K, Suzuki H. One-stage Stent-assisted Coil Embolization for Rupture-side-unknown Bilateral Vertebral Artery Dissecting Aneurysms in an Acute Stage: A Case Report. NMC Case Rep J 2018; 5:45-49. [PMID: 29725567 PMCID: PMC5930239 DOI: 10.2176/nmccrj.cr.2017-0109] [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: 05/09/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022] Open
Abstract
Bilateral vertebral artery dissecting aneurysms (VADAs) with subarachnoid hemorrhage (SAH) are rare and their management is still challenging. In this report, we successfully performed one-stage stent-assisted coil embolization (SAC) for bilateral VADAs with SAH in an acute stage, because the ruptured side could not be diagnosed. A 47-year-old woman presented with a sudden onset of headache without laterality, and left-side dominant SAH with bilateral VADAs was noted on computed tomography (CT) scans. The size of aneurysmal dome and neck was similar between the two VADAs, and a bleb was observed only on the right VADA. In computational fluid dynamics (CFD) simulations, findings of wall shear stress (WSS), normalized WSS, and WSS gradient suggested that the left VADA was ruptured, while the oscillatory shear index and aneurysm formation indicator suggested the opposite-side one to be ruptured. Thus, we could not determine which VADA was ruptured by clinical data and CFD analyses. Therefore, we performed simultaneous treatment for the bilateral VADAs by using SAC technique 8 h after the onset under dual antiplatelet and anticoagulation therapies. There was no evidence of rebleeding and stent thrombosis. Stent thrombosis was monitored by duplex color-coded ultrasonography after the intervention. She was discharged without neurological deficits, and 6-month follow-up cerebral angiography demonstrated no recanalization of VADAs. This is the first report showing bilateral VADAs with SAH treated by one-stage SAC within 24 h of SAH, and the potential risks are discussed.
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Affiliation(s)
- Mio Terashima
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoichi Miura
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, National Hospital Organization, Tsu, Mie, Japan
| | - Naoki Toma
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tomohiro Araki
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
| | - Shinichi Shimosaka
- Department of Neurosurgery, Mie Chuo Medical Center, National Hospital Organization, Tsu, Mie, Japan
| | - Kenji Kanamaru
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Furukawa K, Ishida F, Tsuji M, Miura Y, Kishimoto T, Shiba M, Tanemura H, Umeda Y, Sano T, Yasuda R, Shimosaka S, Suzuki H. Hemodynamic characteristics of hyperplastic remodeling lesions in cerebral aneurysms. PLoS One 2018; 13:e0191287. [PMID: 29338059 PMCID: PMC5770072 DOI: 10.1371/journal.pone.0191287] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022] Open
Abstract
Background & purpose Hyperplastic remodeling (HR) lesions are sometimes found on cerebral aneurysm walls. Atherosclerosis is the results of HR, which may cause an adverse effect on surgical treatment for cerebral aneurysms. Previous studies have demonstrated that atherosclerotic changes had a correlation with certain hemodynamic characteristics. Therefore, we investigated local hemodynamic characteristics of HR lesions of cerebral aneurysms using computational fluid dynamics (CFD). Methods Twenty-four cerebral aneurysms were investigated using CFD and intraoperative video recordings. HR lesions and red walls were confirmed on the intraoperative images, and the qualification points were determined on the center of the HR lesions and the red walls. The qualification points were set on the virtual operative images for evaluation of wall shear stress (WSS), normalized WSS (NWSS), oscillatory shear index (OSI), relative residence time (RRT), and aneurysm formation indicator (AFI). These hemodynamic parameters at the qualification points were compared between HR lesions and red walls. Results HR lesions had lower NWSS, lower AFI, higher OSI and prolonged RRT compared with red walls. From analysis of the receiver-operating characteristic curve for hemodynamic parameters, OSI was the most optimal hemodynamic parameter to predict HR lesions (area under the curve, 0.745; 95% confidence interval, 0.603–0.887; cutoff value, 0.00917; sensitivity, 0.643; specificity, 0.893; P<0.01). With multivariate logistic regression analyses using stepwise method, NWSS was significantly associated with the HR lesions. Conclusions Although low NWSS was independently associated with HR lesions, OSI is the most valuable hemodynamic parameter to distinguish HR lesions from red walls.
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Affiliation(s)
- Kazuhiro Furukawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- * E-mail:
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, National Hospital Organization, Tsu, Mie, Japan
| | - Masanori Tsuji
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoichi Miura
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
| | - Tomoyuki Kishimoto
- Department of Neurosurgery, Mie Chuo Medical Center, National Hospital Organization, Tsu, Mie, Japan
| | - Masato Shiba
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroshi Tanemura
- Department of Neurosurgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Yasuyuki Umeda
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takanori Sano
- Department of Neurosurgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Ryuta Yasuda
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shinichi Shimosaka
- Department of Neurosurgery, Mie Chuo Medical Center, National Hospital Organization, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Nishikawa H, Shimizu S, Nakajima H, Kitano Y, Sano T, Mouri G, Miya F, Suzuki H. Characteristics of Blood Blister-Like Aneurysms with a Saccular-Shape Appearance. World Neurosurg 2017; 108:595-602. [DOI: 10.1016/j.wneu.2017.09.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
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Longo M, Granata F, Racchiusa S, Mormina E, Grasso G, Longo GM, Garufi G, Salpietro FM, Alafaci C. Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario. World Neurosurg 2017; 105:632-642. [DOI: 10.1016/j.wneu.2017.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022]
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Sano T, Ishida F, Tsuji M, Furukawa K, Shimosaka S, Suzuki H. Hemodynamic Differences Between Ruptured and Unruptured Cerebral Aneurysms Simultaneously Existing in the Same Location: 2 Case Reports and Proposal of a Novel Parameter Oscillatory Velocity Index. World Neurosurg 2017; 98:868.e5-868.e10. [DOI: 10.1016/j.wneu.2016.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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