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Geng J, Wang S, Wang Y, Wang W, Fang G, Yang G, Fan X, Hu P, He C, Zhang H. Clinical, 3D Morphological, and Hemodynamic Risk Factors for Instability of Unruptured Intracranial Aneurysms. Clin Neuroradiol 2023; 33:1133-1142. [PMID: 37318560 DOI: 10.1007/s00062-023-01324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Neurosurgeons can manage unruptured intracranial aneurysms (UIAs). However, the stability of UIAs under follow-up remains uncertain. This study aimed to examine the risk factors associated with the instability (rupture or growth) of UIAs during follow-up. METHODS We obtained information on patients with UIA who underwent ≥ 6 months of the time of flight-magnetic resonance angiography (TOF-MRA) imaging follow-up in two centers. Computer-assisted semi-automated measurement (CASAM) techniques were used for recording morphological parameters and determining the growth of these aneurysms. We also recorded hemodynamic parameters at the beginning of the follow-up. The univariate and multivariate Cox regression analyses were performed to calculate hazard ratios with corresponding 95% confidence intervals for the clinical, morphological, and hemodynamic risk factors for aneurysm instability. RESULTS A total of 304 aneurysms from 263 patients (80.4%) were included for analysis. The annual aneurysm growth rate was 4.7%. Significant predictive factors for aneurysm instability in the multivariate analysis were as follows: poorly controlled hypertension (hazard ratio (HR), 2.97 (95% CI, 1.27-6.98), P = 0.012); aneurysms located on posterior circulation (HR, 7.81 (95% CI, 2.28-26.73), P = 0.001), posterior communication artery (HR, 3.01 (95% CI, 1.07-8.46), P = 0.036), and cavernous carotid artery (HR, 3.78 (95% CI, 1.18-12.17), P = 0.026); and size ratio ≥ 0.87 (HR, 2.54 (95% CI, 1.14-5.68), P = 0.023). CONCLUSIONS The management of UIAs should focus on the control of hypertension during the follow-up. Aneurysms on the posterior communicating artery, posterior circulation, and cavernous carotid arteries require intensive surveillance or timely treatment.
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Affiliation(s)
- Jiewen Geng
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Simin Wang
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Yadong Wang
- Department of Neurosurgery, Weihai Municipal Hospital, Weihai, China
| | - Wenzhi Wang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Gang Fang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Guangming Yang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Xinxin Fan
- Department of Neurosurgery, Xi'an NO. 3 Hospital the Affiliated Hospital of Northwest University, Xi'an, China
| | - Peng Hu
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China.
- China International Neuroscience Institute, Beijing, China.
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Diana F, de Dios Lascuevas M, Peschillo S, Raz E, Yoshimura S, Requena Ruiz M, Hernández Morales D, Tomasello A. Intrasaccular Flow Disruptor-Assisted Coiling of Intracranial Aneurysms Using the Novel Contour Neurovascular Systems and NEQSTENT: A Single-Center Safety and Feasibility Study. Brain Sci 2022; 12:brainsci12080991. [PMID: 35892432 PMCID: PMC9394360 DOI: 10.3390/brainsci12080991] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 07/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were designed to reconstruct the aneurysmal neck and both can be used as assisting coiling devices. We aimed to report our preliminary experience with the flow disruptor-assisted coiling (IFD-AC) technique. Methods: We performed a retrospective analysis of prospectively collected data of all patients with IAs treated with the IFD-AC. Results: Between February 2021 and April 2022, we treated 15 IAs with the IFD-AC: 10 ruptured and 5 unruptured. The IFD-AC was successfully performed in 13 cases, with a post-operative RROC 1 in 12 cases (92.3%) and RROC 2 in 1 case (7.7%). There was one ischemic event (6.7%) and no hemorrhagic complications. Twelve patients underwent a mid-term radiologic follow-up: Ten IAs (83.4%) presented an adequate occlusion, while 2 (16.7%) had a recurrence. Conclusions: The IFD-AC, both with the CNS and the NQS, seems a safe technique with promising efficacy profile. The IFD-AC has proved to be safe without antiplatelet therapy in ruptured cases. Further studies are needed to confirm our preliminary results.
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Affiliation(s)
- Francesco Diana
- Neuroradiology, University Hospital ‘San Giovanni di Dio e Ruggi d’Aragona’, 84125 Salerno, Italy;
| | - Marta de Dios Lascuevas
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Simone Peschillo
- UniCamillus International Medical University, 00131 Rome, Italy
- Endovascular Neurosurgery, Pia Fondazione Cardinale G Panico Hospital, 73039 Tricase, Italy
- Correspondence:
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, NY 10016, USA;
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan;
| | - Manuel Requena Ruiz
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - David Hernández Morales
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Alejandro Tomasello
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
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Hadad S, Mut F, Kadirvel R, Ding YH, Kallmes D, Cebral JR. Evaluation of Outcome Prediction of Flow Diversion for Intracranial Aneurysms. AJNR Am J Neuroradiol 2021; 42:1973-1978. [PMID: 34446459 DOI: 10.3174/ajnr.a7263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/10/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Identifying and predicting which aneurysms are likely to quickly occlude and which ones are likely to remain open following treatment with flow-diverting devices is important to develop optimal patient management strategies. The purpose of this study was to evaluate predictions based on computational fluid dynamics models using the elastase rabbit aneurysm model. MATERIALS AND METHODS A series of 13 aneurysms created in rabbits were treated with flow diverters, and outcomes were angiographically assessed at 8 weeks' follow-up. Computational fluid dynamics models were constructed from pretreatment 3D rotational angiograms and Doppler ultrasound flow velocity measurements. Postimplantation mean aneurysm inflow rate and flow velocity were used to prospectively predict aneurysm occlusion blinded to the actual outcomes. Specifically, if both variables were below their corresponding thresholds, fast occlusion was predicted, while if one of them was above the threshold, slow or incomplete occlusion was predicted. RESULTS Of the 13 aneurysms included, 8 were incompletely occluded 8 weeks after treatment, and 5 were completely occluded. A total of 10 computational fluid dynamics-based predictions agreed with the angiographic outcome, reaching 77% accuracy, 80% sensitivity, and 75% specificity. Posttreatment mean velocity alone was able to achieve the same predictive power as the combination of inflow rate and velocity. CONCLUSIONS Subject-specific computational fluid dynamics models of the hemodynamic conditions created immediately after implantation of flow-diverting devices in experimental aneurysms created in rabbits are capable of prospectively predicting, with a reasonable accuracy, which aneurysms will completely occlude and which ones will remain incompletely occluded.
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Affiliation(s)
- S Hadad
- From the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - F Mut
- From the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - R Kadirvel
- Department of Interventional Neuroradiology (R.K., Y.-H.D., D.K.), Mayo Clinic, Rochester, Minnesota
| | - Y-H Ding
- Department of Interventional Neuroradiology (R.K., Y.-H.D., D.K.), Mayo Clinic, Rochester, Minnesota
| | - D Kallmes
- Department of Interventional Neuroradiology (R.K., Y.-H.D., D.K.), Mayo Clinic, Rochester, Minnesota
| | - J R Cebral
- From the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
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Vardar Z, King RM, Kraitem A, Langan ET, Peterson LM, Duncan BH, Raskett CM, Anagnostakou V, Gounis MJ, Puri AS, Ughi GJ. High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography. J Neurointerv Surg 2021; 13:669-673. [PMID: 32989033 PMCID: PMC8205185 DOI: 10.1136/neurintsurg-2020-016447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND High-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 µm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates. METHODS In a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition >50%) were binary coded. A device was considered 'adequately deployed' by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM). RESULTS Adequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R²=0.96; P<0.001). More neointimal coverage of 78%±32% was found on 'adequate deployment' cases versus 31%±24% for the 'inadequate deployment' cases (P=0.001). CONCLUSION HF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.
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Affiliation(s)
- Zeynep Vardar
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Robert M King
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Afif Kraitem
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erin T Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | - Christopher M Raskett
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vania Anagnostakou
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Giovanni J Ughi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Research and Development, Gentuity, Sudbury, Massachusetts, USA
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Dazeo N, Muñoz R, Narata AP, Fernandez H, Larrabide I. Intra-saccular device modeling for treatment planning of intracranial aneurysms: from morphology to hemodynamics. Int J Comput Assist Radiol Surg 2021; 16:1663-1673. [PMID: 34195929 DOI: 10.1007/s11548-021-02427-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
MOTIVATION Intra-saccular devices (ID), developed for the treatment of bifurcation aneurysms, offer new alternatives for treating complex terminal and bifurcation aneurysms. In this work, a complete workflow going from medical images to post-treatment CFD analysis is described and used in the assessment of a concrete clinical problem. MATERIALS AND METHODS Two different intra-saccular device sizes were virtually implanted in 3D models of the patient vasculature using the ID-Fit method. After deployment, the local porosity at the closed end of the device in contact with the blood flow was computed. This porosity was then used to produce a CFD porous medium model of the device. Velocities and wall shear stress were assessed for each model. RESULTS Six patients treated with intra-saccular devices were included in this work. For each case, 2 different device sizes were virtually implanted and 3 CFD simulations were performed: after deployment simulation with each size and before deployment simulation (untreated). A visible reduction in velocities was observed after device implantation. Velocity and WSS reduction was statistically significant (K-S statistics, [Formula: see text]). CONCLUSIONS Placement of different device size can lead to a partial filling of the aneurysm, either at the dome or at the neck, depending on the particular positioning by the interventionist. The methodology used in this work can have a strong clinical impact, since it provides additional information in the process of device selection using preoperative data.
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Affiliation(s)
- Nicolás Dazeo
- Instituto Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.
| | - Romina Muñoz
- Instituto Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Ana Paula Narata
- Neuroradiology Department, University Hospital of Southampton, Southampton, UK
| | | | - Ignacio Larrabide
- Instituto Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.,Galgo Medical S.L., Barcelona, Spain
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In-silico trial of intracranial flow diverters replicates and expands insights from conventional clinical trials. Nat Commun 2021; 12:3861. [PMID: 34162852 PMCID: PMC8222326 DOI: 10.1038/s41467-021-23998-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/25/2021] [Indexed: 01/18/2023] Open
Abstract
The cost of clinical trials is ever-increasing. In-silico trials rely on virtual populations and interventions simulated using patient-specific models and may offer a solution to lower these costs. We present the flow diverter performance assessment (FD-PASS) in-silico trial, which models the treatment of intracranial aneurysms in 164 virtual patients with 82 distinct anatomies with a flow-diverting stent, using computational fluid dynamics to quantify post-treatment flow reduction. The predicted FD-PASS flow-diversion success rates replicate the values previously reported in three clinical trials. The in-silico approach allows broader investigation of factors associated with insufficient flow reduction than feasible in a conventional trial. Our findings demonstrate that in-silico trials of endovascular medical devices can: (i) replicate findings of conventional clinical trials, and (ii) perform virtual experiments and sub-group analyses that are difficult or impossible in conventional trials to discover new insights on treatment failure, e.g. in the presence of side-branches or hypertension. In-silico trials rely on virtual populations and interventions simulated using patient-specific models and may offer a solution to lower costs. Here, the authors present the flow diverter performance assessment in-silico trial, which models the treatment of intracranial aneurysms with a flow-diverting stent.
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