Linkai Jing1, Jian Liu1, Ying Zhang1, Nikhil Paliwal2, Hui Meng3, Shengzhang Wang4, Xinjian Yang5. 1. Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. 2. Department of Mechanical & Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York. 3. Department of Mechanical & Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York; Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, New York. 4. Department of Mechanics and Engineering Science, Fudan University, Shanghai, China. 5. Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: yang-xj@163.net.
Abstract
BACKGROUND: Aneurysm recanalization after coiling, with or without stent assistance, is a major issue in the endovascular management of intracranial aneurysms. Multiple intracranial aneurysms with different outcomes after endovascular treatment may represent a useful disease model in which patient-specific risk factors can be balanced to investigate possible features linked to aneurysm recanalization. In the present study, we evaluated the impact of aneurysm-specific, treatment-related, and hemodynamics-related factors on multiple aneurysms and to explore the reason why one aneurysm recanalized and the other did not. METHODS: Between 2010 and 2015, 763 multiple intracranial aneurysms in 326 patients were diagnosed by digital subtraction angiography. We retrospectively collected and analyzed 13 pairs of multiple aneurysms with different outcomes (recanalized or stable) in the same patient. Patient-specific models were constructed and analyzed by a computational fluid dynamics method. The virtual stent deployment method was used, and the coils were simulated by a porous medium model. Factors were evaluated for significance with respect to recanalization. RESULTS: Aneurysm size (P = 0.021), neck width (P = 0.027), ruptured aneurysms (P = 0.002), reduction ratio of averaged velocity (P = 0.008), and wall shear stress (P = 0.024) were significantly associated with aneurysm recanalization. By contrast, the aneurysm location, all of treatment-related factors (packing density, duration of follow-up, stent use, initial angiographic result) and the reduction ratio of averaged pressure were not significantly associated (P > 0.05). CONCLUSIONS: Small aneurysm size and neck width, unruptured aneurysm, and perianeurysmal hemodynamics with marked reduction may be important factors associated with the midterm durability of aneurysm embolization.
BACKGROUND:Aneurysm recanalization after coiling, with or without stent assistance, is a major issue in the endovascular management of intracranial aneurysms. Multiple intracranial aneurysms with different outcomes after endovascular treatment may represent a useful disease model in which patient-specific risk factors can be balanced to investigate possible features linked to aneurysm recanalization. In the present study, we evaluated the impact of aneurysm-specific, treatment-related, and hemodynamics-related factors on multiple aneurysms and to explore the reason why one aneurysm recanalized and the other did not. METHODS: Between 2010 and 2015, 763 multiple intracranial aneurysms in 326 patients were diagnosed by digital subtraction angiography. We retrospectively collected and analyzed 13 pairs of multiple aneurysms with different outcomes (recanalized or stable) in the same patient. Patient-specific models were constructed and analyzed by a computational fluid dynamics method. The virtual stent deployment method was used, and the coils were simulated by a porous medium model. Factors were evaluated for significance with respect to recanalization. RESULTS:Aneurysm size (P = 0.021), neck width (P = 0.027), ruptured aneurysms (P = 0.002), reduction ratio of averaged velocity (P = 0.008), and wall shear stress (P = 0.024) were significantly associated with aneurysm recanalization. By contrast, the aneurysm location, all of treatment-related factors (packing density, duration of follow-up, stent use, initial angiographic result) and the reduction ratio of averaged pressure were not significantly associated (P > 0.05). CONCLUSIONS: Small aneurysm size and neck width, unruptured aneurysm, and perianeurysmal hemodynamics with marked reduction may be important factors associated with the midterm durability of aneurysm embolization.
Authors: Sophie Gallas; Anne Pasco; Jean-Philippe Cottier; Jean Gabrillargues; Jacques Drouineau; Christophe Cognard; Denis Herbreteau Journal: AJNR Am J Neuroradiol Date: 2005-08 Impact factor: 3.825
Authors: Michel Piotin; Laurent Spelle; Charbel Mounayer; Marco T Salles-Rezende; Daniel Giansante-Abud; Ricardo Vanzin-Santos; Jacques Moret Journal: Radiology Date: 2007-02-09 Impact factor: 11.105
Authors: Yuichi Murayama; Yih Lin Nien; Gary Duckwiler; Y Pierre Gobin; Reza Jahan; John Frazee; Neil Martin; Fernando Viñuela Journal: J Neurosurg Date: 2003-05 Impact factor: 5.115