Jildaz Caroff1, Cristian Mihalea2, Valerio Da Ros3, Takanobu Yagi4, Marta Iacobucci5, Léon Ikka6, Jacques Moret7, Laurent Spelle7. 1. Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France. Electronic address: Jildaz.caroff@aphp.fr. 2. Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Neurosurgery, university of medicine and pharmacy "Victor Babes", Timisoara, Romania. 3. Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata, Rome, Italy. 4. Waseda University, Shinjuku, Tokyo, Japan. 5. Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Bioimaging and Radiological Sciences, Policlinico "A. Gemelli", Rome, Italy. 6. Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France. 7. Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris Sud, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicêtre, France.
Abstract
BACKGROUND: Recent reports have revealed a worsening of aneurysm occlusion between WEB treatment baseline and angiographic follow-up due to "compression" of the device. OBJECTIVE: We utilized computational fluid dynamics (CFD) in order to determine whether the underlying mechanism of this worsening is flow related. METHODS: We included data from all consecutive patients treated in our institution with a WEB for unruptured aneurysms located either at the middle cerebral artery or basilar tip. The CFD study was performed using pre-operative 3D rotational angiography. From digital subtraction follow-up angiographies patients were dichotomized into two groups: one with WEB "compression" and one without. We performed statistical analyses to determine a potential correlation between WEB compression and CFD inflow ratio. RESULTS: Between July 2012 and June 2015, a total of 22 unruptured middle cerebral artery or basilar tip aneurysms were treated with a WEB device in our department. Three patients were excluded from the analysis and the mean follow-up period was 17months. Eleven WEBs presented "compression" during follow-up. Interestingly, device "compression" was statistically correlated to the CFD inflow ratio (P=0.018), although not to aneurysm volume, aspect ratio or neck size. CONCLUSION: The mechanisms underlying the worsening of aneurysm occlusion in WEB-treated patients due to device compression are most likely complex as well as multifactorial. However, it is apparent from our pilot study that a high arterial inflow is, at least, partially involved. Further theoretical and animal research studies are needed to increase our understanding of this phenomenon.
BACKGROUND: Recent reports have revealed a worsening of aneurysm occlusion between WEB treatment baseline and angiographic follow-up due to "compression" of the device. OBJECTIVE: We utilized computational fluid dynamics (CFD) in order to determine whether the underlying mechanism of this worsening is flow related. METHODS: We included data from all consecutive patients treated in our institution with a WEB for unruptured aneurysms located either at the middle cerebral artery or basilar tip. The CFD study was performed using pre-operative 3D rotational angiography. From digital subtraction follow-up angiographies patients were dichotomized into two groups: one with WEB "compression" and one without. We performed statistical analyses to determine a potential correlation between WEB compression and CFD inflow ratio. RESULTS: Between July 2012 and June 2015, a total of 22 unruptured middle cerebral artery or basilar tip aneurysms were treated with a WEB device in our department. Three patients were excluded from the analysis and the mean follow-up period was 17months. Eleven WEBs presented "compression" during follow-up. Interestingly, device "compression" was statistically correlated to the CFD inflow ratio (P=0.018), although not to aneurysm volume, aspect ratio or neck size. CONCLUSION: The mechanisms underlying the worsening of aneurysm occlusion in WEB-treated patients due to device compression are most likely complex as well as multifactorial. However, it is apparent from our pilot study that a high arterial inflow is, at least, partially involved. Further theoretical and animal research studies are needed to increase our understanding of this phenomenon.
Authors: Fernando Mut; Bong Jae Chung; Jorge Chudyk; Pedro Lylyk; Ramanathan Kadirvel; David F Kallmes; Juan R Cebral Journal: Int J Numer Method Biomed Eng Date: 2019-04-11 Impact factor: 2.747
Authors: Jacob Cherian; Stephen R Chen; Ajit Puri; Kunal Vakharia; Elad Levy; Sheila Eshraghi; Brian M Howard; Frank C Tong; C Michael Cawley; Bradley Gross; Matthew D Alexander; Ramesh Grandhi; Visish M Srinivasan; Jan-Karl Burkhardt; Jeremiah N Johnson; Peter Kan Journal: Neurosurgery Date: 2021-07-15 Impact factor: 4.654
Authors: J Cortese; J Caroff; J-B Girot; C Mihalea; V Da Ros; G Aguiar; A Elawady; L Ikka; S Gallas; A Ozanne; V Chalumeau; A Rouchaud; J Moret; L Spelle Journal: AJNR Am J Neuroradiol Date: 2021-06-11 Impact factor: 4.966