Hemodynamic Characteristics Associated With Paraclinoid Aneurysm Recurrence in Patients After Embolization

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.

Assessment and visualization of hemodynamic loading in aneurysm sac and neck: Effect of foam insertion

“…7,8 A large volume of available literature suggests that wall shear stress (WSS) and its derivatives can be used to characterize the influence of blood flow dynamics on the pathology of arterial degeneration. [9][10][11][12] Since in-vivo measurements are not feasible in most cases, the use of CFD is prevalent for calculations of hemodynamic indicators such as WSS. Saqr et al 7 have provided a comprehensive review of the prevalent modeling approach and assumptions used for simulating blood flow inside cerebral aneurysms.…”

“…In literature, investigations often rely on contour visualization to assess treatment effectiveness in reducing fluid loading at crucial sites. 9,10 Although contour visualization provides a comprehensive spatial picture, for proper realization of temporal changes, several contours corresponding to different time instants are analyzed. Rinaudo and Pasta 26 used polar plots to report systolic WSS in ascending thoracic aortic aneurysm but their use of polar plots was limited to single-time instances.…”

Recanalization of Embolized Endovascular Intracranial Aneurysms and Changes in the Blood Viscosity: A Pilot Study

“…Studies conducted by epidemiologists have revealed the rate of incidental aneurysms to be 7% (95% confidence interval [CI]) [5][6][7][8][9], with a corresponding occurrence of clinoid segment aneurysms at 3% (95% CI) [2][3][4]. Globally it is estimated to be roughly 3.2%, at an average age of 50 years, and with the overall gender ratio of 1: 1.…”

“…Neurosurgical (classic) protection of the brain aneurysm against subarachnoid hemorrhage (SAH) is a craniotomy, which slows reaching the location of the brain malformation and closing the aneurysm lumen with a metal clip (clipping) [8]. This is an invasive procedure and, therefore, its use is associated with the risk of potential serious complications.…”

“…Therefore, scientific studies have been conducted to detect various recanalization risk factors that could reduce the incidence of recurrent subarachnoid hemorrhage [17]. Studies confirming the role of hemodynamic factors in the initiation, development, and rupture of this brain malformation have been reported in the literature and it should be noted that unruptured aneurysms with residual necks following endovascular treatment pose a very low risk of rupture (0.6%) [8]. The blood flow of partially occluded aneurysm and hemodynamic disturbances on the recanalization of the aneurysm are rare [18].…”