Proposed Parent Vessel Geometry Based Classification of Anterior Communicating Artery–Located Aneurysms

Hassan, Tamer; El-Sayed, Amr; Abbas, Mohamed; Sultan, Ahmed; Eladawy, Yousry

doi:10.1016/j.wneu.2017.01.096

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…Given the high risk of rupture of AComA aneurysms, it is crucial to properly treat aneurysms at this site. In general, due to hemodynamic influ-ence, many AComA aneurysms arise from the dominant anterior cerebral artery (ACA) and are formed like bifurcation aneurysms among the dominant A1, AComA and ipsilateral A2 17,25) . For wide-necked aneurysms, sometimes, single stenting from A1 to A2 is not sufficient to cover the neck to protect coils from protruding into the AComA.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms

Ban

Kwon

Kim

2022

J Korean Neurosurg Soc

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Objective : Placement of a single transverse stent via the nondominant A1 across the anterior communicating artery (AComA) into the contralateral A2 can provide sufficient neck coverage for wide-necked bifurcation AComA aneurysms. The authors described the feasibility, safety and long-term outcomes of this technique.Methods : Between January 2015 and February 2018, placement of a single transverse stent via the nondominant A1 was attempted in 17 wide-necked bifurcation AComA aneurysms. The authors reviewed the medical records and radiological studies.Results : The technical success rate was 94.1% (16/17). Periprocedural thromboembolic complications occurred in one patient (6.3%) without permanent neurological deficits. The mean clinical follow-up duration was 39.9±9.8 months. No deaths or delayed thromboembolic complications occurred. The mean angiographic follow-up duration was 38.9±9.8 months. The immediate and final follow-up complete occlusion rates were 87.4 and 93.7%, respectively. There was no recanalization during the follow-up period.Conclusion : Placement of a single transverse stent via the nondominant A1 across the AComA into the contralateral A2 is a feasible and relatively safe endovascular technique for the treatment of wide-necked bifurcation AComA aneurysms, with good long-term occlusion rates and a reasonable complication rate, if only the nondominant A1 is applicable.

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Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms

Ban

Kwon

Kim

2022

J Korean Neurosurg Soc

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“…The relationship between aneurysm development and A1 segment asymmetry has been shown in different studies 35,42,43 . In our previous study, in which the factors affecting the development of AComA aneurysms were investigated, the statistical value of the decrease in c‐A1 diameter was found to be higher than the statistical value of the increase in the i‐A1 diameter.…”

Section: Discussionmentioning

confidence: 90%

“…However, there was no significant relationship between ACA diameter and rupture in some studies 7,8,10,38 . Hassan et al 42 . demonstrated that the diameter difference among A1 segments was determinative for aneurysm localization and rupture.…”

Section: Discussionmentioning

confidence: 97%

Anterior communicating artery aneurysms: Nonmodifiable morphological parameters associated with rupture risk

Soylu

Uzunkaya

Akan

2021

Journal of Neuroimaging

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Background and Purpose The aim of this study was to investigate the relationship between arterial morphological parameters and the rupture risk of anterior communicating artery (AComA) aneurysms. Methods A hospital database was retrospectively reviewed to identify patients with AComA aneurysms. Morphologic parameters were evaluated on the 3‐dimensional computed tomography angiograms. The patients were divided into two groups as ruptured and unruptured. Patient age, sex, morphological parameters such as aneurysm height and weight, neck diameter, aspect ratio (AR), size ratio (SR), bifurcation angle, aneurysm shape, and diameters of the artery were statistically compared between two groups. Results Ninety‐five AComA aneurysms were analyzed in this study (60 ruptured and 35 unruptured). The aneurysm neck size (p = .005) and the diameter of the A1 segment of the ipsilateral anterior cerebral artery (i‐A1) were smaller in the ruptured group than in the unruptured group (p = .001), but AR (p = .001) was higher. The number of patients with irregular shape aneurysm were higher in the ruptured group (p = .006). There was no significant difference between the two groups in terms of age, sex, aneurysm height and weight, bifurcation angle, and SR. Univariate logistic regression analysis showed that i‐A1 segment diameter (odds ratio [OR]: –2.070, confidence interval [CI]: 0.030‐0.531, p = .005), aneurysm neck diameter (OR: –0.409, CI: 0.491‐0.899, p = .008), irregular shape (OR: 1.197, CI: 1.382‐7.929, p = .007), and AR (OR: 0.880, CI: 1.315‐4.417, p = .004) were significantly correlated with ruptured status. Multivariate regression analysis demonstrated that aneurysm neck diameter (OR: –0.457, CI: 0.410‐0.977, p = .039) was the only independent variable for rupture. Conclusion AComA aneurysm rupture is more likely to occur in aneurysms with smaller i‐A1 segment diameter, smaller aneurysm neck diameter, irregular aneurysm shape, and higher AR. Aneurysm neck diameter may be a more important determinant for rupture prediction.

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“…However, morphological classification using CFD could possibly yield generalized WSS thresholds that can be utilized in clinical applications. [54][55][56] For this purpose, CFD simulations should account for the sensitive values of WSS, as indicated by the results of Zhou et al 15 Different non-Newtonian models produce deviations from the Newtonian assumption within similar ranges to the MKM. 4 However, due to the empirical nature of the non-Newtonian model, they are not consistent and sometimes they produce higher WSS (i.e.…”

Section: Wall Shear Stressmentioning

confidence: 99%

Computational fluid dynamics simulations of cerebral aneurysm using Newtonian, power-law and quasi-mechanistic blood viscosity models

Saqr

2020

Proc Inst Mech Eng H

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Cerebral aneurysm is a fatal neurovascular disorder. Computational fluid dynamics simulation of aneurysm haemodynamics is one of the most important research tools which provide increasing potential for clinical applications. However, computational fluid dynamics modelling of such delicate neurovascular disorder involves physical complexities that cannot be easily simplified. Recently, it was shown that the Newtonian simplification used to close the shear stress tensor of the Navier–Stokes equation is not sufficient to explore aneurysm haemodynamics. This article explores the differences between the latter simplification, non-Newtonian power-law model and a newly proposed quasi-mechanistic model. The modified Krieger model, which treats blood as a suspension of plasma and particles, was implemented in computational fluid dynamics context here for the first time and is made available to the readers in a C# code in the supplementary material of this article. Two middle-cerebral artery and two anterior-communicating artery aneurysms, all ruptured, were utilized here as case studies. It was shown that the modified Krieger model had higher sensitivity for wall shear stress calculations in comparison with the other two models. The modified Krieger model yielded lower wall shear stress values consistently in comparison with the other two models. Moreover, the modified Krieger model has generally predicted higher pressure in the aneurysm models. Based on published aneurysm rupture studies, it is believed that ruptured aneurysms are usually correlated with lower wall shear stress values than unruptured ones. Therefore, this work concludes that the modified Krieger model is a potential candidate for providing better clinical relevance to aneurysm computational fluid dynamics simulations.

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Proposed Parent Vessel Geometry Based Classification of Anterior Communicating Artery–Located Aneurysms

Cited by 9 publications

References 25 publications

Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms

Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms

Anterior communicating artery aneurysms: Nonmodifiable morphological parameters associated with rupture risk

Computational fluid dynamics simulations of cerebral aneurysm using Newtonian, power-law and quasi-mechanistic blood viscosity models

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