Cerebral Aneurysm Hemodynamics and a Length of Parent Vessel

Author(s):  
J. Poethke ◽  
A. Spuler ◽  
Ch. Petz ◽  
H. -Ch. Hege ◽  
L. Goubergrits ◽  
...  
2019 ◽  
Vol 11 (10) ◽  
pp. 999-1003 ◽  
Author(s):  
Michael R Levitt ◽  
Christian Mandrycky ◽  
Ashley Abel ◽  
Cory M Kelly ◽  
Samuel Levy ◽  
...  

ObjectivesTo study the correlation between wall shear stress and endothelial cell expression in a patient-specific, three-dimensional (3D)-printed model of a cerebral aneurysm.Materials and methodsA 3D-printed model of a cerebral aneurysm was created from a patient’s angiogram. After populating the model with human endothelial cells, it was exposed to media under flow for 24 hours. Endothelial cell morphology was characterized in five regions of the 3D-printed model using confocal microscopy. Endothelial cells were then harvested from distinct regions of the 3D-printed model for mRNA collection and gene analysis via quantitative polymerase chain reaction (qPCR.) Cell morphology and mRNA measurement were correlated with computational fluid dynamics simulations.ResultsThe model was successfully populated with endothelial cells, which survived under flow for 24 hours. Endothelial morphology showed alignment with flow in the proximal and distal parent vessel and aneurysm neck, but disorganization in the aneurysm dome. Genetic analysis of endothelial mRNA expression in the aneurysm dome and distal parent vessel was compared with the proximal parent vessels. ADAMTS-1 and NOS3 were downregulated in the aneurysm dome, while GJA4 was upregulated in the distal parent vessel. Disorganized morphology and decreased ADAMTS-1 and NOS3 expression correlated with areas of substantially lower wall shear stress and wall shear stress gradient in computational fluid dynamics simulations.ConclusionsCreating 3D-printed models of patient-specific cerebral aneurysms populated with human endothelial cells is feasible. Analysis of these cells after exposure to flow demonstrates differences in both cell morphology and genetic expression, which correlate with areas of differential hemodynamic stress.


2002 ◽  
Vol 15 (5) ◽  
pp. 537-548 ◽  
Author(s):  
G.B. Bradač ◽  
G. Stura ◽  
M. Bergui

Balloon occlusion of parent vessel and direct coiling are the two endovascular techniques routinely used and commonly accepted as alternatives to surgery for treatment of the cerebral aneurysm in many patients. Based on our experience and what is reported in the literature, the various aspects concerning techniques, difficulties, risks, are described. In comparison to surgery, the endovascular approach is a relatively new technique, which is still in evolution. To date, there is no objective indication regarding the method to be used in a given case. The experience and attitude of the involved team still play an essential role.


2006 ◽  
Vol 12 (1) ◽  
pp. 31-35 ◽  
Author(s):  
K.F. Layton ◽  
H.J. Cloft ◽  
D.F. Kallmes

Perforation of intracranial aneurysms during endovascular treatment with platinum micro-coils is a well-known and serious complication reported to occur in 2–4% of patients. Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis. In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture.


1971 ◽  
Vol 34 (2) ◽  
pp. 225-228 ◽  
Author(s):  
Henry A. Shenkin ◽  
Felix Jenkins ◽  
Kwang Kim

✓ The removal of an arteriovenous anomaly of the brain resulted in a distinct reduction in the size of a large aneurysm located upon its principal feeding vessel. This confirms previous inferences that the development of aneurysms is related to the amount of blood flow in the parent vessel.


2001 ◽  
Vol 21 (12) ◽  
pp. 1464-1471 ◽  
Author(s):  
Christoph Groden ◽  
Jochen Laudan ◽  
Scott Gatchell ◽  
Herrmann Zeumer

The effect of different percentages of coil mesh in a cerebral aneurysm on the pulsatile flow and pressure in the parent vessel and aneurysm lumen was evaluated. Geometric data on a basilar tip aneurysm and vertebrobasilar arteries after subarachnoid hemorrhage was obtained by computer tomographic angiography. Intraarterial pressure was measured at four vertebrobasilar points before and after treatment with detachable coils. Pulsatile flow was documented by transcranial ultrasonography. A three-dimensional computer simulation was created using a commercial fluid dynamics solver for four aneurysm conditions: (1) before intervention; (2) with a 20% filling showing a complete cessation of the inflow through the aneurysm neck; (3) with a 12% filling showing an incomplete deceleration of inflow through the aneurysm neck, with a remaining flow around the embedded platinum coils; and (4) with a 12% filling and simulation of clotted aneurysm dome, which did not inhibit persisting flow phenomena. The relative pressure amplitudes neither increased nor decreased under the different simulated aneurysm filling conditions. Inserted platinum coils can immediately and decisively relieve the influx of pulsating blood and allow for initial clotting. To reach this effect, a volume density of 20% platinum coil mesh in the aneurysm neck is needed.


TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e155-e162
Author(s):  
Malebogo N. Ngoepe ◽  
Etheresia Pretorius ◽  
Ilunga J. Tshimanga ◽  
Zahra Shaikh ◽  
Yiannis Ventikos ◽  
...  

AbstractCerebral aneurysms are balloon-like structures that develop on weakened areas of cerebral artery walls, with a significant risk of rupture. Thrombi formation is closely associated with cerebral aneurysms and has been observed both before and after intervention, leading to a wide variability of outcomes in patients with the condition. The attempt to manage the outcomes has led to the development of various computational models of cerebral aneurysm thrombosis. In the current study, we developed a simplified thrombin–fibrinogen flow system, based on commercially available purified human-derived plasma proteins, which enables thrombus growth and tracking in an idealized cerebral aneurysm geometry. A three-dimensional printed geometry of an idealized cerebral aneurysm and parent vessel configuration was developed. An unexpected outcome was that this phantom-based flow model allowed us to track clot growth over a period of time, by using optical imaging to record the progression of the growing clot into the flow field. Image processing techniques were subsequently used to extract important quantitative metrics from the imaging dataset, such as end point intracranial thrombus volume. The model clearly demonstrates that clot formation, in cerebral aneurysms, is a complex interplay between mechanics and biochemistry. This system is beneficial for verifying computational models of cerebral aneurysm thrombosis, particularly those focusing on initial angiographic occlusion outcomes, and will also assist manufacturers in optimizing interventional device designs.


Author(s):  
Kingsley E. Abhulimen

This paper presents a novel decision support system (DSS) to assist medics administer optimal clinical diagnosis and effective healthcare post-treatment solutions. The DSS model that evolved from the research work predicted treatment of cerebral aneurysm using fuzzy classifications and neural network algorithms specific to patient clinical case data. The Lyapunov stability implemented with Levenberg–Marquardt model was used to advance DSS learning functional paradigms and algorithms in disease diagnosis to mimic specific patient disease conditions and symptoms. Thus, the patients' disease conditions were assigned fuzzy class dummy data to validate the DSS as a functional system in conformity with core sector standards of International Electrotechnical Commission—IEC61508. The disease conditions and symptoms inputted in the DSS simulated synaptic weights assigned linguistic variables defined as likely, unlikely, and very unlikely to represent clinical conditions to specific patient disease states. Furthermore, DSS simulation results correlated with clinical data to predict quantitative coil embolization packing densities required to limit aneurismal inflow, pressure residence time, and flow rate critical to design treatments required. The profiles of blood flow, hazards risks, safety thresholds, and coiling density requirements to reduce aneurismal inflow significantly at lower parent vessel flow rates was predicted by DSS and relates to specific anatomical and physiological parameters for post-treatment of cerebral aneurysm disease.


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