Hemodynamic Features of Microsurgically Identified, Thin-Walled Regions of Unruptured Middle Cerebral Artery Aneurysms Characterized Using Computational Fluid Dynamics

Neurosurgery ◽  
2019 ◽  
Vol 86 (6) ◽  
pp. 851-859
Author(s):  
Jang Hun Kim ◽  
Huan Han ◽  
Young-June Moon ◽  
Sangil Suh ◽  
Taek-Hyun Kwon ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Microscopic Surgery ◽  
Unruptured Intracranial Aneurysms ◽  
Thin Walled ◽  
Cfd Analyses ◽  
Middle Cerebral Artery Aneurysms

Abstract BACKGROUND Thin-walled regions (TWRs) of aneurysm surfaces observed in microscopic surgery are thought to be vulnerable areas for growth and rupture of unruptured intracranial aneurysms (UIAs). OBJECTIVE To identify hemodynamic features of TWRs of aneurysms by using computational fluid dynamics (CFD) analyses of unruptured middle cerebral artery bifurcation (MCAB) aneurysms. METHODS Nine patients with 11 MCAB aneurysms were enrolled, and their TWRs were identified. CFD analysis was performed using 3 parameters: pressure, wall shear stress (WSS), and WSS divergence (WSSD). Each parameter was evaluated for its correspondence with TWR. RESULTS Among 11 aneurysms, 15 TWRs were identified. Corresponding matches with CFD parameters (pressure, WSS, and WSSD) were 73.33, 46.67, and 86.67%, respectively. CONCLUSION WSSD, a hemodynamic parameter that accounts for both magnitude and directionality of WSS, showed the highest correspondence. High WSSD might correspond with TWR of intracranial aneurysms, which are likely high-risk areas for rupture.

Abstract 110: Stent-Assisted Coiling of Intracranial Aneurysms: Predictors of Complications, Recanalization, and Outcome in 509 Cases.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Pascal Jabbour ◽  
Ross Drueding ◽  
Richard Dalyai ◽  
Robert M Starke ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Stent Placement ◽  
Intracranial Aneurysms ◽  
Multivariate Logistic Regression Analysis ◽  
Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Procedural Complications ◽  
Middle Cerebral Artery Aneurysms

Introduction: Self-expanding stents are increasingly used for treatment of complex intracranial aneurysms. We assess the safety and efficacy of intracranial stenting and determine predictors of complications, recanalization, and outcome in the largest series of intracranial aneurysms to date. Methods: A total of 509 patients were treated with Neuroform and Enterprise stents between 2005-2011 in our institution. A multivariate logistic regression analysis was conducted to detect predictors of complications, recanalization, and outcome. Results: 445 (87.4%) patients were treated electively and 64 (12.6%) in the setting of subarachnoid hemorrhage. Mean aneurysm size was 7.7 mm. Stent placement was successful in 97.6% of patients. The Neuroform stent was used in 56.8% and the Enterprise stent in 43.2%. Complete or near-complete aneurysm occlusion was achieved initially in 87.7% of cases. Procedural complications occurred in 5.6% of patients. In multivariate analysis, subarachnoid hemorrhage (p=0.03), delivery of coils prior to stent placement (p=0.002), and carotid terminus/middle cerebral artery aneurysm locations (p=0.01) were independent predictors of procedural complications. Angiographic follow-up was available for 85.1% of patients at a mean of 27 months. The rates of recanalization and retreatment were respectively 11.7% and 6.1%. Previously coiled aneurysms (p=0.02), ruptured aneurysms (p=0.01), larger aneurysms (p<0.001), incompletely occluded aneurysms (p=0.01), and cavernous/vertebrobasilar/posterior communicating/middle cerebral artery aneurysms (p=0.04) were predictors of recanalization. Favorable outcomes were seen in 99.3% of elective patients and 61% of subarachnoid hemorrhage patients. Patient age (p=0.03), Hunt and Hess Grades (p<0.001), and procedural complications (p<0.001) were predictors of outcome. The type of stent was not a predictor of complications, recanalization, or outcome. Conclusion: Stent-assisted coiling of ruptured and unruptured intracranial aneurysms is safe, effective, and provides durable aneurysm closure. Stent delivery prior to coil deployment reduces the risk of procedural complications. The type of stent used does not affect treatment outcome.

Outcomes following aneurysmal coil embolization with intentionally shortened low-profile visible intraluminal support stent deployment

2021 ◽  
pp. 197140092110269
Author(s):  
Kenji Yatomi ◽  
Yumiko Mitome-Mishima ◽  
Takashi Fujii ◽  
Kohsuke Teranishi ◽  
Hidenori Oishi ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Perioperative Complications ◽  
Flow Diversion ◽  
Stent Deployment ◽  
Coverage Ratio ◽  
Low Profile ◽  
Unruptured Intracranial Aneurysms

Purpose Among all stents available for neuroendovascular therapy, the low-profile visible intraluminal support stent bears the highest metal coverage ratio. We deployed a low-profile visible intraluminal support stent with a delivery wire or/and microcatheter system push action to shorten the low-profile visible intraluminal support stent and thus achieve a flow diversion effect. We report our single-institution experience with the use of low-profile visible intraluminal support stents for intentionally shortened deployment (shortening group) and non-shortened deployment (non-shortening group) for unruptured intracranial aneurysms. Methods We retrospectively reviewed the medical records of 130 patients with 131 intracranial aneurysms who were treated with low-profile visible intraluminal support stent-assisted coil embolization from February 2016–January 2019. All perioperative complications were noted. Every 6 months, we re-examined the patients with cerebral angiography or magnetic resonance angiography. The outcomes of aneurysm occlusion were evaluated by the modified Raymond–Roy occlusion classification. We used the finite element method and computational fluid dynamics to investigate the hemodynamics after shortened low-profile visible intraluminal support stent deployment. Results Immediately after treatment, the modified Raymond-Roy occlusion classification was significantly better in the shortening group than in the non-shortening group ( p<0.05). The latest angiographic outcomes showed the same tendency. Hemodynamic analysis by computational fluid dynamics suggested an adequate flow diversion effect with the use of our intentional shortening method. Conclusions Stent-assisted coil embolization using this technique showed good results of a high complete occlusion rate and low complication rate. These findings suggest that shortened low-profile visible intraluminal support stent deployment yields a flow diversion effect and may lead to early intra-aneurysmal thrombus formation.

An Immersed Porous Boundary Method for Computational Fluid Dynamics of Blood Flow in Aneurysms With Flow Diverters

2012 ◽  
Author(s):  
Viorel Mihalef ◽  
Puneet Sharma ◽  
Ali Kamen ◽  
Thomas Redel
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Flow Diverters

Intracranial aneurysms are pathological dilatations of a cerebral artery that may suffer rupture and lead to subarachnoid hemorrhage. Such a condition presents high morbidity and mortality rates for the patients concerned.

Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon

2014 ◽  
Vol 8 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Arturo Consoli ◽  
Chiara Vignoli ◽  
Leonardo Renieri ◽  
Andrea Rosi ◽  
Ivano Chiarotti ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Complication Rate ◽  
Intracranial Aneurysms ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Complete Occlusion ◽  
Giant Aneurysms ◽  
Unruptured Intracranial Aneurysms

Background and purposeAssisted coiling with stents or balloons enables a higher percentage of complete occlusions of saccular unruptured intracranial aneurysms to be achieved with a reasonable complication rate. The aim of this study was to compare stent-assisted coiling and the balloon remodeling technique in terms of efficacy, stability, and safety for the treatment of comparable unruptured saccular intracranial aneurysms.Materials and methods268 patients with 286 saccular unruptured wide-necked intracranial aneurysms were treated at our institution with stent- or balloon-assisted coiling and retrospectively reviewed. Statistical analysis was performed to assess significant differences between the two groups.ResultsThe rate of complete occlusion at the end of the procedure was higher with stent-assisted coiling than with balloon-assisted coiling (86.8% vs 78%) and the same results were also observed after 6 months (92.1% vs 77.6%; p=0.05). About 50% of major recurrences occurred in large to giant aneurysms (p<0.001). The overall complication rate was similar in the stent-assisted and balloon-assisted groups (10.3% vs 9.3%). Independently of the technique, a higher complication rate was observed with bifurcational aneurysms, particularly in the middle cerebral artery (p=0.016).ConclusionsStent-assisted coiling achieved better results in terms of complete occlusion and stability than balloon-assisted coiling with a lower rate of recurrence without being associated with a higher risk of intraprocedural complications. Bifurcational and large to giant aneurysms were associated with higher complication rates and higher recurrence rates, respectively, and still represent a challenge for both techniques.

Primary Epileptogenic Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1161-1165 ◽  
Author(s):  
Daniel Hänggi ◽  
Peter A. Winkler ◽  
Hans-Jakob Steiger
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Parahippocampal Gyrus ◽  
Anterior Communicating Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Cerebral Artery Aneurysm

Abstract BACKGROUND Seizures as the unique initial manifestation of unruptured intracranial aneurysms have rarely been documented and not systematically described until now. OBJECTIVE The purpose of this large retrospective analysis was to focus on the incidence of primary epileptogenic aneurysms and the influence of treatment on epilepsy. METHODS Within a 16-year period, 347 unruptured aneurysms were surgically treated at centers in Munich (1992–2002) and Düsseldorf (2003–2008), Germany. Of this patient population, 9 patients presented exclusively with epileptic seizures or epileptic equivalents. In 3 of them, a high-lying internal carotid artery aneurysm was diagnosed that was buried in the parahippocampal gyrus. In 4 patients, a middle cerebral artery aneurysm also created contact with the mediotemporal lobe adjacent to the parahippocampal gyrus. An anterior communicating artery aneurysm and a pericallosal artery aneurysm were diagnosed in 2 additional patients. Two patients with a middle cerebral artery aneurysm were initially incompletely occluded with Guglielmi detachable coils and continued to have epilepsy after the intervention. In all but 1 patient, the aneurysms were clipped and completely removed. RESULTS In all 8 patients operated on, there was no sign of hemorrhage intraoperatively but cortical gliosis was seen around the dome of the aneurysm. In all cases, the aneurysm and the surrounding gliosis, if existent, were surgically removed. Freedom from seizures without medication resulted for all patients after microsurgery. DISCUSSION Seizures as a presenting symptom of unruptured intracranial aneurysms are rare. There seems to be a preponderance of aneurysms anatomically related to the temporomedial region. Elimination of the aneurysm and perifocal gliosis provides the possibility of a cure for the epilepsy.

scholarly journals Computational Fluid Dynamics in Unruptured Intracranial Aneurysms

2018 ◽  
Vol 32 (2) ◽  
pp. 332-339 ◽  
Author(s):  
Maruf Matmusaev ◽  
Yasuhiro Yamada ◽  
Tsukasa Kawase ◽  
Riki Tanaka ◽  
Miyatani Kyosuke ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Intracranial Aneurysms ◽  
Thin Wall ◽  
Rupture Risk ◽  
Ct Angiogram ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture

Abstract Introduction and Objective: Intracranial aneurysm, also known as brain aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery causes a localized dilation or ballooning of the blood vessel. There is no objective way, device or tools, of predicting rupture of aneurysm so far. Computational fluid dynamics (CFDs) was proposed as a tool to identify the rupture risk. Purpose of study: To reveal the correlation of CFD findings with intraoperative microscopic findings and prove the relevance of CFDin the prediction of rupture risk and in the management of unruptured intracranial aneurysms. Subjects and Methods: A prospective cohort study was conducted inNeurosurgery department of Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japanduring a 3‑month period in 2018,from January to March, Ten patientswere diagnosed unruptured intracranial aneurysms (UIA). In diagnosis computed tomography (CT) angiogram, CFD and digital subtraction angiogram were included. Intraoperatively microscopic examination of the aneurysm wall was carried out and images recorded. The correlation between microscopic dome morphology and CFD information was performed. Results: Nine cases were found intraoperatively to have a higher risk of rupture based on the thinning of the wall. One cases had an atherosclerotic wall. All cases had low wall shear stress (WSS). In 90 % of cases Low WSS was able to predict the potency rupture risk in the near future. Conclusions: This study of CFD and its correlation with intraoperativefindings of the aneurysm suggested that low WSS of the aneurysm wall is associated with thin wall aneurysm and hence increased risk of aneurysm rupture. Thus CFD can be used to predict the risk of rupture of unruptured aneurysm and for planning of its treatment.

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