Introduction
: Volume embolization ratio (VER) has been reported to be involved in postoperative recanalization of coil embolization. However, despite comparable VER, some cases remained stable, and the others showed recanalization. Hemodynamic and morphological factors, as described in previous studies, may also influence recanalization in addition to VER. In this study, we focused on cerebral aneurysms treated by coil embolization with comparable VER. Blood flow analysis using computational fluid dynamics (CFD) and geometrical measurements were performed to investigate the recanalization factors.
Methods
: We focused on the aneurysms that underwent coil embolization with 15–20% VER. The criteria for the case selection were that the size of the aneurysms was 5–10 mm and that the aneurysm was treated by only coil (i.e., the stent‐assisted cases were excluded). Aneurysms that recanalized after coil embolization and underwent additional coil deployment were defined as “recanalized”, and aneurysms that remained stable after coil embolization without coil compaction were defined as “stable”. Finally, we selected 7 recanalized cases (ICA: 1, MCA: 3, ACA: 3) and 18 stable cases (ICA: 6, MCA: 3, ACA: 9). CFD analysis and morphometry were performed on the vessel geometry after coil embolization. The coil shape was modeled by the virtual coil technique. We calculated three morphological parameters and 34 hemodynamic parameters, then we compared them between the recanalized and stable cases using the Mann‐Whitney U test to identify recanalization factors. In addition, we reconstructed the coil shape from medical images and compared its structure and flow characters for stable and recanalized cases.
Results
: The average VER for the cases analyzed in this study were 16.7% for recanalized cases and 17.7% for stable cases. As hemodynamic parameters, the spatially averaged velocity normal to the neck plane into the cerebral aneurysm (
NV
neck
), and the ratio of the area where blood flows into the cerebral aneurysm after the coil embolization to the area of the neck surface (inflow area ratio: IAR) showed significant difference. Although the hemodynamic parameters were significantly different, morphological parameters did not show statistically significance. In the recanalized case,
NV
neck
tended to be higher (mean value, recanalized: 0.931, stable: 0.822, P < 0.05), and IAR tended to be lower (mean value, recanalized: 0.319, stable: 0.408, P < 0.01). The high
NV
neck
and low IAR indicate that the aneurysm had concentrated flow with a high velocity at the neck surface. There was the concentrated blood flow with the high velocity that collided with the modeled coil in a CFD result for the recanalized case. The area where the blood flow impinged on the modeled coil coincided with the compacted coil region reconstructed from medical images. Therefore, a large force on the coil indicated by these hemodynamic parameters may cause the postoperative recanalization.
Conclusions
: Even with the same level of VER, there was a possibility of recanalization in aneurysms with a high velocity and concentrated flow into the aneurysm. It is necessary to consider not only VER but also hemodynamic factors to investigate recanalization factors after the coil embolization.