High Pressure in Virtual Postcoiling Model is a Predictor of Internal Carotid Artery Aneurysm Recurrence After Coiling

Abstract BACKGROUND Hemodynamic factors play a crucial role in the recurrence of intracranial aneurysms after coiling. However, the strongest factor for predicting recurrence remains unclear because each risk factor has been investigated and reported separately. OBJECTIVE To clarify the strongest pr...

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Bibliographic Details
Published in:	Neurosurgery 2019-03, Vol.84 (3), p.607-615
Main Authors:	Nambu, Iku, Misaki, Kouichi, Uchiyama, Naoyuki, Mohri, Masanao, Suzuki, Takashi, Takao, Hiroyuki, Murayama, Yuichi, Futami, Kazuya, Kawamura, Tomoki, Inoguchi, Yasushi, Matsuzawa, Teruo, Nakada, Mitsutoshi
Format:	Article
Language:	eng
Subjects:	Aged Aneurysm Aneurysms Angiography Carotid arteries Carotid Artery Diseases - diagnostic imaging Carotid Artery Diseases - surgery Carotid Artery, Internal - diagnostic imaging Carotid Artery, Internal - surgery Cerebral aneurysm Diagnostic imaging Embolization, Therapeutic - methods Female Fluid dynamics Forecasting Hemodynamics - physiology Humans Hydrodynamics International economic relations Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Male Medical research Middle Aged Models, Cardiovascular Prognosis Recurrence Retrospective Studies Risk factors Software industry Stents Stress, Mechanical
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Summary:	Abstract BACKGROUND Hemodynamic factors play a crucial role in the recurrence of intracranial aneurysms after coiling. However, the strongest factor for predicting recurrence remains unclear because each risk factor has been investigated and reported separately. OBJECTIVE To clarify the strongest predictor of recurrence with computational fluid dynamics (CFD). METHODS Using pretreatment patient-specific 3-dimensional rotational angiography data of 50 internal carotid artery (ICA) aneurysms (7 recanalized, 43 stable) treated with endovascular coiling, we created a precoiling model and a virtual postcoiling model produced by manually cutting the aneurysm by the flat plane corresponding to the virtual coil surface. We conducted CFD analysis to investigate inflow dynamics in the precoiling model and pressure difference and wall shear stress on the virtual coil surface. The pressure difference was calculated by subtracting average pressure at the proximal ICA from the maximum pressure at the coil surface and dividing by dynamic pressure at the proximal ICA for normalization. We compared hemodynamic parameters in both models between recanalized and stable aneurysms. RESULTS Compared with stable aneurysms, recanalized aneurysms showed a significantly larger inflow area and higher inflow rate in the precoiling model (P = .016, .028), and higher pressure difference at the coil surface in the postcoiling model (P
ISSN:	0148-396X 1524-4040