Neurointervention.  2016 Mar;11(1):30-36. 10.5469/neuroint.2016.11.1.30.

Hemodynamic Characteristics Regarding Recanalization of Completely Coiled Aneurysms: Computational Fluid Dynamic Analysis Using Virtual Models Comparison

• Park W
• Song Y
• Park KJ
• Koo HW
• Yang K
• Suh DC

• KMID: 2155716
• DOI: http://doi.org/10.5469/neuroint.2016.11.1.30

Abstract

PURPOSE
Hemodynamic factors are considered to play an important role in initiation and progression of the recurrence after endosaccular coiling of the intracranial aneurysms. We made paired virtual models of completely coiled aneurysms which were subsequently recanalized and compared to identify hemodynamic characteristics related to the recurred aneurysmal sac.
MATERIALS AND METHODS
We created paired virtual models of computational fluid dynamics (CFD) in five aneurysms which were initially regarded as having achieved complete occlusion and then recurred during follow-up. Paired virtual models consisted of the CFD model of 3D rotational angiography obtained in the recurred aneurysm and the control model of the initial, parent artery after artificial removal of the coiled and recanalized aneurysm. Using the CFD analysis of the virtual model, we analyzed the hemodynamic characteristics on the neck of each aneurysm before and after its recurrence.
RESULTS
High wall shear stress (WSS) was identified at the cross-sectionally identified aneurysm neck at which recurrence developed in all cases. A small vortex formation with relatively low velocity in front of the neck was also identified in four cases. The aneurysm recurrence locations corresponded to the location of high WSS and/or small vortex formation.
CONCLUSION
Recanalized aneurysms revealed increased WSS and small vortex formation at the cross-sectional neck of the aneurysm. This observation may partially explain the hemodynamic causes of future recanalization after coil embolization.

Keyword

Embolization; Hemodynamics; Intracranial aneurysm; Recurrence; Wall shear stress

MeSH Terms

Aneurysm*
Angiography
Arteries
Embolization, Therapeutic
Follow-Up Studies
Hemodynamics*
Humans
Hydrodynamics*
Intracranial Aneurysm
Neck
Parents
Recurrence

Figure

• 

  Fig. 1 Flow sheet of the computational fluid dynamics analysis using new virtual models of completely occluded aneurysms based on patient specific imaging data.

• 

  Fig. 2 Wall shear stress (WSS) of paired CFD virtual models before (left) and after recurrence (right). The round circle indicates the cross-sectional area of the aneurysm neck at the time of the coil embolization. Note the red color of the high WSS in the round circle of the neck. Recanalization developed at the site which corresponds to the high wall shear stress. (A) Case 1. A 48-year-old man with an aneurysm at basilar tip. (B) Case 2. A 64-year-old woman with an aneurysm at anterior communicating artery. (C) Case 3. A 44-year-old woman with an aneurysm at the origin of posterior communicating artery (D) Case 4. A 57-year-old woman with an aneurysm at the origin of posterior communicating artery (E) Case 5. A 37-year-old woman with an aneurysm at the paraclinoid internal carotid artery.

• 

  Fig. 3 Blood flow of paired CFD virtual models before and after recurrence in case 3. (A) White arrow indicates a small vortex formation near the neck of completely occluded aneurysm at the origin of posterior communicating artery. (B) The blood flow entered the sac of recanalized aneurysms through the impingement region and it formed a large and complex vortex in the recanalized aneurysmal sac.

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