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Original research
Determination of a shear rate threshold for thrombus formation in intracranial aneurysms
  1. Daniel Ribeiro de Sousa1,2,
  2. Carolina Vallecilla3,
  3. Kamil Chodzynski1,
  4. Ricardo Corredor Jerez3,
  5. Orestis Malaspinas4,
  6. Omer Faruk Eker5,
  7. Rafik Ouared4,
  8. Luc Vanhamme6,
  9. Alexandre Legrand2,
  10. Bastien Chopard4,
  11. Guy Courbebaisse3,
  12. Karim Zouaoui Boudjeltia1
  1. 1Laboratory of Experimental Medicine (ULB 222 Unit), CHU de Charleroi—A Vesale Hospital, Université Libre de Bruxelles, Montigny-le-Tilleul, Belgium
  2. 2Department of Pharmacy and Physiology, University of Mons, Mons, Belgium
  3. 3CREATIS, CNRS UMR 5220, INSERM U1044, UCB Lyon1, INSA Lyon, University of Lyon, Lyon, France
  4. 4Department of Computer Sciences, University of Geneva, Geneva, Switzerland
  5. 5Department of Neuroradiology, University Hospital Center of Montpellier, Montpellier, France
  6. 6Institute of Molecular Biology and Medicine, Université Libre de Bruxelles, Gosselies, Belgium
  1. Correspondence to D Ribeiro de Sousa, Laboratory of Experimental Medicine, CHU Charleroi, Route de Gozée 706, Montigny-le-Tilleul 6110, Belgium; dribeiro{at}ulb.ac.be

Abstract

Background Particular intra-aneurysmal blood flow conditions, created naturally by the growth of an aneurysm or induced artificially by implantation of a flow diverter stent (FDS), can potentiate intra-aneurysmal thrombosis. The aim of this study was to identify hemodynamic indicators, relevant to this process, which could be used as a prediction of the success of a preventive endovascular treatment.

Method A cross sectional study on 21 patients was carried out to investigate the possible association between intra-aneurysmal spontaneous thrombus volume and the dome to neck aspect ratio (AR) of the aneurysm. The mechanistic link between these two parameters was further investigated through a Fourier analysis of the intra-aneurysmal shear rate (SR) obtained by computational fluid dynamics (CFD). This analysis was first applied to 10 additional patients (4 with and 6 without spontaneous thrombosis) and later to 3 patients whose intracranial aneurysms only thrombosed after FDS implantation.

Results The cross sectional study revealed an association between intra-aneurysmal spontaneous thrombus volume and the AR of the aneurysm (R2=0.67, p<0.001). Fourier analysis revealed that in cases where thrombosis occurred, the SR harmonics 0, 1, and 2 were always less than 25/s, 10/s, and 5/s, respectively, and always greater than these values where spontaneous thrombosis was not observed.

Conclusions Our study suggests the existence of an SR threshold below which thrombosis will occur. Therefore, by analyzing the SR on patient specific data with CFD techniques, it may be potentially possible to predict whether or the intra-aneurysmal flow conditions, after FDS implantation, will become prothrombotic.

  • Aneurysm
  • Blood Flow
  • Flow Diverter
  • Inflammatory Response
  • Vessel Wall

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