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Hemorrhagic stroke
Original research
Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study
  1. Qianqian Zhang1,
  2. Linkai Jing2,
  3. Jian Liu1,
  4. Kun Wang1,
  5. Ying Zhang1,
  6. Nikhil Paliwal3,4,
  7. Hui Meng3,4,5,
  8. Yang Wang6,
  9. Shengzhang Wang7,
  10. Xinjian Yang1
  1. 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
  3. 3Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA
  4. 4Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
  5. 5Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
  6. 6Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
  7. 7Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
  1. Correspondence to Dr Xinjian Yang, Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing 100050, China; yangxinjian{at}bjttyy.org

Abstract

Background The recanalization of cerebral aneurysms after endovascular embolization (coiling or stent-assisted coiling) has been a matter of concern.

Objective To systematically evaluate the predisposing factors for cerebral aneurysm recanalization using multidimensional analysis in a large patient cohort.

Methods In 238 patients with 283 aneurysms, patient baseline characteristics, aneurysm morphological characteristics, treatment-related factors, and changes in flow hemodynamics after endovascular treatment (coiling or stent-assisted coiling) were compared between the recanalization and non-recanalization groups. Multivariate logistic regression analysis was performed to determine independent risk factors correlated with recanalization.

Results 16 aneurysms treated by coiling recanalized, with a recurrence rate of 18.6%, and 24 recanalized in the lesions treated by stent-assisted coiling, with a recanalization rate of 12.2%. Large aneurysms (>10 mm, p=0.002) and a follow-up interval >1 year (p=0.027) were shown to be statistically significant between the recanalization and non-recanalization groups. For flow hemodynamic changes, three parameters (velocity on the neck plane, wall shear stress on the neck wall, and wall shear stress on the whole aneurysm) showed a relatively lower amplitude of decrease after endovascular treatment in the recanalization group. Interestingly, the velocity on the neck plane and wall shear stress on the neck wall may be elevated after treatment. Specifically, the reduction ratio (RR) of velocity on the neck plane showed significant difference between the groups in the multivariate analysis (p=0.013), and was considered an independent risk factor for recanalization.

Conclusions The aneurysm size, follow-up interval, and flow hemodynamic changes, especially the RR of velocity on the neck plane, have important roles in aneurysm recanalization.

  • Aneurysm
  • Blood Flow

https://doi.org/10.1136/neurintsurg-2017-013041

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    Footnotes

    • QZ and LJ contributed equally.

    • Contributors QZ and LJ contributed to the preparation of the manuscript and data collection. KW and JL contributed to revision of the the manuscript. YZ, NP, YW, and SW contributed to data analysis and interpretation. HM and XY contributed to the experimental design and manuscript revision.

    • Funding This work was supported by National Key Research and Development Plan of China (grant number: 2016YFC1300800), the National Natural Science Foundation of China (grant numbers: 81471167, 81671139, 81571128, and 81220108007), the Special Research Project for Capital Health Development (grant number: 2014-1-1071), and National Institutes of Health (R01 NS091075).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the ethics committee of Beijing Tiantan Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors agree to share any data on request. Any data from this study are available by contacting the corresponding author.