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  • A new combined parameter predicts re-treatment for coil-embolized aneurysms: a computational fluid dynamics multivariable analysis study

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Basic Science
Original research
A new combined parameter predicts re-treatment for coil-embolized aneurysms: a computational fluid dynamics multivariable analysis study
  1. Soichiro Fujimura1,2,
  2. Hiroyuki Takao2,3,
  3. Takashi Suzuki2,4,
  4. Chihebeddine Dahmani3,5,
  5. Toshihiro Ishibashi3,
  6. Hiroya Mamori4,
  7. Makoto Yamamoto4,
  8. Yuichi Murayama3
  1. 1 Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
  2. 2 Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
  3. 3 Department of Neurosurgery, Division of Endovascular Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
  4. 4 Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
  5. 5 Sliemens Health K.K, Tokyo, Japan
  1. Correspondence to Dr Hiroyuki Takao, Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; takao{at}jikei.ac.jp

Abstract

Purpose Coil embolization is a minimally invasive method used to treat cerebral aneurysms. Although this endovascular treatment has a high success rate, aneurysmal re-treatment due to recanalization remains a major problem of this method. The purpose of this study was to determine a combined parameter that can be useful for predicting aneurysmal re-treatment due to recanalization.

Methods Patient-specific geometries were used to retrospectively analyze the blood flow for 26 re-treated and 74 non-retreated aneurysms. Post-operatively aneurysms were evaluated at 12-month follow-up. The hemodynamic differences between the re-treatment and non-retreatment aneurysms were analyzed before and after coil embolization using computation fluid dynamics. Basic fluid characteristics, rates of change, morphological factors of aneurysms and patient-specific clinical information were examined. Multivariable analysis and logistic regression analysis were performed to determine a combined parameter—re-treatment predictor (RP).

Results Among examined hemodynamic, morphological, and clinical parameters, slight reduction of blood flow velocity rate in the aneurysm, slight increase of pressure rate at the aneurysmal neck and neck area, and hypertension were the main factors contributing to re-treatment. Notably, hemodynamic parameters between re-treatment and non-retreatment groups before embolization were similar: however, we observed significant differences between the groups in the post-embolization average velocity and the rate of reduction in this velocity in the aneurysmal dome.

Conclusions The combined parameter, RP, which takes into consideration hemodynamic, morphological, and clinical parameters, accurately predicts aneurysm re-treatment. Calculation of RP before embolization may be able to predict the aneurysms that will require re-treatment.

  • aneurysm
  • blood flow
  • coil

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/neurintsurg-2017-013433

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    Footnotes

    • Contributors All authors gave final approval of the published version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SF, HT and TS performed the simulations and collected and analyzed the data. CD, TI, HM, MY and YM helped to evaluate the data. SF and HT wrote the manuscript.

    • Funding This work was supported by Siemens Healthcare K.K. grant number 35993-00211563. JSPS KAKENHI Grant Number JP17J07496.

    • Competing interests None declared.

    • Ethics approval This study was approved by the ethics committee of Jikei University School of Medicine.

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

    • Data sharing statement The authors are ready to share spreadsheets from their data acquisition and experimental set-up details on request.