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Hemorrhagic stroke
Original research
Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization
  1. Jian Liu1,
  2. Linkai Jing1,
  3. Chao Wang1,
  4. Nikhil Paliwal2,3,
  5. Shengzhang Wang4,
  6. Ying Zhang1,
  7. Jianping Xiang2,3,5,
  8. Adnan H Siddiqui2,5,6,
  9. Hui Meng2,3,5,
  10. Xinjian Yang1
  1. 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA
  3. 3Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
  4. 4Department of Mechanics and Engineering Science, Fudan University, Shanghai, China
  5. 5Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
  6. 6Department of Radiology, University at Buffalo, The State University of New York, Buffalo, New York, USA
  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; yang-xj{at}163.net

Abstract

Background Endovascular treatment of paraclinoid aneurysms is preferred in clinical practice. Flow alterations caused by stents and coils may affect treatment outcome.

Objective To assess hemodynamic changes following stent-assisted coil embolization (SACE) in subtotally embolized paraclinoid aneurysms with residual necks that were predisposed to recanalization.

Methods We studied 27 paraclinoid aneurysms (seven recanalized and 20 stable) treated with coils and Enterprise stents. Computational fluid dynamic simulations were performed on patient-specific aneurysm geometries using virtual stenting and porous media technology.

Results After stent placement in 27 cases, aneurysm flow velocity decreased significantly, the reduction gradually increasing from the neck plane (11.9%), to the residual neck (12.3%), to the aneurysm dome (16.3%). Subsequent coil embolization was performed after stent placement and the hemodynamic factors decreased further and significantly at all aneurysm regions except the neck plane. In a comparison of recanalized and stable cases, univariate analysis showed no significant differences in any parameter before treatment. After stent-assisted coiling, only the reduction in area-averaged velocity at the neck plane differed significantly between recanalized (8.1%) and stable cases (20.5%) (p=0.016).

Conclusions Aneurysm flow velocity can be significantly decreased by stent placement and coil embolization. However, hemodynamics at the aneurysm neck plane is less sensitive to coils. Significant reduction in flow velocity at the neck plane may be an important factor in preventing recanalization of paraclinoid aneurysms after subtotal SACE.

  • Aneurysm
  • Blood Flow
  • Stent

https://doi.org/10.1136/neurintsurg-2015-012050

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    Footnotes

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

    • Funding This work was supported by National Natural Science Foundation of China (grant Nos 81301003, 81171079, 81371315, 81471167, and 81220108007), Special Research Project for Capital Health Development (grant No. 2014-1-1071) and National Institutes of Health (R01 NS091075).

    • Competing interests None declared.

    • 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.