RT Journal Article
SR Electronic
T1 Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1140
OP 1147
DO 10.1136/neurintsurg-2015-012050
VO 8
IS 11
A1 Jian Liu
A1 Linkai Jing
A1 Chao Wang
A1 Nikhil Paliwal
A1 Shengzhang Wang
A1 Ying Zhang
A1 Jianping Xiang
A1 Adnan H Siddiqui
A1 Hui Meng
A1 Xinjian Yang
YR 2016
UL http://jnis.bmj.com/content/8/11/1140.abstract
AB 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.