From the Bioengineering Department (J.R.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
Department of Mathematical Sciences (B.J.C.), Montclair State University, Montclair, New Jersey.
AJNR Am J Neuroradiol. 2019 Sep;40(9):1511-1516. doi: 10.3174/ajnr.A6169. Epub 2019 Aug 8.
Intrasaccular flow diversion offers a promising treatment option for complex bifurcation aneurysms. The purpose of this study was to compare the flow conditions between successfully occluded and incompletely occluded aneurysms treated with intrasaccular devices.
The hemodynamics in 18 completely occluded aneurysms after treatment with intrasaccular devices was compared against 18 that were incompletely occluded at follow-up. Hemodynamic and geometric parameters were obtained from computational fluid dynamics models constructed from 3D angiographies. Models of the intrasaccular devices were created and interactively deployed within the vascular models using posttreatment angiography images for guidance. Hemodynamic and geometric variables were compared using the Mann-Whitney test and univariate logistic regression analysis.
Incomplete occlusion was associated with large posttreatment mean aneurysm inflows ( = .02) and small reductions in the mean inflow rate ( = .01) and inflow concentration index ( = .03). Incompletely occluded aneurysms were larger ( = .002) and had wider necks ( = .004) than completely occluded aneurysms and tended to have more complex flow patterns, though this trend was not significant after adjusting for multiple testing.
The outcome of cerebral aneurysm treatment with intrasaccular flow diverters is associated with flow conditions created immediately after device implantation. Flow conditions unfavorable for immediate and complete occlusion seem to be created by improper positioning or orientation of the device. Complete occlusion is more difficult to achieve in larger aneurysms, aneurysms with wider necks, and aneurysms with stronger and more complex flows.
腔内血流分流装置为复杂分叉部动脉瘤提供了一种很有前途的治疗选择。本研究旨在比较完全闭塞和不完全闭塞的颅内血流分流装置治疗后动脉瘤的血流条件。
对比 18 例完全闭塞和 18 例随访时不完全闭塞的颅内血流分流装置治疗后动脉瘤的血流动力学和几何参数。通过对三维血管造影构建的计算流体动力学模型获得了血流动力学和几何参数。使用治疗后血管造影图像为指导，创建并在血管模型中交互式部署了颅内血流分流装置模型。使用曼-惠特尼检验和单变量逻辑回归分析比较了血流动力学和几何变量。
不完全闭塞与较大的治疗后平均动脉瘤流入量（ =.02）和较小的平均流入率（ =.01）和流入浓度指数（ =.03）减少相关。不完全闭塞的动脉瘤比完全闭塞的动脉瘤更大（ =.002），颈部更宽（ =.004），并且倾向于具有更复杂的血流模式，但在进行多次检验调整后，这种趋势并不显著。
颅内血流分流装置治疗脑动脉瘤的结果与装置植入后立即产生的血流条件有关。不利于即刻完全闭塞的血流条件似乎是由装置的不当定位或定向造成的。完全闭塞在更大的动脉瘤、颈部更宽的动脉瘤和更强、更复杂的血流动脉瘤中更难实现。
