High Pressure in Virtual Postcoiling Model is a Predictor of Internal Carotid Artery Aneurysm Recurrence After Coiling
High Pressure in Virtual Postcoiling Model is a Predictor of Internal Carotid Artery Aneurysm Recurrence After Coiling
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DOI：
10.1093/neuros/nyy073
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发表时间：
2019-03-01
期刊：
影响因子：
4.8
通讯作者：
Nakada, Mitsutoshi
中科院分区：
文献类型：
--
作者：
Nambu, Iku;Misaki, Kouichi;Nakada, Mitsutoshi
研究背景血流动力学因素在颅内动脉瘤介入治疗后复发中起重要作用。然而，预测复发的最强因素仍不清楚，因为每个危险因素都已被单独研究和报道。目的用计算流体力学(CFD)来阐明预测复发的最强预测因素。方法利用50个颈内动脉(ICA)动脉瘤(7个再通，43个稳定)血管内弹簧圈治疗前患者特定的三维旋转血管造影数据，我们创建了弹簧圈前模型和虚拟弹簧圈后模型，通过与虚拟弹簧圈表面对应的平面手动切割动脉瘤产生虚拟弹簧圈模型。通过CFD分析，研究了预卷绕模型中的流入动态以及虚拟盘管表面的压差和壁面剪应力。压力差的计算方法是从线圈表面的最大压力减去颈内动脉近端的平均压力，再除以颈内动脉近端的动态压力以进行归一化。结果与稳定型动脉瘤相比，前弹簧圈模型中再通动脉瘤的流入面积和流入速度明显增大(P=0.016，0.028)，弹簧圈后模型中弹簧圈表面压差明显增大(P<0.05)。
BACKGROUND Hemodynamic factors play a crucial role in the recurrence of intracranial aneurysms after coiling. However, the strongest factor for predicting recurrence remains unclear because each risk factor has been investigated and reported separately.OBJECTIVE To clarify the strongest predictor of recurrence with computational fluid dynamics (CFD).METHODS Using pretreatment patient-specific 3-dimensional rotational angiography data of 50 internal carotid artery (ICA) aneurysms (7 recanalized, 43 stable) treated with endovascular coiling, we created a precoiling model and a virtual postcoiling model produced by manually cutting the aneurysm by the flat plane corresponding to the virtual coil surface. We conducted CFD analysis to investigate inflow dynamics in the precoiling model and pressure difference and wall shear stress on the virtual coil surface. The pressure difference was calculated by subtracting average pressure at the proximal ICA from the maximum pressure at the coil surface and dividing by dynamic pressure at the proximal ICA for normalization. We compared hemodynamic parameters in both models between recanalized and stable aneurysms.RESULTS Compared with stable aneurysms, recanalized aneurysms showed a significantly larger inflow area and higher inflow rate in the precoiling model (P = .016, .028), and higher pressure difference at the coil surface in the postcoiling model (P