A computational fluid dynamics (CFD) study of WEB-treated aneurysms: Can CFD predict WEB "compression" during follow-up?
A computational fluid dynamics (CFD) study of WEB-treated aneurysms: Can CFD predict WEB "compression" during follow-up?
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DOI：
10.1016/j.neurad.2017.03.005
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发表时间：
2017-07-01
影响因子：
3.5
通讯作者：
Spelle, Laurent
中科院分区：
文献类型：
--
作者：
Caroff, Jildaz;Mihalea, Cristian;Spelle, Laurent
背景- 最近的报告显示，由于“器械”的“压缩”，WEB治疗基线和血管造影随访之间的动脉瘤闭塞恶化。- 我们利用计算流体动力学（CFD），以确定这种恶化的潜在机制是否与流动有关。- 我们纳入了在我们机构接受WEB治疗的所有连续患者的数据，这些患者的未破裂动脉瘤位于大脑中动脉或基底动脉尖端。使用术前3D旋转血管造影进行CFD研究。根据数字减影随访血管造影，患者被分为两组：一组有WEB“压迫”，另一组没有。我们进行了统计分析，以确定WEB压缩和CFD流入比之间的潜在相关性。- 在2012年7月至2015年6月期间，在我科共使用WEB器械治疗了22例未破裂的大脑中动脉或基底动脉尖端动脉瘤。3例患者被排除在分析之外，平均随访期为17个月。11个WEB在随访期间出现“压迫”。有趣的是，器械“压缩”与CFD流入比具有统计学相关性（P=0.018），但与动脉瘤体积、纵横比或瘤颈尺寸无关。- 由于器械压缩，WEB治疗患者动脉瘤闭塞恶化的潜在机制很可能是复杂的，也是多因素的。然而，从我们的初步研究中可以明显看出，高动脉流入至少部分涉及。需要进一步的理论和动物研究来增加我们对这一现象的理解。(C)2017 Elsevier Masson SAS。All rights reserved.
Background. - Recent reports have revealed a worsening of aneurysm occlusion between WEB treatment baseline and angiographic follow-up due to "compression" of `the device.Objective. - We utilized computational fluid dynamics (CFD) in order to determine whether the underlying mechanism of this worsening is flow related.Methods. - We included data from all consecutive patients treated in our institution with a WEB for unruptured aneurysms located either at the middle cerebral artery or basilar tip. The CFD study was performed using pre-operative 3D rotational angiography. From digital subtraction follow-up angiographies patients were dichotomized into two groups: one with WEB "compression" and one without. We performed statistical analyses to determine a potential correlation between WEB compression and CFD inflow ratio.Results. - Between July 2012 and June 2015, a total of 22 unruptured middle cerebral artery or basilar tip aneurysms were treated with a WEB device in our department. Three patients were excluded from the analysis and the mean follow-up period was 17 months. Eleven WEBs presented "compression" during follow-up. Interestingly, device "compression" was statistically correlated to the CFD inflow ratio (P=0.018), although not to aneurysm volume, aspect ratio or neck size.Conclusion. - The mechanisms underlying the worsening of aneurysm occlusion in WEB-treated patients due to device compression are most likely complex as well as multifactorial. However, it is apparent from our pilot study that a high arterial inflow is, at least, partially involved. Further theoretical and animal research studies are needed to increase our understanding of this phenomenon. (C) 2017 Elsevier Masson SAS. All rights reserved.