Impact of the global outflow angle on recanalization after endovascular treatment of middle cerebral artery bifurcation aneurysms

Torre, Yannick de La; Velasco, Stéphane; Tasu, J.P.; Wanpouille, Cassandre; Chan, Paul S.; Velasco, Raphaël; Sztark, Guillaume; Ingrand, Pierre; Boucebci, S.

doi:10.1136/neurintsurg-2018-013803

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…Similar observations regarding the effect of parent artery lumen are also made by Usmani et al 53 using 3D contour plots of six different time instants. In their paper De La Torre et al 54 reported the outflow angle as one of the risk factors for recananlization in cerebral aneurysms. We find it re-affirming that presented tools in this work are also able to capture the effect of change in outflow angle, due to different downstream vasculature in both geometries, on foam based treatment, see Table 2.…”

Section: Discussionmentioning

confidence: 99%

Assessment and visualization of hemodynamic loading in aneurysm sac and neck: Effect of foam insertion

Pandey

Paul

Das

et al. 2021

Proc Inst Mech Eng H

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Shape memory polymer (SMP) foam is often proposed as the future alternative of coils in aneurysm treatment devices. Present work numerically investigates the unsteady, three-dimensional simulation of blood flow in a cerebral aneurysm filled with SMP foam. Simulations are conducted on patient-specific geometries with realistic blood velocity waveform imposed at the inlet while SMP foam is treated as a porous medium. The present study introduces a “loading risk map” that helps to visualize the hemodynamic effect of foam insertion on the aneurysm sac and neck. The loading risk maps suggest that while the SMP foam subdues the flow and wall shear pulsations in the aneurysm sac, the pressure distribution is minimally affected. The maps suggest that while the downstream lip is the most risk-prone site for both geometries, downstream vascular anatomy significantly influences foam efficiency in reducing pressure and wall shear stress loading.

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Section: Discussionmentioning

confidence: 99%

Assessment and visualization of hemodynamic loading in aneurysm sac and neck: Effect of foam insertion

Pandey

Paul

Das

et al. 2021

Proc Inst Mech Eng H

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“…The inflow angle (IA) was composed of the A2 segment and the axis of the aneurysm (Figure 1A), 22 and the GOA was composed of the A2 segment and the bilateral A3 segments (Figure 1B). 21 The A2 diameter (A2D) near the neck, and the A3 diameter (A3D) of the pericallosal artery and the callosomarginal artery, near the neck were calculated. The difference in diameter between the A2D and A3D (A2-3D), and the difference in diameter between the bilateral A3Ds (A3-3D) were also calculated.…”

Section: Methodsmentioning

confidence: 99%

“…20 Global outflow angle (GOA) was reported as a predictor of re-treatment in coil embolization for unruptured middle cerebral artery bifurcation aneurysms. 21 In the present study, we investigated the treatment outcomes and predictors of silent ischemic events in coil embolization for unruptured DACA aneurysms, focusing on morphological characteristics, especially the angle between the aneurysms and the surrounding blood vessels, and their association with silent ischemic events.…”

Section: Introductionmentioning

confidence: 99%

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Global outflow angle influences silent ischemic events in coil embolization for unruptured distal anterior cerebral artery aneurysms

et al. 2022

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Background Distal anterior cerebral artery (DACA) aneurysms are rare, and endovascular treatment of these aneurysms is challenging. Thromboembolic events, including silent ischemic events, are one of the most important complications of coil embolization for cerebral aneurysms. The treatment outcomes and predictors of silent ischemic events in coil embolization for unruptured DACA aneurysms were investigated, focusing on the morphological characteristics of aneurysms, especially the inflow angle (IA) and global outflow angle (GOA). Methods A total of 12 patients with 12 unruptured DACA aneurysms, treated with coil embolization at our institute, were retrospectively investigated. Predictors for silent ischemic events were evaluated by comparing diffusion-weighted imaging (DWI)-positive and DWI-negative patients. Results Silent ischemic events detected on DWI were observed in eight aneurysms (66.7%). Comparison of the morphological characteristics of aneurysms between the two groups showed a significantly smaller GOA in the DWI-positive group than in the DWI-negative group (172.6 ± 17.7° vs. 216.8 ± 16.8°, P < 0.01). A multivariate analysis showed that GOA <195° was a significant predictor of silent ischemic events ( P = 0.04; odds ratio: 23.62; 95% confidence interval: 1.11–490.39). Conclusion A small GOA was a significant predictor of silent ischemic events after coil embolization for unruptured DACA aneurysms. While some patients can be treated safely with minimally invasive coil embolization, it is necessary to consider surgical clipping in patients at high risk of thromboembolic events with coil embolization.

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“…Além dos locais clássicos identificados anteriormente, outras características dos aneurismas de ACM podem ser avaliadas para prever a formação dessas lesões e os resultados após o TE ou cirúrgico. Entre eles, podemos citar o lado, tamanho, multilobulação, relação domo/colo, relação colo/vaso principal, relação tamanho do aneurisma/ diâmetro do vaso principal, incorporação por ramos lenticuloestriados ou ramos distais da ACM e angulação da bifurcação principal(17,20,(44)(45)(46)(47)(48)(49).Como discutido anteriormente no tópico "hemorragia subaracnóidea", o aumento dos ângulos de bifurcação pode produzir alterações com aumento do estresse hemodinâmico além da tensão protetora das bandas de fibras de colágeno densamente compactadas, consequentemente, causando um remodelamento destrutivo na parede dos vasos e ocasionando a formação de aneurismas. Foi observado também que o ângulo de bifurcação apresenta uma relação inversa com o diâmetro do segmento M1.…”

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Análise do desfecho clínico e taxas de oclusão das diferentes técnicas endovasculares no tratamento de aneurismas da artéria cerebral média

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por disponibilizar sua estrutura e possibilitar a realização desse trabalho e minha formação acadêmica.Ao meu orientador, Professor Doutor Daniel Giansante Abud, grande mentor e motivador. É um dos grandes protagonistas no desenvolvimento da terapia endovascular no mundo, beneficiando milhares de pacientes e permitindo, de modo singular, a propagação do conhecimento e treinamento por novas gerações de intervencionistas. Expresso de modo singelo minha admiração por esse médico, com uma capacidade intelectual diferenciada e um poder visionário extraordinário, pelas quais tive grande inspiração e dotei de habilidades únicas para por em prática na minha vida profissional e pessoal.Aos meus colegas de profissão e tutores, Dr Luís Henrique, Felipe Trevilato, Thiago Abud, Marco Túlio Rezende e Alexandre Ulhôa pela contribuição logística e por terem participado ativamente no tratamento dos pacientes incluídos nesse estudo.Ao meu amigo e colega de residência, Dr Salomão Choudrai que, junto comigo, dedicou parte da sua vida ao trabalho e aprendizado dessa especialidade, apoiando-me e compartilhando experiências que somam até hoje no meu crescimento pessoal e profissional.Aos meus amigos e colegas de trabalho, Dr Alfredo Weltson, Lucas Bonadio e José Zeraick Neto, pelo ensinamento diário, convivência e contribuição no desenvolvimento e aperfeiçoamento da minha técnica.

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Impact of the global outflow angle on recanalization after endovascular treatment of middle cerebral artery bifurcation aneurysms

Abstract: This study emphasizes that a new parameter, the global outflow angle, can be predictive of recanalization for MCA bifurcation aneurysms treated by EVT.

Cited by 9 publications

References 24 publications

Assessment and visualization of hemodynamic loading in aneurysm sac and neck: Effect of foam insertion

Assessment and visualization of hemodynamic loading in aneurysm sac and neck: Effect of foam insertion

Global outflow angle influences silent ischemic events in coil embolization for unruptured distal anterior cerebral artery aneurysms

Análise do desfecho clínico e taxas de oclusão das diferentes técnicas endovasculares no tratamento de aneurismas da artéria cerebral média

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