Independent predictors and risk score for intraprocedural rupture during endovascular treatment of small ruptured intracranial aneurysms (&lt;5 mm)

Peng, Fei; Feng, Xin; He, Xian; Niu, Hao; Zhang, Hong; Tong, Xin; Zhang, Baorui; Xia, Jiaxiang; Chen, Xuge; Xu, Boya; Qi, Peng; Wang, Daming; Liu, Aihua

doi:10.3389/fneur.2022.923645

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Two cases of IPR (A1 and M2) were managed using a straightforward technique with relatively small dome sizes and axial misalignment from the bifurcation, which possibly resulted in microcatheter fixation. Morphologically, small aneurysms have been identified as a risk factor for IPR [ 31 ]. Adjunctive techniques such as balloon- and stent-assisted procedures have the potential to induce IPR due to microcatheter fixation during coil insertion [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Suzuki,

Hasegawa,

Shibuya

et al. 2024

Diagnostics

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Intraprocedural rupture (IPR) during coil embolization (CE) of an intracranial aneurysm is a significant clinical concern that necessitates a comprehensive understanding of its clinical and hemodynamic predictors. Between January 2012 and December 2023, 435 saccular cerebral aneurysms were treated with CE at our institution. The inclusion criterion was extravasation or coil protrusion during CE. Postoperative data were used to confirm rupture points, and computational fluid dynamics (CFD) analysis was performed to assess hemodynamic characteristics, focusing on maximum pressure (Pmax) and wall shear stress (WSS). IPR occurred in six aneurysms (1.3%; three ruptured and three unruptured), with a dome size of 4.7 ± 1.8 mm and a D/N ratio of 1.5 ± 0.5. There were four aneurysms in the internal carotid artery (ICA), one in the anterior cerebral artery, and one in the middle cerebral artery. ICA aneurysms were treated using adjunctive techniques (three balloon-assisted, one stent-assisted). Two aneurysms (M1M2 and A1) were treated simply, yet had relatively small and misaligned domes. CFD analysis identified the rupture point as a flow impingement zone with Pmax in five aneurysms (83.3%). Time-averaged WSS was locally reduced around this area (1.3 ± 0.7 [Pa]), significantly lower than the aneurysmal dome (p < 0.01). Hemodynamically unstable areas have fragile, thin walls with rupture risk. A microcatheter was inserted along the inflow zone, directed towards the caution area. These findings underscore the importance of identifying hemodynamically unstable areas during CE. Adjunctive techniques should be applied with caution, especially in small aneurysms with axial misalignment, to minimize the rupture risk.

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Section: Discussionmentioning

confidence: 99%

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Suzuki,

Hasegawa,

Shibuya

et al. 2024

Diagnostics

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“…Two IPR cases (A1 and M2) were managed using a straightforward technique, with relatively small dome sizes and axial misalignment from the bifurcation, possibly resulting in microcatheter fixation. Morphologically, small aneurysms have been identified as a risk factor for IPR [31]. Adjunctive techniques such as balloon-and stent-assisted procedures hold the potential to induce IPR due to microcatheter fixation during coil insertion [32].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Suzuki,

Hasegawa,

Shibuya

et al. 2024

Preprint

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Intraprocedural rupture (IPR) is a severe complication of coil embolization (CE) for intracranial aneurysms, yet the clinical and hemodynamic features of rupture risk areas remain unclear. From January 2013 to December 2023, 435 saccular cerebral aneurysms (316 unruptured, 119 ruptured) underwent CE at our institution. Included were cases where extravasation or coil protrusion occurred during CE. The rupture point was determined from postoperative data, and computational fluid dynamics (CFD) analysis was conducted to assess hemodynamic features. IPR occurred in six aneurysms (1.3%; three ruptured, three unruptured; dome size: 4.7±1.8 mm, D/N: 1.5±0.5, locations: four internal carotid artery [ICA], one anterior cerebral artery, one middle cerebral artery). ICA aneurysms were treated using adjunctive techniques (three balloon-assisted, one stent-assisted). Two aneurysms (M1M2 and A1) were treated simply, yet had relatively small and misaligned domes. CFD analysis identified the rupture point as a flow impingement zone with maximum pressure (Pmax) in five aneurysms (83.3%). Time-averaged wall shear stress (WSS) was locally reduced around this area (1.3±0.7 [Pa]). Hemodynamically unstable areas indicated fragile, thin walls with rupture risk. Microcatheter insertion along the inflow zone, directed towards the caution area, was practiced. The presence of a flow impingement zone with Pmax and low WSS suggests potential aneurysm rupture in CE, particularly with adjunctive techniques. Small aneurysms, especially those with axial misalignment, warrant careful consideration due to the risk of excessive flow impact stress on the aneurysm wall.

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Independent predictors and risk score for intraprocedural rupture during endovascular treatment of small ruptured intracranial aneurysms (<5 mm)

Cited by 2 publications

References 23 publications

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

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