Infundibular widening of the posterior communicating artery progressing to true aneurysm

Patrick, D. W.; Appleby, Arnold P.

doi:10.1259/0007-1285-56-661-59

Cited by 34 publications

(9 citation statements)

References 6 publications

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“…This slightly higher pressure location coincides with the aforementioned low WSS spot and the rupture location of infundibulae in the previous case reports. 26,31,38,34 The directions of WSS vectors in this region are spatially changing across the pink line in Fig. 4(middle right).…”

Section: Patient A: Infundibulum At the Pcoa With A Far-upstream Aneumentioning

confidence: 90%

“…Moreover, there have been a number of case reports on the progression of funnel-shaped PCoA origin to aneurysm formation and subsequent rupture leading to subarachnoid hemorrhage (SAH). 31, 38 Jang et al 23 also reported a case of ruptured aneurysm harboring on the distal wall of infundibular PCoA and they also summarized 12 cases they found through literature review. More recently, Coupe et al compiled six case reports of SAH from infundibular rupture in patients aged between 40 and 57.…”

Section: Introductionmentioning

confidence: 99%

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Wall Shear Stress and Pressure Distribution on Aneurysms and Infundibulae in the Posterior Communicating Artery Bifurcation

2009

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A growing number of cases of rupture at an infundibulum, progression of infundibulum to a frank aneurysm, and subarachnoid hemorrhage (SAH) in the posterior communicating artery (PCoA) have been reported. Using patient-specific geometric models of the supraclinoid internal carotid artery (ICA) with PCoA infundibulum or aneurysm, high-resolution computational fluid dynamics simulations were performed by solving the Navier-Stokes equations with a spectral/hp element method. Simulation results show that the flow impinges at the distal wall of infundibulum near the outside of the ICA bend and creates a region of higher pressure (4-5 mmHg) surrounded by a band of a high wall shear stress (WSS) (20-30 N/m(2) on average). At the proximal end of the infundibulum, another stagnation area is formed characterized by low WSS (<1 N/m(2)) and high oscillating shear index. This impingement region seems to coincide with the locations of the rupture of infundibulae or progression to aneurysms. In addition, the pulsatile flow becomes unstable due to the presence of aneurysms or aneurysm-like infundibulae, and this leads to WSS temporal fluctuations inside the aneurysm, which may accelerate the degenerative processes in the vessel walls.

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Section: Patient A: Infundibulum At the Pcoa With A Far-upstream Aneumentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Wall Shear Stress and Pressure Distribution on Aneurysms and Infundibulae in the Posterior Communicating Artery Bifurcation

2009

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“…This observation was consistent with our intraoperative finding in the present case and suggests check points for the angiographical interpretation of cerebral aneurysm or infundibular widening. Progression of infundibular widening to true aneurysm is rare, 2,3,10,11,13,[17][18][19][20][21] and the average interval for detection of the developed aneurysm is 7 years. Therefore, a long period of follow up is necessary for patients with infundibular widening.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of a Ruptured Enlarged Infundibular Widening of the Posterior Communicating Artery. Case Report.

Kuwahara¹,

Uga

Mori

2001

Neurol. Med. Chir.(Tokyo)

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A 67-year-old female with a history of hypertension and cerebral infarction presented with subarachnoid hemorrhage (SAH) (Hunt and Kosnik grade 4). Brain computed tomography (CT) revealed a clot dominantly on the right (Fisher's classification Group 4). Cerebral angiography showed funnelshaped widenings at the origins of the bilateral posterior communicating arteries. The maximum diameter of the widening was greater than 3 mm, so this widening was called an enlarged infundibular widening. Angiography showed a small bulge protruding posterolaterally from the wall of the right enlarged infundibular widening, and the right posterior communicating artery arose from the apex of the enlarged infundibular widening. Based on the findings of the brain CT and cerebral angiography, the diagnosis was SAH due to rupture of the right enlarged infundibular widening. Approximately 12 hours after the onset, the clot was evacuated through the right pterional approach. Bleeding from the small bulge of the right enlarged infundibular widening occurred intraoperatively, so a right-angled ring clip was applied parallel to the right internal carotid artery to obliterate the rupture point. Postoperatively, she was discharged without neurological deficit, and follow-up CT showed no other new infarction. We recommend clipping rather than wrapping or coating for similar cases of ruptured enlarged infundibular widening.

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“…Sin embargo, como ocurre en el desarrollo de los aneurismas, pueden influir otros factores de riesgo sistémicos aparte de los murales y hemodinámicos. Así el paciente descrito por Patrick et al 19 había sido sometido a la ligadura de la arteria carótida contralateral, el de Kuwanara et al…”

Section: Aspectos Fisiopatológicosunclassified

Manejo y tratamiento microquirúrgico de las dilataciones infundibulares de la arteria comunicante posterior: Serie de nueve casos y revisión de la literatura

González-Darder¹,

Verdú-López²,

Quilis-Quesada³

2011

Neurocirugía

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Infundibular widening of the posterior communicating artery progressing to true aneurysm

Cited by 34 publications

References 6 publications

Wall Shear Stress and Pressure Distribution on Aneurysms and Infundibulae in the Posterior Communicating Artery Bifurcation

Wall Shear Stress and Pressure Distribution on Aneurysms and Infundibulae in the Posterior Communicating Artery Bifurcation

Successful Treatment of a Ruptured Enlarged Infundibular Widening of the Posterior Communicating Artery. Case Report.

Manejo y tratamiento microquirúrgico de las dilataciones infundibulares de la arteria comunicante posterior: Serie de nueve casos y revisión de la literatura

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