Predictors for ophthalmic segment aneurysms recanalization after coiling and flow diverter embolization in 6- and 12-month follow-up

Wiśniewski, Karol; Tomasik, Bartłomiej; Bobeff, Ernest J.; Stefańczyk, Ludomir; Hupało, Marlena; Jaskólski, Dariusz J.

doi:10.1016/j.jocn.2019.07.007

Cited by 5 publications

(9 citation statements)

References 53 publications

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“…Some studies already reported that the selection of the first coil is an important factor for reaching a high VPD [23,24,48]. First VPD was first introduced by Neki et al as a predictor of recanalization.…”

Section: Discussionmentioning

confidence: 99%

“…Platinum embolization spirals, hydraulically or mechanically released, or electrolytically detachable spirals coated with hydrogel were introduced successively. Their diameter was 0.010 and 0.018", and they were available in two forms of coil: spatial (3D) or helical [24].…”

Section: Digital Subtraction Angiography/embolizationmentioning

confidence: 99%

“…The modified Raymond-Roy scale was used to assess recanalization. Recanalization was noted if there was an increased aneurysm filling compared with the examination performed immediately after embolization [24].…”

Section: Digital Subtraction Angiography/embolizationmentioning

confidence: 99%

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Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Wiśniewski

Tomasik

Tyfa

et al. 2021

JCM

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Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Digital Subtraction Angiography/embolizationmentioning

confidence: 99%

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Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Wiśniewski

Tomasik

Tyfa

et al. 2021

JCM

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“…We performed the analysis of morphometric parameters based on 3D aneurysm models generated from preoperative CTA (all 3D CTAs were performed on GE VCT LightSpeed VCT with slice thickness of 0.625 mm and increment of 0.5 mm using 3D software). We measured the following: Aneurysm dome size (height, width, depth); The maximal perpendicular height; Neck size; Parent artery size; Aneurysm angle; Vessel angle; Neck to parent artery ratio; Aneurysm depth to neck size ratio; Aspect ratio (AR), defined as the maximal perpendicular height (the largest perpendicular distance from the neck of the aneurysm to the dome of the aneurysm) divided by neck width; Size ratio (SR), defined as maximum aneurysm height (between the center of the aneurysm neck and the greatest distance to the aneurysm dome) divided by vessel diameter [ 22 ]. (see Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Size ratio (SR), defined as maximum aneurysm height (between the center of the aneurysm neck and the greatest distance to the aneurysm dome) divided by vessel diameter [ 22 ]. (see Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Recanalization after Coil Embolization

Wiśniewski

Tyfa

Tomasik

et al. 2021

JPM

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The aim of our study was to identify risk factors for recanalization 6 months after coil embolization using clinical data followed by computational fluid dynamics (CFD) analysis. Methods: Firstly, clinical data of 184 patients treated with coil embolization were analyzed retrospectively. Secondly, aneurysm models for high/low recanalization risk were generated based on ROC curves and their cut-off points. Afterward, CFD was utilized to validate the results. Results: In multivariable analysis, aneurysm filling during the first embolization was an independent risk factor whilst packing density was a protective factor of recanalization after 6 months in patients with aSAH. For patients with unruptured aneurysms, packing density was found to be a protective factor whilst the aneurysm neck size was an independent risk factor. Complex flow pattern and multiple vortices were associated with aneurysm shape and were characteristic of the high recanalization risk group. Conclusions: Statistical analysis suggested that there are various factors influencing recanalization risk. Once certain values of morphometric parameters are exceeded, a complex flow with numerous vortices occurs. This phenomenon was revealed due to CFD investigations that validated our statistical research. Thus, the complex flow pattern itself can be treated as a relevant recanalization predictor.

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Aspect Ratio Is Associated with Recanalization after Coiling of Unruptured Intracranial Aneurysms

Hara

Satow

Hamano

et al. 2022

Neurol. Med. Chir.(Tokyo)

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The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3%-49%. This study aims to investigate the factors that influence the recanalization after coil embolization for UIAs in our institution. We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent-used cases were excluded. Cerebral angiography and 3D time-of-flight magnetic resonance angiography (TOF MRA) were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. The mean follow-up period ranged from 6 to 172 months (mean: 79.0 ± 39.8 months). Recanalization was noted in 78 (25.4%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p < 0.001), AR (p = 0.003), and VER (p = 0.012) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p = 0.004) and VER (p =0.015) were significant predictors of recanalization. To summarize, a higher AR and a lower VER could lead to recanalization after coil embolization of UIAs. Careful follow-up is required for coiled aneurysms with these features.

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Predictors for ophthalmic segment aneurysms recanalization after coiling and flow diverter embolization in 6- and 12-month follow-up

Cited by 5 publications

References 53 publications

Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Risk Factors for Recanalization after Coil Embolization

Aspect Ratio Is Associated with Recanalization after Coiling of Unruptured Intracranial Aneurysms

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