Effect of Hemodynamics on Outcome of Subtotally Occluded Paraclinoid Aneurysms After Stent-assisted Coil Embolization

Overview

Journal J Neurointerv Surg

Publisher BMJ Publishing Group

Specialty Neurology

Date 2015 Nov 28

PMID 26610731

Citations 20

Authors

Jian Liu

Linkai Jing

Chao Wang

Nikhil Paliwal

Shengzhang Wang

Ying Zhang

Jianping Xiang

Adnan H Siddiqui

Hui Meng

Xinjian Yang

Affiliations

Soon will be listed here.

Abstract

Background: Endovascular treatment of paraclinoid aneurysms is preferred in clinical practice. Flow alterations caused by stents and coils may affect treatment outcome.

Objective: To assess hemodynamic changes following stent-assisted coil embolization (SACE) in subtotally embolized paraclinoid aneurysms with residual necks that were predisposed to recanalization.

Methods: We studied 27 paraclinoid aneurysms (seven recanalized and 20 stable) treated with coils and Enterprise stents. Computational fluid dynamic simulations were performed on patient-specific aneurysm geometries using virtual stenting and porous media technology.

Results: After stent placement in 27 cases, aneurysm flow velocity decreased significantly, the reduction gradually increasing from the neck plane (11.9%), to the residual neck (12.3%), to the aneurysm dome (16.3%). Subsequent coil embolization was performed after stent placement and the hemodynamic factors decreased further and significantly at all aneurysm regions except the neck plane. In a comparison of recanalized and stable cases, univariate analysis showed no significant differences in any parameter before treatment. After stent-assisted coiling, only the reduction in area-averaged velocity at the neck plane differed significantly between recanalized (8.1%) and stable cases (20.5%) (p=0.016).

Conclusions: Aneurysm flow velocity can be significantly decreased by stent placement and coil embolization. However, hemodynamics at the aneurysm neck plane is less sensitive to coils. Significant reduction in flow velocity at the neck plane may be an important factor in preventing recanalization of paraclinoid aneurysms after subtotal SACE.

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