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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:63-68, January 2004
© 2004 American Society of Neuroradiology

Technical Note
INTERVENTIONAL

Computational Simulation of Therapeutic Parent Artery Occlusion to Treat Giant Vertebrobasilar Aneurysm

Tamer Hassan^a, Masayuki Ezura^a, Eugene V. Timofeev^b,d, Teiji Tominaga^c, Tsutomu Saito^b, Akira Takahashi^a, Kazuyoshi Takayama^b and Takashi Yoshimoto^c

^a Department of Neuroendovascular Therapy, Tohoku University Graduate School of Medicine, Shock Wave Research Center, Sendai, Japan
^b Institute of Fluid Science, Tohoku University, Sendai, Japan
^c Department of Neurosurgery, Tohoku University, Sendai, Japan
^d Ioffe Physico-Technical Institute, Russian Academy of Sciences, St. Petersburg, Russia

Address correspondence to Dr. Tamer Hassan, Department of Neuroendovascular Therapy, Tohoku University Graduate School of Medicine, 1–1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan

Summary: We applied computational fluid dynamics (CFD) analysis to assess 3D digital subtraction angiography findings in a patient with a giant vertebrobasilar aneurysm to simulate and compare the consequences of left and right vertebral artery occlusion. The balloon occlusion test suggested that occlusion of the right vertebral artery is the better way to treat this patient’s aneurysm from the point of view of aneurysmal thrombosis and isolation from the circulation. The computer simulation supported this conclusion, at the same time indicating that from the point of view of pressure distribution on the wall of the aneurysm, the right vertebral occlusion may be also accompanied by an undesirable effect. A high-pressure area on the aneurysm wall in systole was revealed. This high pressure potentially could lead to subsequent aneurysmal growth, which indeed occurred, as was revealed by a follow-up examination 6 months later. This study is a good example of possible future applications of CFD in patients with cerebrovascular disease before therapeutic intervention.