Flow Dynamics in a Lethal Anterior Communicating Artery Aneurysm
Charles W. Kerber
,a,
Steven G. Imbesia and
Kim Knoxa
a From the Department of Radiology (C.W.K., K.K.), University of California, San Diego Medical Center, San Diego, CA, and the Department of Radiology (S.G.I.), Hospital of the University of Pennsylvania, Philadelphia, PA
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FIG 1. Angiogram of the left ICA, obtained before death, shows a multilobulated aneurysm at the junction of the right ACA and anterior communicating artery.
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FIG 2. Symmetric flow between the afferent ICAs and the efferent ACAs and MCAs results in no significant slipstream entry into the anterior communicating artery aneurysm.
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FIG 3. Asymmetric ICA flow. Images show opacified slipstreams entering the aneurysm neck and swirling within the aneurysm, with flow in the right ICA being twice that of flow in the left ICA. Although there is flow in both the ACAs and MCAs, for purposes of comparison with figure 4, individual slipstreams that primarily flow into the ACAs from the ICAs were opacified.
A, Image obtained 0.5 second before that shown in B.
B, Image obtained 0.5 second after that shown in A. Note the rapid run-off of dye within the right ICA compared with the left ICA.
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FIG 4. Asymmetrical ACA flow.
A, Flow in the right ACA is reduced by 20% compared with flow in the left ACA, with slipstream entry into the aneurysm from the right ICA.
B, Flow in the left ACA is reduced by 20% compared with flow in the right ACA, with slipstream entry into the aneurysm from the left ICA.
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FIG 5. Image pairs and further anatomic clarification.
A, CT angiogram of the anterior communicating artery replica and the surrounding vessels.
B, 3D projection and rotation showing excellent detail of the aneurysm neck and its relationship to the parent vessels.
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