Hemodynamic Analysis of Postoperative Rupture of Unruptured Intracranial Aneurysms after Placement of Flow-Diverting Stents: A Matched Case-Control Study

W. Li; Z. Tian; W. Zhu; Y.S. Zhang; K. Wang; Y. Zhang; Y. Wang; X. Yang; J. Liu

doi:10.3174/ajnr.A6256

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Fig 1.
A female patient with a right internal carotid aneurysm was treated with PED-assisted coil embolization. Compared with the anteroposterior and lateral position of preoperative angiography (A and B), the aneurysm is embolized completely (C). Unfortunately, the aneurysm ruptured 3 days postoperatively (D, arrow). After CFD analysis, we found that an unstable flow pattern appeared after treatment. Compared with the streamlines at end diastole, the vortex structure in the preoperative streamlines (E, arrow) is not changed at peak systole (I, arrow). However, after treatment, the vortex structure is moved at peak systole (F and J, arrows). Isovelocity surfaces show that the velocity in the aneurysm lumen decreased between the preoperative (G) and postoperative (H) periods.
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Fig 2.
A female patient with a right internal carotid aneurysm treated with a PED-assisted coil embolization. Compared with the anteroposterior and lateral position of preoperative angiography (A and B), the aneurysm is embolized (C). At follow-up, the aneurysm is successfully embolized (D). After CFD analysis, we found that the unstable flow pattern disappeared after treatment. Compared with the streamlines at end diastole, 1 vortex structure in the preoperative streamlines (E, arrow) was found, and a created vortex appears at peak systole (I, arrow). However, after treatment, the amount of vortex structure is not changed at peak systole (F and J, arrows). Isovelocity surfaces show that the velocity in the aneurysm lumen decreased between the preoperative (G) and postoperative (H) periods.
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Fig 3.
Comparisons of reduction ratios of hemodynamic parameters between the 2 groups. The asterisk indicates P < .05.

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Table 1:

Univariate analysis results for hemodynamic parameters between POR and POU groups^{^a}

Parameters	POR Group (n = 10)	POU Group (n = 20)	P Value
Unstable flow (pre) (No.) (%)	3 (30.0)	10 (50.0)	.297
Unstable flow (post) (No.) (%)	6 (60.0)	4 (20.0)	.028^{^b}
Inflow jet (pre) (No.) (%)	8 (80.0)	15 (75.0)	.760
Inflow jet (post) (No.) (%)	2 (20.0)	9 (45.0)	.180
Flow complex (pre) (No.) (%)	4 (40.0)	9 (45.0)	.439
Flow complex (post) (No.) (%)	4 (40.0)	6 (30.0)	.584
Velocity (post) (m/s)	0.03 ± 0.04	0.04 ± 0.05	.286
WSS (post) (Pa)	1.42 ± 2.55	1.07 ± 1.36	.792
Pressure (post) (Pa)	1487.31 ± 799.68	4127.68 ± 5613.52	.930
Velocity at neck (post) (m/s)	0.30 ± 0.33	0.20 ± 0.37	.567
EL (post) (W/m³)	906.32 ± 707.56	9871.75 ± 22215.52	.628
LSA (post) (mm²)	0.56 ± 0.32	0.74 ± 0.26	.147
OSI (post)	0.02 ± 0.06	0.00 ± 0.00	.428
TAWSS (post) (Pa)	0.39 ± 0.68	0.23 ± 0.29	.965
RRT (post) (sec)	1.46 ± 2.54	1.07 ± 1.36	.725

Note:—Pre indicates before; post, after.
↵a Continuous variables are expressed as mean ± SD. Categoric variables are expressed as (No.) (%).
↵b P < .05. The Mann–Whitney U test was used, with P < .05 considered statistically significant.