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Research ArticleInterventional
Open Access

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 and J. Liu
American Journal of Neuroradiology November 2019, 40 (11) 1916-1923; DOI: https://doi.org/10.3174/ajnr.A6256
W. Li
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Z. Tian
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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W. Zhu
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Y.S. Zhang
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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K. Wang
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Y. Zhang
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Y. Wang
bDepartment of Neurosurgery (Y.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
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X. Yang
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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J. Liu
aFrom the Department of Interventional Neuroradiology (W.L., Z.T., W.Z., Y.S.Z., K.W., Y.Z., X.Y., J.L.), Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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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 groupsa

    ParametersPOR 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).028b
    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 ± 0.040.04 ± 0.05.286
    WSS (post) (Pa)1.42 ± 2.551.07 ± 1.36.792
    Pressure (post) (Pa)1487.31 ± 799.684127.68 ± 5613.52.930
    Velocity at neck (post) (m/s)0.30 ± 0.330.20 ± 0.37.567
    EL (post) (W/m3)906.32 ± 707.569871.75 ± 22215.52.628
    LSA (post) (mm2)0.56 ± 0.320.74 ± 0.26.147
    OSI (post)0.02 ± 0.060.00 ± 0.00.428
    TAWSS (post) (Pa)0.39 ± 0.680.23 ± 0.29.965
    RRT (post) (sec)1.46 ± 2.541.07 ± 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.

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American Journal of Neuroradiology: 40 (11)
American Journal of Neuroradiology
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1 Nov 2019
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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
American Journal of Neuroradiology Nov 2019, 40 (11) 1916-1923; DOI: 10.3174/ajnr.A6256

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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
American Journal of Neuroradiology Nov 2019, 40 (11) 1916-1923; DOI: 10.3174/ajnr.A6256
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