Document Detail


Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment.
MedLine Citation:
PMID:  21071533     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Flow-diverting approaches to intracranial aneurysm treatment had many promising early results, but recent apparently successful treatments have been complicated by later aneurysm hemorrhage. We analyzed 7 cases of aneurysms treated with flow diversion to explore the possible rupture mechanisms.
MATERIALS AND METHODS: CFD analysis of pre- and posttreatment conditions was performed on 3 giant aneurysms that ruptured after treatment and 4 successfully treated aneurysms. Pre- and posttreatment hemodynamics were compared including WSS, relative blood flows, vascular resistances, and pressures, to identify the effects of flow-diverter placements.
RESULTS: Expected reductions in aneurysm velocity and WSS were obtained, indicating effective flow diversion from the sac into the parent artery, consistent with periprocedural observations. In each case with postaneurysm rupture, the result of flow diversion led to an increase in pressure within the aneurysm. This pressure increase is related to larger effective resistance in the parent artery from placement of the devices and, in 2 cases, the reduction of a preaneurysm stenosis.
CONCLUSIONS: Flow-diversion devices can cause intra-aneurysmal pressure increases, which can potentially lead to rupture, especially for giant aneurysms. This relates both to changes in the parent artery configuration, such as reduction of a proximal stenosis, and to the flow diversion into higher resistance parent artery pathways combined with cerebral autoregulation, leading to higher pressure gradients. These may be important effects that should be considered when planning interventions. Potentially dangerous cases could be identified with angiography and/or patient-specific CFD models.
Authors:
J R Cebral; F Mut; M Raschi; E Scrivano; R Ceratto; P Lylyk; C M Putman
Related Documents :
11452853 - Giant brain aneurysm--difficulties in diagnosis and treatment. case report.
6857483 - Computed tomographic demonstration of the effect of proximal parent artery ligation for...
14533953 - Delayed diagnosis of leiomyosarcoma of the common femoral artery after endovascular rep...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-11
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  32     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-14     Completed Date:  2011-05-10     Revised Date:  2011-08-02    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-33     Citation Subset:  IM    
Affiliation:
Center for Computational Fluid Dynamics, George Mason University, Fairfax, Virginia 22030, USA. jcebral@gmu.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aneurysm, Ruptured / diagnosis,  etiology*,  physiopathology*
Blood Flow Velocity
Cerebral Arteries / physiopathology
Cerebral Revascularization / adverse effects,  instrumentation
Cerebrovascular Circulation*
Computer Simulation
Diagnosis, Computer-Assisted / methods
Female
Humans
Intracranial Aneurysm / complications,  physiopathology*,  surgery*
Male
Middle Aged
Models, Cardiovascular*
Stents / adverse effects*
Treatment Outcome
Comments/Corrections
Comment In:
AJNR Am J Neuroradiol. 2011 Jun-Jul;32(6):981-3   [PMID:  21622579 ]
AJNR Am J Neuroradiol. 2011 May;32(5):E95-7; author reply E98-100   [PMID:  21511857 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  CT Angiography for Differentiation between Intracerebral and Intra-Sylvian Hematoma in Patients with...
Next Document:  Recovery of ophthalmoplegia after endovascular treatment of intracranial aneurysms.