Assessing the Hemodynamics in Residual Cavities of Intracranial Aneurysm after Coil Embolization with Combined Computational Flow Dynamics and Silent Magnetic Resonance Angiography |
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| Affiliation: | 2. Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata 951-8585, Japan;2. Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, United States;3. Department of Neuroradiology, University of Texas Health Science Center at Houston, United States;4. Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, United States;2. RAND Corporation, Boston, MA; 703-413-1100, U.S.A.;3. Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston MA; 617-724-4100, U.S.A.;4. Wake Forest School of Medicine, Winston-Salem NC; (336) 716-9253, U.S.A.;5. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; (617) 724-6400, U.S.A.;2. Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503 Krakow, Poland;2. Department of Neurology, United States;3. Department of Neurosurgery, United States;4. Department of Internal Medicine, United States;5. Yale University School of Medicine, New Haven CT, United States;2. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada;3. Department of Medicine, Health Sciences North, Sudbury, Canada;4. Department of Radiology, University of Calgary, Calgary, Canada;5. University Hospital Bern, Inselspital, University of Bern, Switzerland;6. Department of Neurosurgery Hyogo College of Medicine 1-1 Mukogawa, Nishinomiya, Hyogo, Japan;11. Department of Neurology, Comprehensive Stroke Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India;12. Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea;8. Division of Neurology, Department of Medicine, St. Michael''s Hospital, University of Toronto; Canada |
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| Abstract: | Background and PurposeMetal artifacts limit computational fluid dynamics analysis after coil embolization. Silent magnetic resonance angiography reduces metal artifacts and improves visualization of the residual cavity of coil-embolized aneurysms. This study investigated the flow dynamics of the residual cavity after coil embolization using silent magnetic resonance angiography and computational fluid dynamics to elucidate the hemodynamic characteristics of recanalization.MethodsTwenty internal carotid-posterior communicating aneurysm cases treated with coil embolization and without stent assistance were followed up (mean±standard deviation, 13.0±6.1 months) and assessed using silent magnetic resonance angiography. The hemodynamic characteristics of the residual cavities in both types of aneurysms were compared between neck remnants, which persisted for >12 months (NR group), and those treated with coil compaction-induced body filling (BF group). Computational fluid dynamics analysis of each aneurysm was performed using morphological data obtained from silent magnetic resonance angiography. Pressure, pressure difference, normalized wall shear stress, and flow velocity were measured.ResultsThe residual cavity was well-visualized using silent magnetic resonance angiography and compared with those imaged using conventional time-of-flight magnetic resonance angiography, and eight internal carotid-posterior communicating aneurysms with neck remnants and body filling were investigated. The maximum pressure area was localized to the aneurysm wall in the NR group (n=4) and to sides of the coil surface in the BF group (n=4). No significant differences were observed for each hemodynamic parameter.ConclusionsCombination of silent magnetic resonance angiography and computational fluid dynamics helps to understand the hemodynamic characteristics of residual cavity in coil- embolized aneurysms. The flow-impingement zone at the coil surface (maximum pressure area) may influence the risk for future coil compaction. |
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