PMID- 26610731 OWN - NLM STAT- MEDLINE DCOM- 20170316 LR - 20220310 IS - 1759-8486 (Electronic) IS - 1759-8478 (Print) IS - 1759-8478 (Linking) VI - 8 IP - 11 DP - 2016 Nov TI - Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization. PG - 1140-1147 LID - 10.1136/neurintsurg-2015-012050 [doi] AB - BACKGROUND: Endovascular treatment of paraclinoid aneurysms is preferred in clinical practice. Flow alterations caused by stents and coils may affect treatment outcome. OBJECTIVE: To assess hemodynamic changes following stent-assisted coil embolization (SACE) in subtotally embolized paraclinoid aneurysms with residual necks that were predisposed to recanalization. METHODS: We studied 27 paraclinoid aneurysms (seven recanalized and 20 stable) treated with coils and Enterprise stents. Computational fluid dynamic simulations were performed on patient-specific aneurysm geometries using virtual stenting and porous media technology. RESULTS: After stent placement in 27 cases, aneurysm flow velocity decreased significantly, the reduction gradually increasing from the neck plane (11.9%), to the residual neck (12.3%), to the aneurysm dome (16.3%). Subsequent coil embolization was performed after stent placement and the hemodynamic factors decreased further and significantly at all aneurysm regions except the neck plane. In a comparison of recanalized and stable cases, univariate analysis showed no significant differences in any parameter before treatment. After stent-assisted coiling, only the reduction in area-averaged velocity at the neck plane differed significantly between recanalized (8.1%) and stable cases (20.5%) (p=0.016). CONCLUSIONS: Aneurysm flow velocity can be significantly decreased by stent placement and coil embolization. However, hemodynamics at the aneurysm neck plane is less sensitive to coils. Significant reduction in flow velocity at the neck plane may be an important factor in preventing recanalization of paraclinoid aneurysms after subtotal SACE. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. FAU - Liu, Jian AU - Liu J AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Jing, Linkai AU - Jing L AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Wang, Chao AU - Wang C AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Paliwal, Nikhil AU - Paliwal N AD - Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA. FAU - Wang, Shengzhang AU - Wang S AD - Department of Mechanics and Engineering Science, Fudan University, Shanghai, China. FAU - Zhang, Ying AU - Zhang Y AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China. FAU - Xiang, Jianping AU - Xiang J AD - Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA. FAU - Siddiqui, Adnan H AU - Siddiqui AH AD - Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Radiology, University at Buffalo, The State University of New York, Buffalo, New York, USA. FAU - Meng, Hui AU - Meng H AD - Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA. FAU - Yang, Xinjian AU - Yang X AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China. LA - eng GR - R01 NS091075/NS/NINDS NIH HHS/United States PT - Journal Article DEP - 20151126 PL - England TA - J Neurointerv Surg JT - Journal of neurointerventional surgery JID - 101517079 SB - IM MH - Blood Vessel Prosthesis MH - Embolization, Therapeutic/adverse effects/*trends MH - Female MH - Follow-Up Studies MH - *Hemodynamics MH - Humans MH - Intracranial Aneurysm/*diagnostic imaging/*therapy MH - Male MH - Middle Aged MH - Retrospective Studies MH - *Stents/adverse effects MH - Treatment Outcome PMC - PMC4882272 MID - NIHMS766554 OTO - NOTNLM OT - Aneurysm OT - Blood Flow OT - Stent COIS- None. EDAT- 2015/11/28 06:00 MHDA- 2017/03/17 06:00 PMCR- 2016/11/01 CRDT- 2015/11/28 06:00 PHST- 2015/08/28 00:00 [received] PHST- 2015/11/09 00:00 [accepted] PHST- 2015/11/28 06:00 [pubmed] PHST- 2017/03/17 06:00 [medline] PHST- 2015/11/28 06:00 [entrez] PHST- 2016/11/01 00:00 [pmc-release] AID - neurintsurg-2015-012050 [pii] AID - 10.1136/neurintsurg-2015-012050 [doi] PST - ppublish SO - J Neurointerv Surg. 2016 Nov;8(11):1140-1147. doi: 10.1136/neurintsurg-2015-012050. Epub 2015 Nov 26.