Objective:The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries,utilizin...Objective:The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries,utilizing computational fluid dynamics as a tool for analysis.Methods:In line with the designated inclusion criteria,this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,China,from January 2021 to September 2022.Utilizing follow-up digital subtraction angiography(DSA)data,these cases were classified into two distinct groups:the sidewall aneurysm group and the bifurcation aneurysm group.Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model.Results:No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation.However,pronounced differences were identified between sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel(Dvessel),inflow angle(θF),and size ratio(SR),as well as the hemodynamic parameter of inflow concentration index(ICI)(P<0.001).Notably,only the SR exhibited a significant correlation with multiple hemodynamic parameters(P<0.001),while the ICI was closely related to several morphological parameters(R>0.5,P<0.001).Conclusions:The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms.Whether it is a bifurcation or sidewall aneurysm,these disparities should be considered.The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with sidewall and bifurcation aneurysms.展开更多
Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device(PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery(ICA). Methods: The clinical data...Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device(PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery(ICA). Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed. Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent(10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months(average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm(Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases(Raymondl Class Ⅱ; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case(MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis(0.13%). Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications.展开更多
Background and Purpose: Endovascular coiling is widely used for treatment of both ruptured and unruptured aneurysms. Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment...Background and Purpose: Endovascular coiling is widely used for treatment of both ruptured and unruptured aneurysms. Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment because of the risk of coil protrusion into the parent vessel. The introduction stent assisted coiling has allowed the bifurcation aneurysms to be endovascularly treated. The present study aims to evaluate the efficacy of the endovascular treatment of the intracranial bifurcation aneurysms. Methods: This study was conducted on 76 patients with radiologically documented intracranial aneurysms at bifurcation sites either ruptured (12 aneurysms) or unruptured (64 aneurysms). Endovascular coiling of intracranial aneurysms was done for all patients in our study aided in some with single or Y-configuration stenting. The radiological outcome was assessed immediately postoperative, and at follow-up at 6 and 12 month with grading of the angiograms on the basis of modified 3-point Raymond scale. Results: In terms of the Raymond grading (RG), the initial angiographic outcome was complete occlusion (RG1) in 45 aneurysms (59.2%), neck remnant (RG2) in 20 aneurysms (26.3%), and body filling (RG3) in 11 aneurysms (14.5%), while the final angiographic outcome at 1 year was RG1 in 55 aneurysms (72.4%), RG2 in 13 aneurysms (17.1%), and RG3 in 8 aneurysms (10.5%). Eleven aneurysms (14.5%) showed recanalization. The aneurysm size and the neck width were the statistically significant factors affecting the initial RG (P = 0.0005, 0.001 respectively), final RG (P = 0.015, 0.012 respectively), and the recanalization rate (P = 0.012, 0.01 respectively). Conclusions: Endovascular treatment of intracranial aneurysms at bifurcation sites is safe and effective. Stent assisted coiling (SAC) has enabled us to offer a safe and effective endovascular treatment for bifurcation aneurysms by preventing coils herniation. Smaller aneurysm size and neck size are indicators of complete occlusion and lower recanalization rate.展开更多
Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furt...Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.展开更多
Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrol...Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis and extensive periaortic infection. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. They are more likely to expand rapidly and rupture without surgical intervention. We report a case of a middle-aged man presented with 3-week history of fever, abdominal pain and low back pain. Initially presented as acute pyelonephritis with subsequent findings of liver abscess, right epididymoorchitis and left infrarenal mycotic aneurysm, which rapidly increased in size and underwent successful endovascular surgery.展开更多
文摘Objective:The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries,utilizing computational fluid dynamics as a tool for analysis.Methods:In line with the designated inclusion criteria,this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,China,from January 2021 to September 2022.Utilizing follow-up digital subtraction angiography(DSA)data,these cases were classified into two distinct groups:the sidewall aneurysm group and the bifurcation aneurysm group.Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model.Results:No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation.However,pronounced differences were identified between sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel(Dvessel),inflow angle(θF),and size ratio(SR),as well as the hemodynamic parameter of inflow concentration index(ICI)(P<0.001).Notably,only the SR exhibited a significant correlation with multiple hemodynamic parameters(P<0.001),while the ICI was closely related to several morphological parameters(R>0.5,P<0.001).Conclusions:The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms.Whether it is a bifurcation or sidewall aneurysm,these disparities should be considered.The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with sidewall and bifurcation aneurysms.
文摘Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device(PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery(ICA). Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed. Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent(10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months(average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm(Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases(Raymondl Class Ⅱ; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case(MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis(0.13%). Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications.
文摘Background and Purpose: Endovascular coiling is widely used for treatment of both ruptured and unruptured aneurysms. Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment because of the risk of coil protrusion into the parent vessel. The introduction stent assisted coiling has allowed the bifurcation aneurysms to be endovascularly treated. The present study aims to evaluate the efficacy of the endovascular treatment of the intracranial bifurcation aneurysms. Methods: This study was conducted on 76 patients with radiologically documented intracranial aneurysms at bifurcation sites either ruptured (12 aneurysms) or unruptured (64 aneurysms). Endovascular coiling of intracranial aneurysms was done for all patients in our study aided in some with single or Y-configuration stenting. The radiological outcome was assessed immediately postoperative, and at follow-up at 6 and 12 month with grading of the angiograms on the basis of modified 3-point Raymond scale. Results: In terms of the Raymond grading (RG), the initial angiographic outcome was complete occlusion (RG1) in 45 aneurysms (59.2%), neck remnant (RG2) in 20 aneurysms (26.3%), and body filling (RG3) in 11 aneurysms (14.5%), while the final angiographic outcome at 1 year was RG1 in 55 aneurysms (72.4%), RG2 in 13 aneurysms (17.1%), and RG3 in 8 aneurysms (10.5%). Eleven aneurysms (14.5%) showed recanalization. The aneurysm size and the neck width were the statistically significant factors affecting the initial RG (P = 0.0005, 0.001 respectively), final RG (P = 0.015, 0.012 respectively), and the recanalization rate (P = 0.012, 0.01 respectively). Conclusions: Endovascular treatment of intracranial aneurysms at bifurcation sites is safe and effective. Stent assisted coiling (SAC) has enabled us to offer a safe and effective endovascular treatment for bifurcation aneurysms by preventing coils herniation. Smaller aneurysm size and neck size are indicators of complete occlusion and lower recanalization rate.
文摘Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.
文摘Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis and extensive periaortic infection. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. They are more likely to expand rapidly and rupture without surgical intervention. We report a case of a middle-aged man presented with 3-week history of fever, abdominal pain and low back pain. Initially presented as acute pyelonephritis with subsequent findings of liver abscess, right epididymoorchitis and left infrarenal mycotic aneurysm, which rapidly increased in size and underwent successful endovascular surgery.
