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      Hemodynamics and coil distribution with changing coil stiffness and length in intracranial aneurysms

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          Abstract

          Purpose

          The purpose of this study was to investigate hemodynamics and coil distribution with changing coil stiffness and length using the finite element method (FEM) and computational fluid dynamics (CFD) analysis.

          Methods

          Basic side-wall and bifurcation type aneurysm models were used. Six types of coil models were generated by changing the coil stiffness and length, based on commercially available embolic coils. Coil embolization was simulated using FEM. CFD was performed to characterize the hemodynamics in the aneurysms after embolization. Coil distribution and velocity reduction in the aneurysms were evaluated.

          Results

          The median value of radial coil distribution was shifted from the center to the outer side of the aneurysmal dome by changing coil stiffness: harder coils entered the outer side of the aneurysmal dome more easily. Short coils were more distributed at the neck region, since their small size made it easy for them to enter the tighter area. CFD results also indicated that velocity in the aneurysm was effectively reduced when the coils were more distributed at the neck region and the outer side of the aneurysmal dome because of the disturbance in blood inflow.

          Conclusions

          It is easier for coils to enter the outer side of the aneurysmal sphere when they are harder. If coils are short, they can enter tighter areas more easily. In addition, high coil density at the outer side of the aneurysmal dome and at the neck region is important to achieve effective velocity reduction.

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          Most cited references25

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          Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment.

          The purpose of this study was to analyze angiographic and clinical results before and after additional endovascular therapy in patients with previously coiled but reopened cerebral aneurysms and to identify possible risk factors for retreatment of an aneurysm. Follow-up with selective digital subtraction angiography was performed in 323/596 (54.2%) patients harboring 342 aneurysms with a mean follow-up time of 28.6 months. The patients were divided into 3 groups: group A, who remained stable after initial treatment; group B, who showed minor morphologic changes; and group C, who underwent repeat treatment. Univariate and multivariate regression analyses were performed to determine possible risk factors for aneurysmal retreatment. Single or multiple retreatment was performed in 33 of 323 (10.2%) patients. Retreatment of small aneurysms ( 4 mm and diameter >10 mm) and the presence of a residual aneurysm after initial treatment. A limitation in our study was the significant number of patients lost to follow-up (22.7%).
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            High shear stress and flow velocity in partially occluded aneurysms prone to recanalization.

            Hemodynamic factors are thought to play an important role in the initiation, growth, and rupture of cerebral aneurysms. However, the hemodynamic features in the residual neck of the partially embolized aneurysms and their influences on recanalization are rarely reported. In this study, we characterized the hemodynamics of partially occluded aneurysms, which were proven to undergo recanalization during follow-up using computational fluid dynamic analysis. From May 2007 to June 2009, we identified 11 partial aneurysms during follow-up, including 5 recanalized cases and 6 stable cases with 3-dimensional digital subtraction angiography. We retrospectively characterized the hemodynamic features around the residual aneurysmal pouch using the available postprocedural digital subtraction angiography image data. The occluded part of the aneurysm was regarded as completely separated from the circulation. The overall blood flow patterns before embolization were almost the same in the recanalized and stable groups. After occlusion, the flow pattern changes, wall shear stress (WSS), and velocity at the remnant neck demonstrated different changes between the 2 groups. Specifically, in the recanalized group, high WSS regions were found near the neck in all 5 cases, with 4 of them being even higher than those before occlusion. Interestingly, in all cases, the high WSS area of the remnant neck coincided with the location where the aneurysm recanalization occurred. In the stable group, 5 out of 6 cases demonstrated lower WSS and velocity at the remnant neck after occlusion. High WSS and blood flow velocity were consistently observed near the remnant neck of partially embolized aneurysms prone to future recanalization, suggesting that hemodynamic factors may have an important role in aneurysmal recurrence after endovascular treatment. The difference in flow pattern could be caused by the incomplete occlusion of the aneurysms.
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              Comparative effectiveness of unruptured cerebral aneurysm therapies: propensity score analysis of clipping versus coiling.

              Endovascular therapy has increasingly become the most common treatment for unruptured cerebral aneurysms in the United States. We evaluated a national, multi-hospital database to examine recent utilization trends and compare periprocedural outcomes between clipping and coiling treatments of unruptured aneurysms.
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                Author and article information

                Journal
                J Neurointerv Surg
                J Neurointerv Surg
                neurintsurg
                jnis
                Journal of Neurointerventional Surgery
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1759-8478
                1759-8486
                August 2018
                19 December 2017
                : 10
                : 8
                : 797-801
                Affiliations
                [1 ] departmentGraduate School of Mechanical Engineering , Tokyo University of Science , Tokyo, Japan
                [2 ] departmentDepartment of Innovation for Medical Information Technology , The Jikei University School of Medicine , Tokyo, Japan
                [3 ] departmentDepartment of Neurosurgery , The Jikei University School of Medicine , Tokyo, Japan
                [4 ] departmentDepartment of Mechanical Engineering , Tokyo University of Science , Tokyo, Japan
                [5 ] Siemens Healthcare KK , Tokyo, Japan
                Author notes
                [Correspondence to ] Dr Hiroyuki Takao, Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo 1058461, Japan; takao@ 123456jikei.ac.jp
                Article
                neurintsurg-2017-013457
                10.1136/neurintsurg-2017-013457
                6204941
                29259122
                c943da4b-764c-4b36-891c-fff82b0596a3
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 01 September 2017
                : 25 November 2017
                : 27 November 2017
                Funding
                Funded by: Siemens Healthcare K.K.;
                Funded by: FundRef http://dx.doi.org/10.13039/501100001691, Japan Society for the Promotion of Science;
                Categories
                Basic Science
                1506
                1541
                Original research
                Custom metadata
                unlocked

                Surgery
                aneurysm,blood flow,coil
                Surgery
                aneurysm, blood flow, coil

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