Purpose

Preoperative simulations tailored to the therapeutic device are desirable to predict treatment efficacy. We investigated the hemodynamics associated with complete obliteration (CO) of intracranial aneurysms after endovascular treatment by computational fluid dynamics (CFD) using porous media modeling.

Methods

From June 2015 to December 2020, 48 patients with 55 unruptured aneurysms treated with simple coiling or stent-assisted coiling at our institution were included. Patient-specific geometry models were generated from pre-treatment 3 dimension (D) rotational angiography or 3D computed tomography angiography. We simulated the coil and neck-bridging stent with porous media modeling for steady state analysis and calculated residual flow volume (RFV) associated with thrombosis formation after coil embolization. Patients were classified into CO and non-CO groups based on digital subtraction angiography findings after 6 months of treatment, and the groups were statistically evaluated using the Brunner-Munzel test. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the diagnostic accuracy in predicting CO.

Results

The aneurysms were classified into 22 CO and 33 non-CO group. There were no significant differences in morphological variables between the two groups. In hemodynamic parameters, RFV was significantly lower in the CO group. The ROC curve analyses showed that RFV with an average flow velocity of more than 0.5 [cm/s] in aneurysm was the most useful to predict CO (AUC, 0.66 [95% CI, 0.51–0.81]; cut-off value, 32.8 mm³; sensitivity, 60.6%; and specificity, 78.9%).

Conclusion

These results indicated that CFD could predict aneurysmal CO after coil embolization.

中文翻译：

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使用多孔介质模型计算流体动力学预测未破裂脑动脉瘤线圈栓塞后的血栓形成

目的

需要针对治疗设备量身定制的术前模拟来预测治疗效果。我们使用多孔介质模型通过计算流体动力学 (CFD) 研究了血管内治疗后与颅内动脉瘤完全闭塞 (CO) 相关的血流动力学。

方法

2015年6月至2020年12月，纳入48名患有55个未破裂动脉瘤的患者，在我们机构接受了简单弹簧圈弹簧栓塞或支架辅助弹簧圈弹簧圈栓塞治疗。患者特定的几何模型是通过治疗前 3 维 (D) 旋转血管造影或 3D 计算机断层扫描血管造影生成的。我们使用多孔介质模型模拟弹簧圈和颈桥支架进行稳态分析，并计算与弹簧圈栓塞后血栓形成相关的残余流量（RFV）。治疗6个月后根据数字减影血管造影结果将患者分为CO组和非CO组，并使用Brunner-Munzel检验对各组进行统计评估。受试者工作特征 (ROC) 曲线下面积 (AUC) 用于评估预测 CO 的诊断准确性。

结果

将动脉瘤分为22个CO组和33个非CO组。两组之间的形态学变量没有显着差异。在血流动力学参数方面，CO 组的 RFV 显着较低。 ROC 曲线分析表明，动脉瘤中平均流速超过 0.5 [cm/s] 的 RFV 对预测 CO 最有用（AUC，0.66 [95% CI，0.51–0.81]；截止值，32.8 mm ³；敏感性，60.6%；特异性，78.9%）。

结论

这些结果表明 CFD 可以预测弹簧圈栓塞后动脉瘤性 CO。