Proximal Clipping and Distal High-Flow Bypass in the Treatment of Giant/Complex Intracranial Aneurysm: An Opportunity or a Risk from a Fluid-Structural Interaction Analysis,Cardiovascular Engineering and Technology

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Proximal Clipping and Distal High-Flow Bypass in the Treatment of Giant/Complex Intracranial Aneurysm: An Opportunity or a Risk from a Fluid-Structural Interaction Analysis
Cardiovascular Engineering and Technology ( IF 1.6 ) Pub Date : 2023-12-13 , DOI: 10.1007/s13239-023-00704-z
Shifu Li _{1,

2,

3,

4,

5} , Zheng Huang _{1,

2,

3,

4} , Hua Chen ₆ , Fenghua Chen _{1,

2,

3,

4}

Affiliation

Objectives

Conventional clipping and endovascular treatment are difficult to apply for some giant intracranial aneurysms (GIAs), and sometimes extracranial-to-intracranial (EC-IC) bypass becomes the optional choice. However, not all GIA patients can benefit from it. This study aims to recognize the underlying problems.

Methods

We included eligible patients in our care. Then, we researched from three levels: a retrospective review of clinical data, fluid-structural analysis from two representative patient-specific models, and fluid-structural interaction analysis for idealized models to investigate the hemodynamic and biomechanical mechanisms.

Results

In this article, we report nine patients with GIA who underwent EC-IC surgery. Of them, three experienced dangerous postoperative hemorrhage, and one patient died. Among these three patients, two lacked the A1 segment of the anterior cerebral artery (ACA). The numerical simulation showed that after surgery, for the patient with an unruptured aneurysm and existence of ACA, the wall deformation, wall stress, pressure, and area of the oscillatory shear index (OSI) > 0.2 were decreased by 43%, 39%, 33%, and 13%, while the patient without A1 segment having postoperative hemorrhage showed 36%, 45%, 13%, and 55% increased, respectively. Thus, we postulated a dangerous “stump phenomenon” in such conditions and further demonstrated it from idealized models with different sizes of ACA. Finally, we found a larger anastomosis angle and smaller diameter of the graft can alleviate this effect.

Conclusions

Neurosurgeon should cautiously evaluate the opportunity and risk for such patients who have aplasia of the A1 segment of ACA when making clinical decisions.

中文翻译：

近端夹闭和远端高流量旁路治疗巨大/复杂颅内动脉瘤：流固相互作用分析的机遇或风险

目标

传统的夹闭和血管内治疗对于一些巨大颅内动脉瘤（GIA）难以适用，有时颅外-颅内（EC-IC）搭桥成为可选选择。然而，并非所有 GIA 患者都能从中受益。本研究旨在认识根本问题。

方法

我们将符合条件的患者纳入我们的护理范围。然后，我们从三个层面进行研究：临床数据的回顾性回顾、两个代表性患者特异性模型的流-结构分析、以及理想化模型的流-结构相互作用分析，以研究血流动力学和生物力学机制。

结果

在本文中，我们报告了 9 名接受 EC-IC 手术的 GIA 患者。其中三人经历了危险的术后大出血，一名患者死亡。在这三名患者中，两名患者缺乏大脑前动脉 (ACA) 的 A1 段。数值模拟显示，对于未破裂动脉瘤且存在ACA的患者，术后壁变形、壁应力、压力以及振荡剪切指数(OSI)>0.2的面积分别下降了43%、39%， 33%、13%，而无A1段术后出血的患者则分别增加36%、45%、13%、55%。因此，我们假设在这种情况下会出现危险的“树桩现象”，并通过不同大小的 ACA 的理想化模型进一步证明了这一点。最后，我们发现较大的吻合角度和较小的移植物直径可以减轻这种影响。