Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms
Abstract
:1. Introduction
2. Material and Methods
2.1. Ethics Approval
2.2. Patients
2.3. Digital Subtraction Angiography/Embolization
- aneurysm dome height (H), width (S), and depth size (D);
- aneurysm neck size (N);
- parent artery size (P);
- the largest aneurysm dimension perpendicular to the neck (Hmax);
- aspect ratio (AR), defined as the maximal perpendicular height (the largest perpendicular distance from the neck of the aneurysm to the dome of the aneurysm) divided by neck width;
- size ratio (SR), defined as maximum aneurysm height (between the center of the aneurysm neck and the greatest distance to the aneurysm dome), divided by the parent artery diameter;
- the index determining the ratio of aneurysm neck width to diameter of the parent artery.
2.4. Statistical Analysis
2.5. Computational Fluid Dynamics Analysis
3. Results
3.1. Patients
3.2. Aneurysm Location
3.3. Laboratory Results, Morphometric Parameters, Packing Density, 1st VPD of Intracranial Aneurysms
3.4. Complete Aneurysm Filling during the First Embolization
3.5. Type of Embolization Material
3.6. Recanalization
3.6.1. Early Recanalization (after 6 Months)
3.6.2. Late Recanalization (after 12 Months)
3.7. Statistical Analysis
3.7.1. Late Recanalization
3.7.2. Morphometric Parameters
3.8. Computational Fluid Dynamics Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Consent for publication
References
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Study Group | |
---|---|
Inclusion criteria |
|
Exclusion criteria |
|
N1–14039328 elements N2–6237876 elements N3–2436595 elements | r21–1.310 r32–1.368 | ||||
Right posterior cerebral artery; velocity (m/s) | Left superior cerebellar artery; velocity (m/s) | Median cross section of the aneurysm; velocity (m/s) | Frontal cross section of the aneurysm; velocity (m/s) | Aneurysm walls; WSS (Pa) | |
0.1334 | 0.1391 | 0.182 | 0.221 | 3.82 | |
0.1328 | 0.1388 | 0.179 | 0.218 | 3.83 | |
0.1340 | 0.1375 | 0.169 | 0.19 | 3.74 | |
p | 2.319 | 4.450 | 3.575 | 6.984 | 4.219 |
0.132 | 0.139 | 0.184 | 0.222 | 4.969 | |
0.90% | 0.94% | 5.59% | 12.84% | 0.36% | |
0.85% | 0.31% | 2.63% | 1.60% | 0.13% | |
0.134 | 0.139 | 0.184 | 0.222 | 4.983 | |
0.45% | 0.22% | 1.65% | 1.36% | 0.10% | |
0.51% | 0.09% | 1.00% | 0.24% | 0.05% | |
1.29% | 0.50% | 4.29% | 2.86% | 0.21% | |
0.64% | 0.12% | 1.26% | 0.30% | 0.06% |
Type of Scale | Numer of Cases |
---|---|
Hunt-Hess grade | n = 66 |
I | 11 |
II | 26 |
III | 24 |
IV | 5 |
V | 0 |
Fisher grade * | n = 66 |
I | 11 |
II | 23 |
III | 15 |
IV | 13 |
Glasgow Outcome Scale (GOS) at discharge | n = 66 |
V | 13 |
IV | 32 |
III | 10 |
II | 7 |
I | 4 |
Modified Rankin scale (after 12 moths) | n = 66 |
1 | 22 |
2 | 16 |
3 | 6 |
4 | 9 |
5 | 9 |
6 | 4 |
Comorbidities (mostly arterial hypertension, diabetes mellitus-DM (type I or II)) | 47/66 |
Value | Mean ± SD without Recanalization | Mean ± SD with Recanalization | p |
---|---|---|---|
Age (years) | 56.75 ± 15.28 | 56.89 ± 16.12 | 0.974 |
depth (mm) | 5.46 ± 2.68 | 6.42 ± 3.29 | 0.229 |
height (mm) | 6.86 ± 3.22 | 9.49 ± 5.19 | 0.016 |
width (mm) | 5.37 ± 2.63 | 6.63 ± 3.31 | 0.111 |
neck size (mm) | 3.27 ± 0.83 | 4.14 ± 0.66 | <0.001 * |
APTT | 30.09 ± 5.51 | 28.97 ± 2.86 | 0.473 |
INR | 1.07 ± 0.28 | 1.08 ± 0.13 | 0.916 |
HCT | 35.55 ± 11.42 | 36.49 ± 10.09 | 0.759 |
APTT ratio | 96.64 ± 14.03 | 95.19 ± 8.26 | 0.683 |
aneurysm volume (mm3) | 166.48 ± 274.3 | 349.15 ± 432.39 | 0.045 |
packing density (%) | 35.0 ± 10.8 | 21.2 ± 6.6 | <0.001 * |
1st VPD (%) | 18.28 ± 4.16 | 10.51 ± 2.83 | <0.001 * |
Parent artery diameter (mm) | 3.75 ± 0.92 | 3.92 ± 1.08 | 0.525 |
The largest aneurysm size (mm) | 7.04 ± 3.16 | 9.44 ± 5.17 | 0.026 |
SR (maximum aneurysm height divided by the parent artery diameter) | 2.02 ± 1.12 | 2.49 ± 1.27 | 0.147 |
index determining the ratio of neck width to diameter of the parent artery | 0.92 ± 0.29 | 1.16 ± 0.46 | 0.015 |
Hmax - the largest aneurysm dimension perpendicular to the neck (mm) | 6.89 ± 3.41 | 12.03 ± 5.09 | <0.001 * |
aspect ratio (AR)—index determining the ratio of the largest dimension of the aneurysm perpendicular to the neck to the width of the aneurysm neck | 2.14 ± 0.90 | 3.03 ± 1.59 | 0.006 |
Variable | Odds Ratio (95% CI) | p Value |
---|---|---|
Multivariate analysis for late recanalization | ||
1st VPD | 0.50 (0.35–0.72) | <0.001 |
Multivariate analysis for long-term outcome | ||
GOS at discharge | 0.06 (0.01–0.28) | <0.001 |
1st VPD (%) | Velocity at the Aneurysm Neck (m/s) | WSS at the Artery Wall (Pa) | WSS at the Aneurysm Wall (Pa) | Pressure at the Aneurysm Wall (Pa) | RFV/AV (%) |
---|---|---|---|---|---|
0 | 0.243 | 4.99 | 5.36 | 11,344.0 | 98.9 |
1 | 0.214 | 4.98 | 3.83 | 11,341.8 | 98.7 |
2 | 0.203 | 4.98 | 3.01 | 11,341.5 | 98.4 |
3 | 0.199 | 4.98 | 2.44 | 11,343.1 | 97.8 |
4 | 0.199 | 4.98 | 2.07 | 11,345.5 | 96.8 |
5 | 0.200 | 4.99 | 1.84 | 11,348.3 | 95.3 |
6 | 0.202 | 4.99 | 1.67 | 11,351.0 | 93.6 |
7 | 0.204 | 5.00 | 1.53 | 11,353.1 | 91.6 |
8 | 0.206 | 5.00 | 1.41 | 11,354.7 | 89.2 |
9 | 0.207 | 5.01 | 1.31 | 11,355.7 | 86.5 |
10 | 0.207 | 5.01 | 1.21 | 11,356.1 | 83.3 |
11 | 0.206 | 5.02 | 1.13 | 11,356.0 | 79.6 |
12 | 0.203 | 5.02 | 1.04 | 11,355.7 | 75.2 |
13 | 0.200 | 5.02 | 0.96 | 11,355.0 | 69.9 |
14 | 0.195 | 5.03 | 0.89 | 11,354.2 | 64.0 |
15 | 0.188 | 5.03 | 0.82 | 11,353.2 | 57.8 |
16 | 0.181 | 5.03 | 0.75 | 11,352.0 | 51.8 |
17 | 0.173 | 5.04 | 0.69 | 11,351.0 | 46.3 |
18 | 0.164 | 5.04 | 0.63 | 11,350.0 | 41.7 |
19 | 0.155 | 5.05 | 0.58 | 11,349.0 | 37.7 |
20 | 0.147 | 5.05 | 0.54 | 11,348.0 | 34.2 |
21 | 0.138 | 5.06 | 0.50 | 11,347.5 | 31.1 |
22 | 0.131 | 5.06 | 0.46 | 11,346.8 | 28.3 |
23 | 0.123 | 5.06 | 0.43 | 11,346.3 | 25.8 |
24 | 0.116 | 5.07 | 0.41 | 11,345.8 | 23.6 |
25 | 0.109 | 5.07 | 0.38 | 11,345.5 | 21.5 |
26 | 0.103 | 5.07 | 0.36 | 11,345.2 | 19.7 |
27 | 0.097 | 5.08 | 0.34 | 11,344.9 | 17.9 |
28 | 0.092 | 5.08 | 0.32 | 11,344.9 | 16.3 |
29 | 0.087 | 5.08 | 0.31 | 11,344.9 | 14.8 |
30 | 0.082 | 5.08 | 0.29 | 11,344.9 | 13.4 |
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Wiśniewski, K.; Tomasik, B.; Tyfa, Z.; Reorowicz, P.; Bobeff, E.J.; Stefańczyk, L.; Posmyk, B.J.; Jóźwik, K.; Jaskólski, D.J. Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms. J. Clin. Med. 2021, 10, 1348. https://doi.org/10.3390/jcm10071348
Wiśniewski K, Tomasik B, Tyfa Z, Reorowicz P, Bobeff EJ, Stefańczyk L, Posmyk BJ, Jóźwik K, Jaskólski DJ. Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms. Journal of Clinical Medicine. 2021; 10(7):1348. https://doi.org/10.3390/jcm10071348
Chicago/Turabian StyleWiśniewski, Karol, Bartłomiej Tomasik, Zbigniew Tyfa, Piotr Reorowicz, Ernest J. Bobeff, Ludomir Stefańczyk, Bartłomiej J. Posmyk, Krzysztof Jóźwik, and Dariusz J. Jaskólski. 2021. "Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms" Journal of Clinical Medicine 10, no. 7: 1348. https://doi.org/10.3390/jcm10071348