Hemodynamic Changes in the Treatment of Multiple Intracranial Aneurysms: A Computational Fluid Dynamics Study

• Published in: World neurosurgery Vol. 118; pp. e631 - e638
• Main Authors: Thenier-Villa, José Luis, Riveiro Rodríguez, Antonio, Martínez-Rolán, Rosa María, Gelabert-González, Miguel, González-Vargas, Pedro Miguel, Galarraga Campoverde, Raúl Alejandro, Díaz Molina, Jorge, De La Lama Zaragoza, Adolfo, Martínez-Cueto, Pedro, Pou, Juan, Conde Alonso, Cesáreo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2018
• Subjects: Adult; Aged; Aneurysm, Ruptured - etiology; Aneurysm, Ruptured - surgery; Angiography, Digital Subtraction - methods; Cerebral Angiography - methods; Computational fluid dynamics; Female; Hemodynamics - physiology; Humans; Imaging, Three-Dimensional - methods; Intracranial aneurysm; Intracranial Aneurysm - complications; Intracranial Aneurysm - surgery; Magnetic Resonance Angiography - methods; Male; Middle Aged; Multiple aneurysms; Risk; Shear Strength; Subarachnoid hemorrhage; Wall shear stress; CFD; DSA; Computational fluid dynamics; Subarachnoid hemorrhage; Intracranial aneurysm; WSS; HSA; Wall shear stress; LSA; SAH; Multiple aneurysms
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.07.009

Intracranial aneurysm rupture is associated with a high mortality and disability despite modern medical care. Multiple aneurysms occur in nearly 16% of patients, and imaging studies of naturally occurring multiple aneurysms are valuable for computational fluid dynamics studies. In this study, we describe and analyze the hemodynamic changes produced in a distal aneurysm after the treatment of a proximal aneurysm. Between January 2008 and December 2017, 24 cases of multiple intracranial aneurysms of the same vascular tree were treated in our center. Full carotid segmentations from digital subtraction angiography, computed tomography angiography, or magnetic resonance angiography were obtained, and transient pulsatile simulations were performed using computational fluid dynamics software. Output variables included maximum peak systole wall shear stress (WSS), minimum mid-diastolic WSS, maximum systolic pressure, low shear area, and high shear area both before and after treatment of the proximal aneurysm. The mean size of ruptured and unruptured aneurysms was 7.05 and 5.23 mm, respectively (P = 0.035), with respective aspect ratios of 1.22 and 2.04 (P = 0.001). Maximum peak systole WSS was lower and minimum mid-diastolic WSS was higher in unruptured aneurysms (P = 0.04 and 0.034, respectively). After treatment of the proximal aneurysm, low shear area in the distal aneurysm increased from 54.15% to 56.93% (P = 0.02). The opposite effect is noted in aneurysms with an interaneurysmal distance <10 mm. Posttreatment peak systole pressure was also increased significantly (P = 0.03). The hemodynamic changes in a distal aneurysm after treatment of a proximal aneurysm showed an unfavorable profile associated with an increased theoretical risk of bleeding. •Multiple aneurysms of the same vascular tree are rare, and there is no consensus on the most effective treatment.•Computational fluid dynamics studies are valuable in this scenario.•Treatment of a proximal intracranial aneurysm produces hemodynamic changes in a distal aneurysm.•These changes induce an unfavorable profile of hemodynamic parameters, theoretically increasing the risk of rupture.•An interaneurysmal distance <10 mm decreases the low shear area and reduces this theoretical risk of rupture.