Prediction of Post-Embolization Recurrence of Anterior Communicating Aneurysms with A1 Segment Asymmetry by Fluid Dynamic Analysis

Kouichi Misaki; Takehiro Uno; Iku Nambu; Akifumi Yoshikawa; Tomoya Kamide; Naoyuki Uchiyama; Mitsutoshi Nakada

doi:10.5797/jnet.oa.2020-0021

Prediction of Post-Embolization Recurrence of Anterior Communicating Aneurysms with A1 Segment Asymmetry by Fluid Dynamic Analysis

J Neuroendovasc Ther. 2021;15(2):71-76. doi: 10.5797/jnet.oa.2020-0021. Epub 2020 Sep 8.

Authors

Kouichi Misaki¹, Takehiro Uno¹, Iku Nambu¹, Akifumi Yoshikawa¹, Tomoya Kamide¹, Naoyuki Uchiyama¹, Mitsutoshi Nakada¹

Affiliation

¹ Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan.

Abstract

Objective: The increased surface pressure of the coil mass calculated by computational fluid dynamics (CFD) analysis has been reported to be associated with the recurrence of internal carotid aneurysms after coil embolization. In this study, we investigated the relationship between the pressure on the coil surface and the recurrence of anterior communicating aneurysms.

Methods: Among patients with anterior communicating aneurysms who underwent coil embolization at a volume embolization rate of 20% or more without using a stent, only one proximal anterior communicating artery (A1) was visualized by magnetic resonance angiography (MRA). A virtual post-coiling model was created by eliminating the aneurysm at the neck position from the blood vessel model based on three-dimensional rotational angiography (3D-RA) data before treatment, and the neck plane was defined as the virtual coil plane. Using CFD analysis, the pressure difference (PD) was calculated by subtracting the average pressure of A1 from the maximum pressure on the virtual coil surface and dividing by the dynamic pressure of A1 for normalization. PD was statistically compared between the recurrent group and the non-recurrent group.

Results: Four of 10 patients with anterior communicating aneurysms exhibited recurrence. The PD was 2.54 ± 0.24 and 2.12 ± 0.26 in the recurrent and non-recurrent groups, respectively, and was significantly higher in the recurrent group (p=0.038). In the receiver operating characteristics (ROC) analysis, the area under the curve (AUC) was 0.917, and with a cutoff value of 2.31, the sensitivity was 1.000 and the specificity was 0.833.

Conclusion: PD was considered a predictor of recurrence after coil embolization in anterior communicating aneurysms with asymmetrical A1. Preoperative prediction of recurrence after cerebral aneurysm embolization may be possible using CFD analysis.

Keywords: cerebral aneurysm; coil embolization; computational fluid dynamics; pressure difference; recurrence after coil embolization.