Analysis of Multiple Intracranial Aneurysms with Different Outcomes in the Same Patient After Endovascular Treatment

Abstract

Aneurysm recanalization after coiling, with or without stent assistance, is a major issue in the endovascular management of intracranial aneurysms. Multiple intracranial aneurysms with different outcomes after endovascular treatment may represent a useful disease model in which patient-specific risk factors can be balanced to investigate possible features linked to aneurysm recanalization. In the present study, we evaluated the impact of aneurysm-specific, treatment-related, and hemodynamics-related factors on multiple aneurysms and to explore the reason why one aneurysm recanalized and the other did not. Between 2010 and 2015, 763 multiple intracranial aneurysms in 326 patients were diagnosed by digital subtraction angiography. We retrospectively collected and analyzed 13 pairs of multiple aneurysms with different outcomes (recanalized or stable) in the same patient. Patient-specific models were constructed and analyzed by a computational fluid dynamics method. The virtual stent deployment method was used, and the coils were simulated by a porous medium model. Factors were evaluated for significance with respect to recanalization. Aneurysm size (P= 0.021), neck width (P=0.027), ruptured aneurysms (P= 0.002), reduction ratio of averaged velocity (P= 0.008), and wall shear stress (P= 0.024) were significantly associated with aneurysm recanalization. By contrast, the aneurysm location, all of treatment-related factors (packing density, duration of follow-up, stent use, initial angiographic result) and the reduction ratio of averaged pressure were not significantly associated (P > 0.05). Small aneurysm size and neck width, unruptured aneurysm, and perianeurysmal hemodynamics with marked reduction may be important factors associated with the midterm durability of aneurysm embolization.