Higher oscillatory shear index is related to aneurysm recanalization after coil embolization in posterior communicating artery aneurysms.

Abstract

The recurrence rate of posterior communicating artery (Pcom) aneurysms after endovascular treatment (EVT) is higher than that for aneurysms located in other sites. However, it is still unclear what mechanisms are responsible for the recanalization of cerebral aneurysms. In this investigation, we compared hemodynamic factors related with recanalization of Pcom aneurysms treated by endoluminal coiling using computational fluid dynamics (CFD) with high-resolution three-dimensional digital subtraction angiography images. Twenty patients were enrolled. A double-sinogram acquisition was performed with and without contrast injection after coil embolization to get true blood vessel lumen by relatively complementing the first sinogram with the second. Adaptive Cartesian meshing was performed to produce vascular wall objects for CFD simulation. The boundary condition for inlet (ICA) was set for dynamic velocity according to the cardiac cycle (0.8s). Hemodynamic parameters were recorded at two specific points (branching point of Pcom and residual sac). The peak pressure, peak WSS, and oscillatory shear index (OSI) were recorded and analyzed. The median age was 61.0years, and 18 patients (90%) were female. During a median follow-up of 12months, seven (35%) treated aneurysms showed recanalization. The median aneurysm volume was significantly higher, and aneurysm height and neck sizes were significantly longer in the recanalization group than those in the stable group. At the branching point of the Pcom, the peak pressure, peak WSS, or OSI did not significantly differ between the two groups. The only statistically significant hemodynamic parameter related with recanalization was the OSI at the aneurysm point. Multivariate logistic regression showed that with an increase of 0.01 OSI at the aneurysm point, the odds ratio for the aneurysm recanalization was 1.19. A higher OSI is related with recanalization after coil embolization for a Pcom aneurysm.