title: Recanalization, Regrowth, and Delayed Rupture of a Previously Coiled Unruptured Anterior Communicating Artery Aneurysm: A Longitudinal Hemodynamic Analysis.
abstract: BACKGROUND
  Delayed rupture of a previously coiled unruptured aneurysm is extremely rare, and no hemodynamic analysis of such aneurysms has been reported during the postprocedural course.
  
  
  METHODS
  We present a case of an initially successfully embolized, unruptured anterior communicating artery aneurysm that subsequently underwent recanalization, regrowth, and delayed rupture 35 months after embolization. We used computational fluid dynamics to determine the hemodynamics at different stages during longitudinal follow-up and to evaluate wall shear stress (WSS) and flow velocity at peak systole. We found that high-flow impingement was associated with recanalization, that regrowth as bleb formation was induced by high WSS and flow velocity, and that low WSS was a risk factor for aneurysm rupture.
  
  
  CONCLUSIONS
  Heterogeneous hemodynamic characteristics were involved in the outcomes of intracranial aneurysm after endovascular treatment. High-flow impingement and WSS were associated with recanalization and regrowth, whereas low WSS was associated with aneurysm rupture.
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Linkai
authors.initials: L
authors.lastname: Jing
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: yang-xj@163.net.
authors.forename: Xinjian
authors.initials: X
authors.lastname: Yang
mesh_terms: D017542:Aneurysm, Ruptured / Q000517:prevention & control*; D015901:Angiography, Digital Subtraction; D003198:Computer Simulation; D004621:Embolization, Therapeutic / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008954:Models, Biological
keywords: Hemodynamics; Intracranial aneurysms; Recanalization; Regrowth; Rupture