Blood Flow Into Basilar Tip Aneurysms: A Predictor for Recanalization After Coil Embolization.
Hemodynamic forces may play a role in the recanalization of coiled aneurysms. The purpose of this study was to investigate the influence of presurgical hemodynamics on the efficacy of coil embolization for basilar tip aneurysms.



We identified 82 patients who underwent endovascular coil embolization for basilar tip aneurysms with a follow-up of >1 year. Presurgical hemodynamics were investigated using computational fluid dynamics with 3-dimensional data derived from rotational angiography. During postprocessing, we quantified the rate of net flow entering the aneurysm through its neck and calculated the proportion of the aneurysmal inflow rate to the basilar artery flow rate. In addition, we investigated the correlation between the basilar bifurcation configuration and the hemodynamics.



Twenty-five of the 82 patients were excluded because of difficult vascular geometry reconstruction. Among the 57 examined patients, angiographic recanalization was observed in 19 patients (33.3%). The proportion of the aneurysmal inflow rate to the basilar artery flow rate and a coil packing density <30% were independent and significant predictors for the recanalization of coiled aneurysms. Additional investigation revealed that a small branch angle formed by the basilar artery and the posterior cerebral artery increased blood flow into the aneurysm.



The proportion of the aneurysmal inflow rate to the basilar artery flow rate, influenced by the basilar bifurcation configuration, was an independent and significant predictor for recanalization after coil embolization in basilar tip aneurysms.
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan. sugiyama@nsg.med.tohoku.ac.jp.
Shin-Ichiro
S
Sugiyama
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Kuniyasu
K
Niizuma
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Kenichi
K
Sato
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Sherif
S
Rashad
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Misaki
M
Kohama
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Hidenori
H
Endo
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Toshiki
T
Endo
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Yasushi
Y
Matsumoto
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Makoto
M
Ohta
From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan.
Teiji
T
Tominaga
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000503:physiopathology / Q000601:surgery*; D003198:Computer Simulation; D004621:Embolization, Therapeutic; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular
hemodynamics; intracranial aneurysm; recurrence; rest; risk factor