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Proximal Clipping and Distal High-Flow Bypass in the Treatment of Giant/Complex Intracranial Aneurysm: An Opportunity or a Risk from a Fluid-Structural Interaction Analysis

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Abstract

Objectives

Conventional clipping and endovascular treatment are difficult to apply for some giant intracranial aneurysms (GIAs), and sometimes extracranial-to-intracranial (EC-IC) bypass becomes the optional choice. However, not all GIA patients can benefit from it. This study aims to recognize the underlying problems.

Methods

We included eligible patients in our care. Then, we researched from three levels: a retrospective review of clinical data, fluid-structural analysis from two representative patient-specific models, and fluid-structural interaction analysis for idealized models to investigate the hemodynamic and biomechanical mechanisms.

Results

In this article, we report nine patients with GIA who underwent EC-IC surgery. Of them, three experienced dangerous postoperative hemorrhage, and one patient died. Among these three patients, two lacked the A1 segment of the anterior cerebral artery (ACA). The numerical simulation showed that after surgery, for the patient with an unruptured aneurysm and existence of ACA, the wall deformation, wall stress, pressure, and area of the oscillatory shear index (OSI) > 0.2 were decreased by 43%, 39%, 33%, and 13%, while the patient without A1 segment having postoperative hemorrhage showed 36%, 45%, 13%, and 55% increased, respectively. Thus, we postulated a dangerous “stump phenomenon” in such conditions and further demonstrated it from idealized models with different sizes of ACA. Finally, we found a larger anastomosis angle and smaller diameter of the graft can alleviate this effect.

Conclusions

Neurosurgeon should cautiously evaluate the opportunity and risk for such patients who have aplasia of the A1 segment of ACA when making clinical decisions.

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Data Availability

The original contributions presented in the study are included in the article/ Supplementary Material. Further inquiries can be directed to the corresponding authors.

Abbreviations

ACA:

Anterior cerebral artery

ALE:

Arbitrary Lagrangian–Eulerian

CFD:

Computational fluid dynamics

CTA:

Computed tomography angiography

EC-IC:

Extracranial-to-intracranial

FSI:

Fluid-structural interaction

GIAs:

Giant intracranial aneurysms

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

NURBS:

Non-Uniform Rational B-splines

OSI:

Oscillatory shear index

RA:

Radial artery

RRT:

Relative residence time

SV:

Saphenous vein

Tawss:

Time-averaged wall shear stress

WSS:

Wall shear stress

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Acknowledgement

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Funding

The authors received no financial support for the research authorship and/or publication of this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China

    Shifu Li, Zheng Huang & Fenghua Chen

  2. National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China

    Shifu Li, Zheng Huang & Fenghua Chen

  3. Research Center for Cerebrovascular Diseases, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China

    Shifu Li, Zheng Huang & Fenghua Chen

  4. Xiangya Hospital, Hypothalamic-Pituitary Research Center, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China

    Shifu Li, Zheng Huang & Fenghua Chen

  5. Department of Neurosurgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde, China

    Hua Chen

  6. Research Center for Cerebrovascular Disease, Central South University, 87 Xiangya Road, 410008, changsha, China

    Shifu Li

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Contributions

SL: made substantial contributions to the conception, design, analysis, and interpretation of data, and has drafted the manuscript. SL: made contributions to the design of the work and revision of the manuscript. SL and ZH: made contributions to the acquisition of data. HC & FC: the corresponding author, made contributions to the conception and interpretation of data and has determined the final version to be submitted for publishing. SL, ZH, HC, FC read and approved the final manuscript.

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Correspondence to Hua Chen or Fenghua Chen.

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This study was approved by the Ethics Committee of Xiangya Hospital.

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Associate Editor Jamshid Karimov, MD, PhD oversaw the review of this article.

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Li, S., Huang, Z., Chen, H. et al. Proximal Clipping and Distal High-Flow Bypass in the Treatment of Giant/Complex Intracranial Aneurysm: An Opportunity or a Risk from a Fluid-Structural Interaction Analysis. Cardiovasc Eng Tech (2023). https://doi.org/10.1007/s13239-023-00704-z

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  • DOI: https://doi.org/10.1007/s13239-023-00704-z

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