Study On Hemodynamic Changes Of Intracranial Aneurysms With Enterprise Stent-assisted Coil Embolization

Background and purpose:Intracranial aneurysms are abnormal vascular wall bulges of cerebral vessels.The prevalence rate of MRA in some communities of the Chinese population is about 7%,while that of autopsy is 1%-5%.Subarachnoid hemorrhage caused by rupture of intracranial aneurysms is one of the most serious subtypes of stroke,often manifested as sudden cerebral hemorrhage in healthy individuals,is the most common cause of non-traumatic SAH,and is a destructive event with high morbidity,mortality and disability.Intracranial aneurysms can lead to spontaneous subarachnoid hemorrhage.The mortality rate within one month is close to 50%.About one third of the surviving patients are accompanied by different degrees of neurological impairment,which poses a great threat to national health.Because of the high recurrence rate of simple coil embolization,stent-assisted therapy has been developed.The main principles of conventional metal stents such as Enterprise stents to assist coil embolization of intracranial aneurysms are as follows:1.After stent implantation,the eddy current at the neck of the aneurysm can be directly weakened,and the impact of blood flow in the parent artery on the inflow of the lateral wall of the tumor can be blocked;2.Changing the local hemodynamic direction of the parent artery is beneficial to reduce recurrence;3.The release of the metal stent can provide physical support for the creeping growth of vascular endothelial cells,which is conducive to the healing of the tumor neck.In this study,computational fluid dynamics analysis was performed before and immediately after the embolization of internal carotid artery posterior communicating aneurysms with Enterprise stent-assisted coil,and some hemodynamic parameters were selected to follow up the patients after treatment to determine whether there was recurrence of aneurysms.To reveal the hemodynamic changes of aneurysms before and after treatment,as well as the hemodynamic characteristics of recurrent aneurysms.Methods:From March 2018 to September 2021,48 cases of posterior communicating artery aneurysms of internal carotid artery were selected from the neurosurgery department of the General Hospital of Central Theater Command of the Chinese People’s Liberation Army,who were confirmed by whole-brain angiography and received Enterprise stent-assisted coil embolization.A series of software was used to carry out numerical simulation of aneurysms,and SPSS 25.0 was used to statistically analyze the data.The difference was statistically significant with P<0.05.Results:1.Comparison of hemodynamic parameters before and after operation in the non-recurrent group:after EP stent-assisted coil embolization,WSS minimum value increased,WSS maximum value decreased,WSS mean value increased,NWSS minimum value increased,maximum value decreased,mean value increased,WSSG minimum value increased,WSSG maximum value decreased,SWSSG minimum value increased,SWSSG maximum value decreased,OSI maximum value decreased,OSI mean value decreased(P<0.05).2.Comparison of hemodynamic parameters before and after operation in the recurrence group:after EP stent-assisted coil embolization,the mean value of WSSG increased and the maximum value of OSI decreased(P<0.05).3.Comparison of hemodynamic parameters after operationbetween the recurrent group and the non-recurrent group:the minimum postoperative WSS in the recurrent group is lower than that in the non-recurrent group,the minimum postoperative NWSS in the recurrent group is lower than that in the non-recurrent group,the average postoperative NWSS in the recurrent group is lower than that in the non-recurrent group,the minimum postoperative WSSG in the recurrent group is lower than that in the non-recurrent group,the maximum postoperative OSI in the recurrent group is higher than that in the non-recurrent group,and the average postoperative OSI in the recurrent group is higher than that in the non-recurrent group(P<0.05).4.The preoperative parameters hemodynamics of the recurrence group and the non-recurrence group were compared:the minimum preoperative WSS value of the recurrence group was lower than that of the non-recurrence group,the minimum preoperative NWSS value of the recurrence group was lower than that of the non-recurrence group,and the maximum preoperative OSI value of the recurrence group was higher than that of the non-recurrence group(P<0.05),the difference was statistically significant.Conclusion:Based on computational fluid dynamics numerical simulation on the hemodynamics of quantitative research,this study selected can be used as part of the hemodynamic parameters of optional parameter evaluation relapse after treatment.The clinical work to provide more detailed aneurysm hemodynamic information,has certain for preoperative and postoperative hemodynamic characteristics of patients,treatment should be more targeted,to provide the basis for the future construction of aneurysm recurrence risk assessment after treatment.