Hemodynamic Effects

Hemodynamic stress has been implicated in the formation, growth, and rupture of intracranial aneurysms. GDC treatment of aneurysms is effective in reducing the rebleeding rate. Animal studies have shown that coiling of intracranial aneurysms does not reduce the mean intraaneurysmal pressure (34,35). However, GDC treatment was shown to dampen the pressure amplitude and delayed pressure increases during locally induced hypertension (36). Moreover, the intraaneurysmal flow was significantly reduced even after incomplete treatment with GDC (37). Graves et al. (38) investigated the flow dynamics of lateral carotid aneurysms and their effects on coils and balloons in an experimental canine model. They found that the inflow zone at the distal aspect of the aneurysm ostium is a major determining factor in the placement and stability of coils in aneurysms. Modification of the inflow zone can be used to promote aneurysmal thrombosis. The distal neck of the aneurysm is exposed to the highest shear stress pressures, and its obliteration is crucial whether the aneurysm is being surgically or endovascularly treated (39).

The 3D angiography (3DA) data can be used as the basis for computational simulation of intraaneurysmal flow in order to elucidate the patient-specific aneurysm hemodynamic information (40). It is hoped that in the future it will be possible to use these simulations for patient triage to therapy.

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