A case of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage evaluated using computational fluid dynamics: Which is the rupture side?

IF 1.3 Q4 CLINICAL NEUROLOGY

Brain Hemorrhages Pub Date : 2025-02-01 DOI:10.1016/j.hest.2024.04.006

Masanori Tsuji , Fujimaro Ishida , Ryuta Yasuda , Tomonori Ichikawa , Takenori Sato , Kazuhiro Furukawa , Yoichi Miura , Yasuyuki Umeda , Naoki Toma , Hidenori Suzuki

{"title":"A case of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage evaluated using computational fluid dynamics: Which is the rupture side?","authors":"Masanori Tsuji , Fujimaro Ishida , Ryuta Yasuda , Tomonori Ichikawa , Takenori Sato , Kazuhiro Furukawa , Yoichi Miura , Yasuyuki Umeda , Naoki Toma , Hidenori Suzuki","doi":"10.1016/j.hest.2024.04.006","DOIUrl":null,"url":null,"abstract":"<div><div><em>Background:</em> Saccular aneurysms (SAs) have been long studied in hemodynamics using computational fluid dynamics (CFD), while dissecting aneurysms (DAs) remain unclear. To estimate which side of the aneurysm ruptured, we evaluated the hemodynamics of the bilateral vertebral artery DAs (VADAs).</div><div><em>Case presentation:</em> A 44-year-old male was diagnosed with subarachnoid hemorrhage by the rupture of either side of bilateral VADAs. The rupture side could not be determined on admission (Day 0). CFD was performed using a patient-specific geometry model obtained from 3-demensional (3D) rotational angiography (RA) on day 1. We predicted that the right DA had ruptured based on the hemodynamics, associated with flow stagnation and complexity in the ruptured SAs by a transient analysis with the patient-specific blood flow velocity waveforms. After careful observation, gadolinium-enhanced MRI on day 16 showed a contrast effect in the right wall and a change in the right shape was confirmed on the second 3D RA on day 17. According to both imaging evaluations and CFD, the right was presumed to be ruptured, and a flow-diverter stent was placed at the right VA. The right VADA did not re-rupture for 12 months.</div><div><em>Conclusion:</em> Our results indicated that hemodynamics of ruptured DAs would be similar to that of ruptured SAs.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"6 1","pages":"Pages 57-60"},"PeriodicalIF":1.3000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain Hemorrhages","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589238X24000330","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Saccular aneurysms (SAs) have been long studied in hemodynamics using computational fluid dynamics (CFD), while dissecting aneurysms (DAs) remain unclear. To estimate which side of the aneurysm ruptured, we evaluated the hemodynamics of the bilateral vertebral artery DAs (VADAs).

Case presentation: A 44-year-old male was diagnosed with subarachnoid hemorrhage by the rupture of either side of bilateral VADAs. The rupture side could not be determined on admission (Day 0). CFD was performed using a patient-specific geometry model obtained from 3-demensional (3D) rotational angiography (RA) on day 1. We predicted that the right DA had ruptured based on the hemodynamics, associated with flow stagnation and complexity in the ruptured SAs by a transient analysis with the patient-specific blood flow velocity waveforms. After careful observation, gadolinium-enhanced MRI on day 16 showed a contrast effect in the right wall and a change in the right shape was confirmed on the second 3D RA on day 17. According to both imaging evaluations and CFD, the right was presumed to be ruptured, and a flow-diverter stent was placed at the right VA. The right VADA did not re-rupture for 12 months.

Conclusion: Our results indicated that hemodynamics of ruptured DAs would be similar to that of ruptured SAs.

查看原文本刊更多论文

利用计算流体动力学评估一例伴有蛛网膜下腔出血的双侧椎动脉剥离性动脉瘤：哪一侧破裂？

背景：利用计算流体动力学（CFD）对囊状动脉瘤（SAs）进行了长期的血流动力学研究，而解剖性动脉瘤（DAs）尚不清楚。为了估计哪一侧动脉瘤破裂，我们评估了双侧椎动脉DAs （VADAs）的血流动力学。病例介绍：一名44岁男性被诊断为蛛网膜下腔出血两侧vada破裂。入院时（第0天）无法确定破裂侧。第1天使用三维旋转血管造影（RA）获得的患者特定几何模型进行CFD。通过对患者特异性血流速度波形的瞬态分析，我们预测右侧DA已经破裂，与破裂的sa中的血流停滞和复杂性有关。经过仔细观察，第16天的钆增强MRI显示右壁造影剂效果，第17天的第二次3D RA证实右形状改变。根据影像学评估和CFD，推定右侧VADA破裂，在右侧VADA放置分流支架。右侧VADA 12个月未再次破裂。结论：肝动脉破裂的血流动力学与肝动脉破裂的血流动力学相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊