Three-dimensional blood flow analysis in a wide-necked internal carotid artery—ophthalmic artery aneurysm

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Object. The aim of this study was to evaluate axial and secondary flow structures in a wide-necked internal carotid artery—ophthalmic artery aneurysm, one of the most common locations for endovascular coil placement.

Methods. A clear acrylic aneurysm model was manufactured from a three-dimensional computerized tomography angiogram. Intraaneurysm blood flow analysis was conducted using an acrylic aneurysm model together with laser Doppler velocimetry and particle imaging velocimetry. The maximal axial blood flow velocities in the inflow and outflow zones at the aneurysm orifice were noted at the peak systolic phase, measuring 46.8 and 24.9% of that in the parent artery, respectively. The mean size of the inflow zone during one cardiac cycle was 44.3 ± 9.8% (range 35.6–58.7%) the size of the axial section at the aneurysm orifice. In the lower and upper planes of the aneurysm dome, the mean size of inward and outward flow areas were 43.3 ± 6.7% and 43.8 ± 6.8% the size of the axial cross-sectional plane, respectively. The axial flow velocity structures were dynamically altered throughout the cardiac cycle, particularly at the aneurysm orifice. The fastest secondary flow at the opening was also noted at the peak systolic and early diastolic phases. Axial blood flow velocity was slower in the upper axial plane of the aneurysm dome than in the lower one. Conversely, the secondary flow component was faster in the upper plane.

Conclusions. The side-wall aneurysm in this study did not demonstrate a simple flow pattern as was previously seen in ideally shaped experimental aneurysms in vitro and in vivo. The flow patterns of inflow and outflow zones were very difficult to predict based on the limited flow information provided on standard digital subtraction angiography, even in an aneurysm with a relatively simple dome shape.

Article Information

Address reprint requests to: Satoshi Tateshima, M.D., Division of Interventional Neuroradiology, Department of Radiological Sciences, University of California at Los Angeles Medical Center and David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, CHS Room B7-146B, Los Angeles, California 90095–1721. email: stateshima@mednet.ucla.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    A 3D CT angiogram demonstrating the circle of Willis with a left ICA—OphA aneurysm (arrow), superoinferior view.

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    Left: A CT angiography study converted into 3D surface data demonstrating an ICA—OphA aneurysm with the parent artery, anteroposterior view. Center: Photograph depicting a male cast of the ICA—OphA aneurysm that was manufactured with the use of stereolithography. The distal M1 segment (arrow) of the MCA was cut off prior to the creation of an actual test section. Right: Photograph depicting an actual test section made of clear acrylic plastic (female cast), anteroposterior view. This section was created using the male cast of the ICA—OphA aneurysm as a mold. One inlet tube was connected to the ICA, and the aneurysm (arrow) appears between two outlet tubes connected to the ACA and the MCA.

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    One cardiac cycle (4 seconds) was divided into six phases. Black and red lines indicate inward and outward flows, respectively. Upper: Illustrations of isovelocity contours demonstrating the alteration in axial flow velocity at the aneurysm orifice during one cardiac cycle. The contour pitch was 0.5 cm/second. Two outflow zones were seen at t = 0.35, and two inflow zones from t = 2.48 through t = 3.89. Lower: Illustrations of vectors revealing the alteration in the secondary flow component at the aneurysm orifice during one cardiac cycle. Dis = distal; L = lateral; M = medial; Pr = proximal; t = time.

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    One cardiac cycle (4 seconds) was divided into six phases. Axial and secondary flow structures in the upper axial plane of the aneurysm dome are featured. Upper: Illustrations of isovelocity contours demonstrating the axial flow velocity pattern in the upper plane of the aneurysm dome. The contour pitch was 0.5 cm/second. Lower: Illustrations of the alteration in the secondary flow component in the upper plane of the aneurysm dome during one cardiac cycle. See Fig. 3 for explanation of abbreviations.

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    Illustrations demonstrating the alteration in the flow velocity pattern in the midsagittal plane of the aneurysm during one cardiac cycle. See Fig. 3 for explanation of abbreviations.

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