Quantitative evaluation of hemodynamic changes in aneurysm sacs of intracranial aneurysms after PED treatment alone and its relationship with aneurysm occlusion

FENG Jun-qiang; YOU Wei; TANG Yu-di; LI You-xiang; WANG Yang

doi:10.13798/j.issn.1009-153X.2024.04.002

Abstract：Objective To investigate the changes of blood flow dynamics in aneurysm sacs of intracranial aneurysms after Pipeline embolization device(PED)treatment alone and its correlation with aneurysm occlusion.Methods The clinical data and DSA imaging data of 63 patients(68 aneurysms)who underwent PED treatment alone from January 2016 to December 2020 were retrospectively collected.The center of aneurysm sac and the point of parent artery at 2 cm proximal to aneurysm neck(reference point)were selected as the regions of interest.A self-developed Python-based program was used to perform angiographic parameter imaging analysis using the DSA data,obtaining the time-density curve to calculate hemodynamic parameters and their rates of change(△),including the mean transit time(MTT),time to peak(TTP),peak high(PH),area under the curve(AUC),and full width at half maximum(FWHM).Results A total of 68 PEDs was uesed in 68 aneurysms,of which 52 aneurysms(76.5%)were completely occluded and 16 aneurysms(23.5%)were not completely occluded at 6 months after treatment.The API analysis showed that the FWHM at the reference point was significantly prolonged(P<0.05),and the hemodynamic parameters in the aneurysm sac,including TTP,FWHM,and MTT,were significantly prolonged(P<0.05)and the PH was significantly lower(P<0.05).Compared with the reference point,the hemodynamic changes in the aneurysm sac after treatment were more significant(P<0.05).The hemodynamic parameters in the aneurysm sacs of completely occluded aneurysms changed significantly after treatment,with TTP,FWHM,and MTT being significantly prolonged(P<0.05)and the PH being significantly lower(P<0.05).However,there were no significant changes in the hemodynamic parameters within the aneurysm sacs of incompletely occluded aneurysms(P>0.05).After surgery,the TTP,FWHM,and MTT within the 68 aneurysms were prolonged by 22.8%,36.0%,and 25.0%,respectively;the TTP,FWHM,and MTT within the 52 completely occluded aneurysms were prolonged by 43.9%,53.0%,and 38.3%,respectively.ROC curve analysis showed that∆MTT,∆TTP,and∆FWHM had certain predictive value for the occlusion of intracranial aneurysms at 6 months after PED treatment alone,and the predicting effect of the combination of thses parameters was better.Conclusions The occlusion of intracranial aneurysms after PED treatment alone are related to the slowdown of blood flow within the aneurysms.The API technology has good feedback on the real blood flow effect and can quantitatively characterize the changes in blood flow information.It can predict the occlusion of intracranial aneurysms after PED treatment alone.