Introduction

Delayed intraparenchymal hemorrhage is a known complication of the Pipeline Embolization device (PED); however, its etiology is unclear and some have suggested it is a flow related phenomenon. Quantitative magnetic resonance angiography (QMRA) serves as a powerful tool to collect and analyze hemodynamic data. We report a detailed characterization of short-term hemodynamics after PED placement.

Methods

Patients who underwent PED placement for a distal internal carotid artery (ICA) aneurysm between 2017 to 2019 with post embolization QMRA were reviewed. Aneurysm characteristics, flow volume rate (ml/min), mean, systolic, and diastolic flow velocities (cm/s), vessel diameter (mm), pulsatility index, Lindegaard ratio, and wall shear stress (WSS) were collected.

Results

A total of 67 patients were included. Post-procedure patients were found to have a significantly lower ICA flow on the side with flow diversion when compared to the side without flow diversion (218 vs. 236.3; P < 0.05). Average ICA flow after flow diversion for aneurysms >2 cm was significantly lower when compared to the untreated side (187.7 vs. 240.4; P < 0.05). There was no difference in MCA or ACA flow or velocity. WSS was significantly lower in the treated ICA (8.2 vs. 9.0; P < 0.05). Lindegaard ratio was not different in the treated vs. contralateral untreated sides.

Conclusion

PED placement for distal ICA aneurysms results in lower flow, mean velocity, and WSS when compared to the contralateral untreated ICA. This is not demonstrated distal to the Pipeline device in the ACA or MCA territories. Ultimately these findings suggest hemodynamic changes are not a cause of PED complications.

中文翻译：

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定量磁共振血管造影评估管道栓塞后栓塞后血流动力学

介绍

迟发性脑实质内出血是管道栓塞装置 (PED) 的已知并发症；然而，其病因尚不清楚，有人认为这是一种与血流有关的现象。定量磁共振血管造影 (QMRA) 是收集和分析血液动力学数据的有力工具。我们报告了 PED 放置后短期血流动力学的详细特征。

方法

回顾了 2017 年至 2019 年间接受 PED 植入远端颈内动脉 (ICA) 动脉瘤并进行栓塞后 QMRA 的患者。收集了动脉瘤特征、流速 (ml/min)、平均、收缩和舒张流速 (cm/s)、血管直径 (mm)、搏动指数、林德加比和壁面剪切应力 (WSS)。

结果

总共包括 67 名患者。与没有分流的一侧相比，术后患者在有分流的一侧的 ICA 流量显着降低（218 对 236.3；P  < 0.05）。与未治疗侧相比，大于 2 cm 的动脉瘤分流后的平均 ICA 流量显着降低（187.7 对 240.4；P  < 0.05）。MCA 或 ACA 流量或速度没有差异。经治疗的 ICA 患者的 WSS 显着降低（8.2 与 9.0；P  < 0.05）。Lindegaard 比率在治疗侧与对侧未治疗侧没有差异。

结论

与对侧未经治疗的 ICA 相比，远端 ICA 动脉瘤的 PED 放置导致较低的流量、平均速度和 WSS。这在 ACA 或 MCA 地区的管道设备远端并未得到证明。最终，这些发现表明血流动力学变化不是 PED 并发症的原因。