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Impact of cerebral aneurysm size on distal intracranial hemodynamics and changes following flow diversion
Interventional Neuroradiology ( IF 1.7 ) Pub Date : 2021-08-23 , DOI: 10.1177/15910199211032467
Denise Brunozzi 1 , Alfred See 1 , Mark Rizko 1 , Jason Choi 1 , Gursant Atwal 1 , Ali Alaraj 1, 2
Affiliation  

Background

The impact of cerebral aneurysm size on distal intracranial hemodynamics such as arterial pressure and Pulsatility Index is not completely understood, either before or after flow diversion.

Objective

The aim of the study is to assess the impact of aneurysm size on distal Pulsatility Index and pressure before and after flow diversion.

Methods

From December 2015, prospective measurement of middle cerebral artery pressure and Pulsatility Index was performed in consecutive patients with unruptured cerebral aneurysms in the cavernous to communicating segments of the internal carotid artery, which were treated with single flow diversion. Pressure and Pulsatility Index were recorded at the M1-segment ipsilateral to the cerebral aneurysm. Ratio of middle cerebral artery to radial arterial pressure (pressure ratio) was calculated to control for variations in systemic blood pressure. Correlations between aneurysm size and pressure ratio and Pulsatility Index were assessed before and after treatment.

Results

A total of 28 aneurysms were treated. The mean aneurysm size was 7.2 mm. Aneurysm size correlated linearly with systolic pressure ratio (1% pressure ratio increase per mm aneurysm size increase, P = 0.002, r2 = 0.33), mean pressure ratio (0.6% per mm, P = 0.03, r2 = 0.17) and Pulsatility Index (5% Pulsatility Index increase per mm, P = 0.003, r2 = 0.43). After flow diversion, aneurysm size preserved a linear correlation with the systolic pressure ratio (1% per mm, P = 0.004, r2 = 0.28), but not with the mean pressure ratio (0.4% per mm, P = 0.15, r2 < 0.1) or Pulsatility Index (0.3% per mm, P = 0.78, r2 < 0.1).

Conclusion

Aneurysm size affects distal hemodynamics: patients with larger aneurysms have increased systolic and mean pressure ratio, and increased Pulsatility Index. After flow diversion, mean pressure ratio and Pulsatility Index no longer associate with the aneurysm size, suggesting an effect of the flow diversion also on distal intracranial hemodynamics.



中文翻译:

脑动脉瘤大小对远端颅内血流动力学的影响和分流后的变化

背景

无论是在分流之前还是之后,脑动脉瘤大小对动脉压和搏动指数等远端颅内血流动力学的影响尚不完全清楚。

客观的

该研究的目的是评估动脉瘤大小对远端搏动指数和分流前后压力的影响。

方法

从 2015 年 12 月开始,对颈内动脉海绵体至交通段未破裂脑动脉瘤的连续患者进行了大脑中动脉压力和搏动指数的前瞻性测量,这些患者接受了单流分流治疗。在脑动脉瘤同侧的 M1 段记录压力和搏动指数。计算大脑中动脉与桡动脉压力的比率(压力比)以控制全身血压的变化。在治疗前后评估动脉瘤大小和压力比以及搏动指数之间的相关性。

结果

总共治疗了 28 个动脉瘤。平均动脉瘤大小为 7.2 毫米。动脉瘤大小与收缩压比(每毫米动脉瘤尺寸增加 1% 压力比增加,P  = 0.002,r 2  = 0.33)、平均压力比(每毫米 0.6%,P  = 0.03,r 2  = 0.17)和脉动性呈线性相关指数(每毫米增加 5% 的搏动指数,P  = 0.003,r 2  = 0.43)。分流后,动脉瘤大小与收缩压比(每毫米 1%,P  = 0.004,r 2 = 0.28)保持线性相关,但与平均压力比(每毫米 0.4%,P  = 0.15,r 2  < 0.1) 或搏动指数(每毫米 0.3%,P  = 0.78,r 2  < 0.1)。

结论

动脉瘤大小影响远端血流动力学:动脉瘤较大的患者收缩压和平均压力比增加,搏动指数增加。分流后,平均压力比和搏动指数不再与动脉瘤大小相关,表明分流对远端颅内血流动力学也有影响。

更新日期:2021-08-24
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