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Abstract：
Intraprocedural rupture (IPR) during coil embolization (CE) of an intracranial aneurysm is a significant clinical concern that necessitates a comprehensive understanding of its clinical and hemodynamic predictors. Between January 2012 and December 2023, 435 saccular cerebral aneurysms were treated with CE at our institution. The inclusion criterion was extravasation or coil protrusion during CE. Postoperative data were used to confirm rupture points, and computational fluid dynamics (CFD) analysis was performed to assess hemodynamic characteristics, focusing on maximum pressure (Pmax) and wall shear stress (WSS). IPR occurred in six aneurysms (1.3%; three ruptured and three unruptured), with a dome size of 4.7 ± 1.8 mm and a D/N ratio of 1.5 ± 0.5. There were four aneurysms in the internal carotid artery (ICA), one in the anterior cerebral artery, and one in the middle cerebral artery. ICA aneurysms were treated using adjunctive techniques (three balloon-assisted, one stent-assisted). Two aneurysms (M1M2 and A1) were treated simply, yet had relatively small and misaligned domes. CFD analysis identified the rupture point as a flow impingement zone with Pmax in five aneurysms (83.3%). Time-averaged WSS was locally reduced around this area (1.3 ± 0.7 [Pa]), significantly lower than the aneurysmal dome (p < 0.01). Hemodynamically unstable areas have fragile, thin walls with rupture risk. A microcatheter was inserted along the inflow zone, directed towards the caution area. These findings underscore the importance of identifying hemodynamically unstable areas during CE. Adjunctive techniques should be applied with caution, especially in small aneurysms with axial misalignment, to minimize the rupture risk.
摘要：
颅内动脉瘤的线圈栓塞（CE）过程中的术中破裂（IPR）是一个重要的临床问题，需要对其临床和血流动力学预测因子进行全面了解。在2012年1月至2023年12月之间，我们机构对435例囊状脑动脉瘤进行了CE治疗。纳入标准是CE期间的外渗或线圈突出。术后数据用于确认破裂点，和计算流体动力学（CFD）分析进行评估血液动力学特征，重点是最大压力（Pmax）和壁面剪应力（WSS）。IPR发生在6个动脉瘤（1.3%；3个破裂和3个未破裂），圆顶尺寸为4.7±1.8mm，D/N比为1.5±0.5。颈内动脉（ICA）有四个动脉瘤，一个在大脑前动脉,一个在大脑中动脉.使用辅助技术治疗ICA动脉瘤（三个球囊辅助，一个支架辅助)。两个动脉瘤（M1M2和A1）进行了简单的治疗，然而有相对较小和错位的圆顶。CFD分析确定破裂点为5个动脉瘤中Pmax的血流冲击区(83.3%)。时间平均WSS在该区域周围局部降低(1.3±0.7[Pa]),显著低于动脉瘤圆顶(p<0.01)。血液动力学不稳定的地区有脆弱的，薄壁有破裂的风险。沿着流入区插入微导管，指向警戒区。这些发现强调了在CE期间识别血流动力学不稳定区域的重要性。辅助技术应谨慎使用，特别是在轴向错位的小动脉瘤中，将破裂风险降至最低。
