• José Luis Thenier-Villa, Antonio Riveiro Rodríguez, Rosa María Martínez-Rolán, Miguel Gelabert-González, Pedro Miguel González-Vargas, Raúl Alejandro Galarraga Campoverde, Jorge Díaz Molina, Adolfo De La Lama Zaragoza, Pedro Martínez-Cueto, Juan Pou, and Cesáreo Conde Alonso.
• Department of Neurosurgery, University Hospital Complex of Vigo, Vigo, Spain; Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Spain. Electronic address: jose.luis.thenier.villa@sergas.es.
• World Neurosurg. 2018 Oct 1; 118: e631-e638.

BackgroundIntracranial aneurysm rupture is associated with a high mortality and disability despite modern medical care. Multiple aneurysms occur in nearly 16% of patients, and imaging studies of naturally occurring multiple aneurysms are valuable for computational fluid dynamics studies. In this study, we describe and analyze the hemodynamic changes produced in a distal aneurysm after the treatment of a proximal aneurysm.MethodsBetween January 2008 and December 2017, 24 cases of multiple intracranial aneurysms of the same vascular tree were treated in our center. Full carotid segmentations from digital subtraction angiography, computed tomography angiography, or magnetic resonance angiography were obtained, and transient pulsatile simulations were performed using computational fluid dynamics software. Output variables included maximum peak systole wall shear stress (WSS), minimum mid-diastolic WSS, maximum systolic pressure, low shear area, and high shear area both before and after treatment of the proximal aneurysm.ResultsThe mean size of ruptured and unruptured aneurysms was 7.05 and 5.23 mm, respectively (P = 0.035), with respective aspect ratios of 1.22 and 2.04 (P = 0.001). Maximum peak systole WSS was lower and minimum mid-diastolic WSS was higher in unruptured aneurysms (P = 0.04 and 0.034, respectively). After treatment of the proximal aneurysm, low shear area in the distal aneurysm increased from 54.15% to 56.93% (P = 0.02). The opposite effect is noted in aneurysms with an interaneurysmal distance <10 mm. Posttreatment peak systole pressure was also increased significantly (P = 0.03).ConclusionsThe hemodynamic changes in a distal aneurysm after treatment of a proximal aneurysm showed an unfavorable profile associated with an increased theoretical risk of bleeding.Copyright © 2018 Elsevier Inc. All rights reserved.

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