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Vascular responses to abrupt blood flow change after bypass surgery for complex intracranial aneurysms

Abstract

Background

Bypass surgery for complex intracranial aneurysms (IAs) results in drastic blood flow changes in intracranial arteries. The aim of the study was to elucidate how vessels adapt to blood flow changes after bypass surgery with phase-contrast magnetic resonance imaging (PC-MRI).

Methods

This is a prospective observational study to assess changes of the blood flow in intracranial arteries after bypass surgery for IAs. Flow rates and vessel diameters were measured with PC-MRI in 52 intracranial arteries of 7 healthy volunteers and 31 arteries of 8 IA patients who underwent bypass surgery. Wall shear stress (WSS) was calculated with the Hagen-Poiseuille formula. In 18 arteries of 5 patients, the same measurement was performed 1, 3, and 12 months after surgery.

Results

PC-MRI showed a strong positive correlation between the flow rate and the third power of vessel diameter in both healthy volunteers (r = 0.82, P < 0.0001) and IA patients (r = 0.90, P < 0.0001), indicating the constant WSS. Of the 18 arteries in 5 patients, WSS increased in 7 arteries and decreased in 11 arteries immediately after surgery. In the WSS-increased group, WSS returned to the preoperative value in the third postoperative month. In the WSS-decreased group, WSS increased in the 12th month, but did not return to the preoperative level.

Conclusions

In a physiological state, WSS was constant in intracranial arteries. Changed WSS after bypass surgery tended to return to the preoperative value, suggesting that vessel diameter and flow rate might be controlled so that WSS remains constant.

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Abbreviations

IA:

Intracranial aneurysm

PC-MRI:

Phase-contrast magnetic resonance imaging

WSS:

Wall shear stress

EC-IC bypass:

Extracranial-intracranial bypass

RA:

Radial artery

SV:

Saphenous vein

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

STA:

Superficial temporal artery

SCA:

Superior cerebellar artery

NEX:

Number of excitations

VENC:

Velocity encoding

FOV:

Field of view

ANOVA:

Analysis of variance

EC:

Endothelial cell

SMC:

Smooth muscle cell

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Acknowledgements

The authors would like to thank Yoshifumi Hayashi M.D. and Hirotaka Yoshida M.D. at Kitahara International Hospital, Tokyo, Japan, for PC-MRI measurements of healthy volunteers.

Funding

This work was supported in part by Grants-in-aid for Scientific Research (grant numbers: 24592150 and 15H04952) from the Japan Society for the Promotion of Science and The Ministry of Education, Culture, Sports, Science, and Technology of Japan.

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Correspondence to Hiroharu Kataoka.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. This study was approved by the Institutional Review Board at our institutes.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This article is part of the Topical Collection on Vascular Neurosurgery – Aneurysm

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Kataoka, H., Makino, Y., Takanishi, K. et al. Vascular responses to abrupt blood flow change after bypass surgery for complex intracranial aneurysms. Acta Neurochir 160, 1945–1953 (2018). https://doi.org/10.1007/s00701-018-3653-2

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  • DOI: https://doi.org/10.1007/s00701-018-3653-2

Keywords

  • Intracranial aneurysm
  • Bypass surgery
  • Phase contrast
  • Magnetic resonance imaging
  • Wall shear stress