Article Figures & Data
Figures
- Fig 1.
Digital subtraction angiography. A, Left vertebral DSA (lateral view). The giant aneurysm at the VBJ is depicted. The lesion presented an almost spherical shape and a large neck, measuring 14 mm. B, Left vertebral DSA (anterior view). The GA shifted the basilar artery to the right side. C–D, Endovascular treatment, Part 1. Left vertebral DSA (lateral view). E–F, Aneurysm recanalization and endovascular treatment, Part 2. F, Left vertebral DSA (anterior view).
- Fig 2.
Numeric models of the VBJ GA. A, Outset GA with blood flow (red area). B–C, Endovascular treatment, Part 1. B, Early phase of the embolization treatment. The dome of the aneurysm was filled with coils (through the porous medium material; yellow area) and the neck region with blood flow (red area). C, Late phase of embolization process. The model was divided into 3 regions: 1) a superior half, with attenuated packing of coils (black area); 2) an inferior half (yellow area) with less packing of coils; and 3) the neck region (red area), with blood flow. D–E, Aneurysm recanalization and endovascular treatment, Part 2. The model of the GA was equally increased to 10%. These models have been simulated as being completely filled by a solid material (black region), except at the neck region. E, The model was built without the right VA.
- Fig 3.
Streamlines, velocity magnitude, and viscosity distributions. A, Streamlines (lateral views). A1, The blood flow formed rotating vortices at the inflow zone. A2, The attenuation of the coils inside the aneurysm provided a reduction of the swirling structure of the blood flow. A3, The vortex structure of the flow was squeezed and limited to the inferior half and to the neck region of the aneurysm. A4 and A5, Blood flow inside the aneurysm was reduced to a value of zero. No flow changes occurred with the suppression of the right VA. B, Velocity magnitude (cross-sectional views). B1, The highest velocity of the blood flow was found at the neck region. B2, Although coils occupied only a small part of the aneurysm, they induced significant disturbances in flow. B3, The velocity magnitude of the blood flow remained constantly high at the neck region. B4 and B5, These models have been simulated as being completely solid; therefore, the velocity magnitude was zero. C, Viscosity (cross-sectional views). C1, The apparent viscosity at the central area was elevated, whereas it was very low at the neck region. C2, The viscosity of the blood was increased in the central area. C3, The inferior half of the aneurysm presented a decreased viscosity. C4 and C5, In the neck region, where blood flow was still simulated, a very low viscosity was seen.
- Fig 4.
Static pressure and wall shear stress distributions. A1 and B1, Hot spots of high static pressure and WSS were observed on the posteromedial surface of the right half of the outset aneurysm, in proximity to the VBJ. A2 and B2, The hot spots of static pressure and WSS decreased along the posteromedial surface of the right half of the aneurysm. A3 and B3, The hot spots of static pressure and WSS moved to the posteromedial surface of the right half of the aneurysm and to the neck region, and their values increased. A4 and A5 and B4 and B5, At the neck region, the hot spots of static pressure and WSS were larger and higher.
