Introduction: We present the largest prospective cohort of intra-saccular pressure recordings of ruptured and non-ruptured intracranial aneurysms.
Methods: Aneurysmal dome pressure was collected using a standard 1.8 Fr micro-catheter which was navigated into the dome of the aneurysm under continuous roadmap and fluoroscopic guidance taking care to avoid placement against the wall and past the neck. Once in place, a transducer was attached to the proximal end of the micro-catheter to measure stump pressures for an estimated 60 seconds and only considered valid when clear systole and diastole profiles were observed. Transducer re-zeroing and line re-prepping was performed in the absence of systole and diastole profiles to confirm invalid data prior to data exclusion.
Results: A prospective cohort of 38 patients were included in the study. 8 patients' data were discarded due to poor waveform during measurement. Of the remaining 30 patients, 14 presented with ruptured aneurysms while 16 were elective non-ruptured cases. The mean pulse pressure in non-ruptured cases was 21.7 with standard deviation of 17.0 compared to mean of 5.8 and standard deviation of 5.0 in ruptured cases. In addition the average systolic aneurysm pressure was 91% of the systolic blood pressure in non-ruptured cases compared to 78% in ruptured cases.
Conclusions: There is a significant difference noted in systolic and overall pulse pressures between ruptured and non-ruptured aneurysm groups with P = 0.05 and 0.005 respectively. This finding could be due to rupture effect phenomenon in which case this technique could aid in differentiating between ruptured and non-ruptured aneurysms (see attachment). We hypothesize that lower aneurysm systolic and pulse pressures could be suggestive of low wall shear stress at the aneurysm dome which has been implicated in secondary inflammation of the aneurysm wall leading to aneurysmal rupture. This information could be important for risk stratification of non-ruptured intracranial aneurysms.
Patient Care: There is a potential application of aneurysm pressure recordings for risk stratification of non-ruptured intracranial aneurysms. (ie. Are non-ruptured aneurysms presenting with low pulse pressures more likely to ruptured due to low wall shear stress and secondary inflammation) and in differentiating between ruptured and non-ruptured aneurysms
Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the importance of intra-aneurysmal hemodynamics 2) discuss the potential application of aneurysm pressure recordings for differentiating between ruptured and non-ruptured aneurysms and 3) discuss the potential value of pulse pressures in risk stratification of non-ruptured intracranial aneurysms.