Multiple paraclinoid aneurysms induce more prominent hemodynamic disturbances in the parent artery, and while aneurysm obliteration appears to have minimal immediate impact on the distal vessel wall, stent placement may produce favorable long-term vascular remodeling.
Key Findings
Results
The multiple-aneurysm group exhibited greater variability and instability in wall shear stress and flow velocity compared to single-aneurysm and normal groups.
Study included 57 patients treated between 2020 and 2024: 18 cases with multiple paraclinoid aneurysms, 19 with a single paraclinoid aneurysm, and 20 with normal vascular anatomy.
Parameters including peak systolic flow velocity and wall shear stress were derived from reconstructed hemodynamic models based on digital subtraction angiography images.
The multiple-aneurysm group showed more prominent hemodynamic disturbances in the parent artery than either comparison group.
Greater variability and instability in both wall shear stress and flow velocity were the distinguishing hemodynamic features of the multiple-aneurysm group.
Results
Simulated aneurysm elimination showed no significant hemodynamic effect on distal vessels proximal to the carotid bifurcation.
The simulation modeled the effects of aneurysm obliteration on the distal vessel wall proximal to the carotid bifurcation.
No significant hemodynamic effect was found on distal vessels following simulated aneurysm elimination (P > .05).
This finding suggests minimal immediate impact of aneurysm obliteration on downstream vascular hemodynamics in the computational model.
Results
In clinical follow-up cases, noticeable morphological and hemodynamic alterations were observed following stent deployment.
Four real-world follow-up cases were analyzed for morphological and hemodynamic changes after treatment.
Stent placement was associated with favorable long-term vascular remodeling, including straightened curvature and improved mild stenosis.
These real-world findings contrasted with the simulation results, which showed no significant immediate hemodynamic effect on distal vessels.
The morphological changes observed in follow-up suggest stent deployment produces effects beyond immediate aneurysm obliteration.
Background
Multiple paraclinoid aneurysms of the internal carotid artery present distinct clinical and anatomical challenges compared with other aneurysms.
The study retrospectively reviewed digital subtraction angiography images from a cohort treated between 2020 and 2024.
The study population included three groups: multiple paraclinoid aneurysms (n=18), single paraclinoid aneurysm (n=19), and normal vascular anatomy (n=20).
Hemodynamic models were reconstructed from imaging data to derive flow parameters.
The paraclinoid location of the internal carotid artery was identified as a site with distinct hemodynamic behavior warranting separate investigation.
Discussion
Stent placement may produce favorable long-term vascular remodeling including straightened curvature and improved mild stenosis in patients with paraclinoid aneurysms.
Long-term vascular remodeling effects were observed in the four clinical follow-up cases.
Specific morphological changes documented included straightened vessel curvature and improvement of mild stenosis.
These findings were described as favorable outcomes associated with stent deployment.
The authors used this evidence to provide 'evidence-based suggestions for clinical treatment' of multiple paraclinoid aneurysms.
What This Means
This research suggests that when multiple aneurysms (balloon-like bulges in blood vessel walls) are present near the base of the brain in a region called the paraclinoid segment of the internal carotid artery, the blood flow patterns in that area are more chaotic and unstable than when only a single aneurysm is present or when the vessels are normal. The researchers used computer models built from detailed X-ray images of 57 patients to measure blood flow speed and the forces that blood exerts on vessel walls, comparing people with multiple aneurysms, a single aneurysm, or no aneurysms.
When the researchers used their computer models to simulate what would happen if the aneurysms were sealed off, they found no significant immediate changes in blood flow in the blood vessels downstream. However, when they followed four real patients who had stents placed to treat their aneurysms, they observed actual physical changes over time — the vessels became straighter and areas of mild narrowing improved. This suggests that while the immediate effects of treatment on downstream blood flow may be limited, the physical presence of a stent can lead to beneficial reshaping of the blood vessel over the longer term.
This research matters because multiple aneurysms in this particular location are especially challenging to treat, and understanding the unique blood flow disturbances they cause may help doctors better plan treatment strategies. The findings suggest that stent-based treatments may offer benefits beyond simply sealing off the aneurysm, potentially improving the overall health of the blood vessel over time, though the small number of follow-up cases (only four patients) means these observations should be interpreted cautiously.
Zhao X, Wang J, Gao C, Gao S, Wang X, Wang X, et al.. (2026). Analysis, evaluation of hemodynamic differences and treatment strategy recommendations for multiple paraclinoid aneurysms.. Medicine. https://doi.org/10.1097/MD.0000000000050783