Analysis, evaluation of hemodynamic differences and treatment strategy recommendations for multiple paraclinoid aneurysms

Multiple paraclinoid aneurysms of the internal carotid artery present distinct clinical and anatomical challenges compared with other aneurysms. This study aimed to investigate the hemodynamic characteristics of the parent artery adjacent to these lesions and to provide evidence-based suggestions for clinical treatment. We retrospectively reviewed digital subtraction angiography images of 57 patients treated between 2020 and 2024, including 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. We compared hemodynamic profiles among groups and evaluated the effects of simulated aneurysm obliteration on the distal vessel wall proximal to the carotid bifurcation. Four real-world follow-up cases were also analyzed for morphological and hemodynamic changes after treatment. The multiple-aneurysm group exhibited greater variability and instability in wall shear stress and flow velocity than the single-aneurysm and normal groups. Simulated aneurysm elimination showed no significant hemodynamic effect on distal vessels ( P  > .05). In clinical follow-up, however, noticeable morphological and hemodynamic alterations were observed following stent deployment. Multiple paraclinoid aneurysms induce more prominent hemodynamic disturbances in the parent artery. Aneurysm obliteration appears to have minimal immediate impact on the distal vessel wall, but stent placement may produce favorable long-term vascular remodeling, including straightened curvature and improved mild stenosis.