Robert Fahed1, Tim E Darsaut2, Jean-Christophe Gentric3, Behzad Farzin1, Igor Salazkin1, Guylaine Gevry1, Jean Raymond4,5. 1. Notre-Dame Hospital Research Centre (CRCHUM), Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 2. Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta, Canada. 3. Groupe d'étude de la Thrombose en Bretagne Occidentale (GETBO, EA 3878), Brest, France. 4. Notre-Dame Hospital Research Centre (CRCHUM), Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. Jean.raymond@umontreal.ca. 5. Notre-Dame Hospital, Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke East, Pav. Simard Z-12909, Montreal, Quebec, H2L 4M1, Canada. Jean.raymond@umontreal.ca.
Abstract
INTRODUCTION: Flow diversion is increasingly used for treating intracranial aneurysms. This article aims to review the evidence obtained from animal models and summarizes the findings that might be of clinical interest. METHODS: From a systematic review of studies published between 2000 and 2016, we extracted the data on the following questions: What roles do aneurysm dimension, morphology, and vascular geometry have on success of flow diversion? What characteristics of a flow diverter can influence aneurysm occlusion? What are the risk factors for jailed branch occlusion? RESULTS: Flow diversion has been shown to be less effective in occluding large aneurysms with wide or undefined necks, as compared to smaller aneurysms with narrower necks. Straight sidewall aneurysms were more likely to occlude after flow diversion than curved sidewall aneurysms or bifurcation aneurysms with branches originating from the neck or the fundus. The main characteristics of devices that may impact on the success of flow diversion are porosity and pore-density, but challenging aneurysm models were not better occluded with devices of lower porosity. Porosity is not uniform when devices deform to adapt to local in vivo anatomy when deployed. Neointima formation on devices correlates with low porosity. Branches are rarely occluded when they are jailed, but persistent branch flow may prevent aneurysm occlusion. CONCLUSION: Experimental models may help anticipate clinical results of flow diversion.
INTRODUCTION: Flow diversion is increasingly used for treating intracranial aneurysms. This article aims to review the evidence obtained from animal models and summarizes the findings that might be of clinical interest. METHODS: From a systematic review of studies published between 2000 and 2016, we extracted the data on the following questions: What roles do aneurysm dimension, morphology, and vascular geometry have on success of flow diversion? What characteristics of a flow diverter can influence aneurysm occlusion? What are the risk factors for jailed branch occlusion? RESULTS: Flow diversion has been shown to be less effective in occluding large aneurysms with wide or undefined necks, as compared to smaller aneurysms with narrower necks. Straight sidewall aneurysms were more likely to occlude after flow diversion than curved sidewall aneurysms or bifurcation aneurysms with branches originating from the neck or the fundus. The main characteristics of devices that may impact on the success of flow diversion are porosity and pore-density, but challenging aneurysm models were not better occluded with devices of lower porosity. Porosity is not uniform when devices deform to adapt to local in vivo anatomy when deployed. Neointima formation on devices correlates with low porosity. Branches are rarely occluded when they are jailed, but persistent branch flow may prevent aneurysm occlusion. CONCLUSION: Experimental models may help anticipate clinical results of flow diversion.
Authors: Tim E Darsaut; Fabrice Bing; Alina Makoyeva; Guylaine Gevry; Igor Salazkin; Jean Raymond Journal: World Neurosurg Date: 2013-09-23 Impact factor: 2.104
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Authors: Ajit S Puri; Francesco Massari; Takumi Asai; Miklos Marosfoi; Peter Kan; Samuel Y Hou; Mary Howk; Mary Perras; Christopher Brooks; Frederic Clarencon; Matthew J Gounis; Ajay K Wakhloo Journal: Neuroradiology Date: 2015-12-23 Impact factor: 2.804
Authors: Anderson Chun On Tsang; Arthur Man Yuen Fung; Frederick Chun Pong Tsang; Gilberto Ka Kit Leung; Raymand Lee; Wai Man Lui Journal: Neurointervention Date: 2015-09-02
Authors: K Janot; R Fahed; A Rouchaud; K Zuber; G Boulouis; G Forestier; C Mounayer; M Piotin Journal: AJNR Am J Neuroradiol Date: 2021-11-18 Impact factor: 3.825