Xiaochang Leng1,2, Hailin Wan3, Gaohui Li1, Yeqing Jiang3, Lei Huang3, Adnan H Siddiqui4, Xiaolong Zhang3, Jianping Xiang1. 1. ArteryFlow Technology Co., Ltd., Hangzhou, China. 2. School of Civil Engineering and Architecture, Nanchang University, Nanchang, China. 3. Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China. 4. Department of Neurosurgery and Radiology, University at Buffalo, The State University of New York, Buffalo, NY, USA.
Abstract
BACKGROUND: Straightening of parent vessels happens for stent-assisted coiling embolization (SACE) treatment of intracranial aneurysms. This study aims to investigate aneurysmal hemodynamic modifications caused by stent-induced vessel straightening. METHODS: Stent and coil deployments of a SACE-treated distal bifurcation aneurysm by finite element method were performed first with the preoperative (not straightened, NS) and postoperative (straightened, S) vessel models respectively. Computational fluid dynamics were then performed for eight models, including (I) NS only model, (II) NS+stent model, (III) NS+coils model, (IV) NS+stent+coils model, (V) S only model, (VI) S+stent model, (VII) S+coils model, and (VIII) S+stent+coils model. Finally, changes in aneurysmal flow velocity, isovelocity surface and wall shear stress (WSS) were analyzed qualitatively and quantitatively. RESULTS: The flow was less in the S models than that in the corresponding NS models. Coils blocked most of the flow into the aneurysm sac in both NS models and S models and vessel straightening had more profound effect on the high aneurysmal flow volume reduction than coiling, while stenting generated adverse effect on flow reduction. Taking the NS only model as baseline (100%), the sac-averaged velocities of models II to VIII were 112%, 36%, 42%, 45%, 39%, 12%, 13%, and high flow volumes were 119%, 21%, 30%, 10%, 8%, 3%, 3%, while the sac-averaged WSSs were 106%, 37%, 44%, 41%, 35%, 17% and 24%, respectively. CONCLUSIONS: Stent-induced vessel straightening combined coil embolization has the best performance in hemodynamic modifications and may reduce the recurrence rate, whereas stenting may generate adverse effect on hemodynamic alterations.
BACKGROUND: Straightening of parent vessels happens for stent-assisted coiling embolization (SACE) treatment of intracranial aneurysms. This study aims to investigate aneurysmal hemodynamic modifications caused by stent-induced vessel straightening. METHODS: Stent and coil deployments of a SACE-treated distal bifurcation aneurysm by finite element method were performed first with the preoperative (not straightened, NS) and postoperative (straightened, S) vessel models respectively. Computational fluid dynamics were then performed for eight models, including (I) NS only model, (II) NS+stent model, (III) NS+coils model, (IV) NS+stent+coils model, (V) S only model, (VI) S+stent model, (VII) S+coils model, and (VIII) S+stent+coils model. Finally, changes in aneurysmal flow velocity, isovelocity surface and wall shear stress (WSS) were analyzed qualitatively and quantitatively. RESULTS: The flow was less in the S models than that in the corresponding NS models. Coils blocked most of the flow into the aneurysm sac in both NS models and S models and vessel straightening had more profound effect on the high aneurysmal flow volume reduction than coiling, while stenting generated adverse effect on flow reduction. Taking the NS only model as baseline (100%), the sac-averaged velocities of models II to VIII were 112%, 36%, 42%, 45%, 39%, 12%, 13%, and high flow volumes were 119%, 21%, 30%, 10%, 8%, 3%, 3%, while the sac-averaged WSSs were 106%, 37%, 44%, 41%, 35%, 17% and 24%, respectively. CONCLUSIONS: Stent-induced vessel straightening combined coil embolization has the best performance in hemodynamic modifications and may reduce the recurrence rate, whereas stenting may generate adverse effect on hemodynamic alterations.
Authors: Markus Tremmel; Jianping Xiang; Sabareesh K Natarajan; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy; Hui Meng Journal: World Neurosurg Date: 2010 Aug-Sep Impact factor: 2.104
Authors: Juan R Cebral; Marcelo A Castro; Sunil Appanaboyina; Christopher M Putman; Daniel Millan; Alejandro F Frangi Journal: IEEE Trans Med Imaging Date: 2005-04 Impact factor: 10.048