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Building multidevice pipeline constructs of favorable metal coverage: a practical guide
1From the Departments of Radiology (M.S., E.R., T.B., P.K.N.), Bernard and Irene Schwartz Neurointerventional Radiology SectionNeurology (M.S., T.B.) maksim.shapiro@nyumc.org neuroangio@neuroangio.org.
AJNR. American Journal of Neuroradiology
|March 29, 2014
Summary
Optimizing flow diverter placement is key for cerebral aneurysm treatment. Multidevice constructs require careful consideration of device diameter and overlap to achieve desired metal coverage and favorable geometric outcomes.
Area of Science:
- Neuroendovascular therapy
- Medical device engineering
Background:
- Flow diverters represent a paradigm shift in treating cerebral aneurysms.
- Key questions persist regarding optimal use of these endoluminal devices.
- Device geometry significantly impacts metal coverage, especially with oversizing.
Purpose of the Study:
- To investigate the geometry and coverage of multidevice constructs.
- To analyze the effects of overlapping flow diverters.
Main Methods:
- Pipeline devices were deployed in tubes of known diameters.
- Image segmentation was used to determine metal coverage.
- Multidevice constructs were analyzed to estimate coverage from overlap.
Main Results:
- Double overlap of flow diverters results in a range of metal coverage, not a single value.
- Coverage variation is greatest with identical-diameter devices (e.g., 24%-41% for two 3.75-mm devices in a 3.5-mm vessel).
- Overlapping devices of different diameters yield more uniform coverage but may reduce maximum achievable coverage.
Conclusions:
- Strategic construction of multidevice constructs can lead to favorable geometric outcomes.
- Careful planning of device overlap is essential for predictable results.
