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Enhanced aneurysmal flow diversion using a dynamic push-pull technique: an experimental and modeling study.

D Ma1, J Xiang2, H Choi3

  • 1From the Toshiba Stroke and Vascular Research Center (D.M., J.X., A.H.S., H.M.) Departments of Mechanical and Aerospace Engineering (D.M., J.X., H.M.).

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Summary
This summary is machine-generated.

The dynamic push-pull technique enhances flow diversion for intracranial aneurysms by increasing mesh density at the aneurysm opening. This method optimizes flow diverter placement, improving treatment efficacy and safety.

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Area of Science:

  • Biomedical Engineering
  • Medical Imaging
  • Computational Fluid Dynamics

Background:

  • Neurovascular flow diverters are crucial for treating intracranial aneurysms.
  • Optimizing flow diverter mesh density is key to maximizing treatment effectiveness.
  • Patient-specific computational modeling offers a high-fidelity approach to study hemodynamic impacts.

Purpose of the Study:

  • To investigate the hemodynamic impact of the dynamic push-pull technique on patient-specific aneurysms.
  • To evaluate the manipulation of flow diverter mesh density at the aneurysm orifice.
  • To assess the efficacy of computational modeling in simulating flow diverter deployment.

Main Methods:

  • Utilized a dynamic push-pull technique to deploy Pipeline Embolization Devices in aneurysm phantoms.
  • Employed high-fidelity virtual-stenting and computational fluid dynamics (CFD) for numerical simulations.
  • Validated simulated mesh geometries against in vitro deployments and analyzed hemodynamic changes in sidewall and fusiform aneurysms.

Main Results:

  • The dynamic push-pull technique accurately replicated in vitro flow diverter geometries in silico.
  • Increased delivery wire advancement led to higher mesh compaction at the aneurysm orifice (50% vs. 36% metal coverage).
  • Higher mesh compaction resulted in more effective aneurysmal inflow reduction (up to 62% in sidewall and 57% in fusiform aneurysms).

Conclusions:

  • The dynamic push-pull technique effectively increases flow diverter mesh coverage at the aneurysm orifice.
  • This technique enhances flow diversion for intracranial aneurysms.
  • It also reduces parent vessel coverage, potentially preserving flow to perforator arteries.