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Increasing flow diversion for cerebral aneurysm treatment using a single flow diverter
Jianping Xiang1, Ding Ma, Kenneth V Snyder
1*Toshiba Stroke and Vascular Research Center, Departments of ‡Neurosurgery, §Mechanical and Aerospace Engineering, ‖Biomedical Engineering, and ¶Radiology, University at Buffalo, State University of New York, Buffalo, New York.
Neurosurgery
|May 29, 2014
Summary
Maximum compaction of flow diverters (FDs) significantly enhances cerebral aneurysm occlusion by doubling flow reduction. This strategy, alongside observed ultrahigh blood shear stress, may accelerate thrombosis and improve treatment outcomes.
Area of Science:
- Biomedical Engineering
- Medical Devices
- Neurosurgery
Background:
- Neurovascular flow diverters (FDs) treat cerebral aneurysms by altering hemodynamics.
- FD mesh flexibility allows for variable densities, impacting treatment efficacy.
Purpose of the Study:
- To investigate if increased FD local compaction at the aneurysm orifice affects hemodynamic outcomes.
- To compare standard (no compaction) versus emerging (maximum compaction) FD deployment strategies.
Main Methods:
- Simulated deployment of a single FD using two strategies: no compaction (C1) and maximum compaction (C2).
- Utilized patient-specific aneurysm models and pulsatile computational fluid dynamics.
- Analyzed pre- and post-treatment hemodynamics, including flow-stasis and blood shear stress.
Main Results:
- Maximum compaction (C2) resulted in a 29% average intra-aneurysmal flow velocity compared to 67% with C1.
- Flow turnover time was significantly longer with C2 (237% of pretreatment) versus C1 (134%).
- C2 demonstrated greater reduction in aneurysmal flow complexity and enhanced flow reduction.
Conclusions:
- Maximum FD compaction effectively doubles aneurysmal flow reduction, potentially accelerating occlusion.
- Observed ultrahigh blood shear stress through FD pores may promote platelet activation and thrombosis.
