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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment

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Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational

R J Damiano^1,2, V M Tutino^2,3, N Paliwal^1,2

¹From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).

AJNR. American Journal of Neuroradiology

|January 7, 2017

Summary

Locally compacting a single flow diverter (FD) can enhance intracranial aneurysm healing. This strategy may outperform overlapping two FDs for aneurysmal flow reduction, especially in large or fusiform aneurysms.

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Area of Science:

Biomedical Engineering
Medical Devices
Computational Fluid Dynamics

Background:

Intracranial aneurysms pose significant health risks.
Flow diverters (FDs) are used to treat aneurysms by redirecting blood flow.
Mesh compaction is a technique to enhance FD performance.

Purpose of the Study:

To compare the efficacy of a single compacted FD versus two overlapped FDs for reducing blood flow in aneurysms.
To investigate the relationship between FD compaction and aneurysm orifice area.

Main Methods:

Simulated three FD strategies (single noncompacted, two overlapped, single compacted) in three aneurysm models (fusiform, large saccular, medium saccular) using virtual stent placement.
Utilized computational fluid dynamics (CFD) to analyze hemodynamic parameters post-treatment.
Examined the correlation between the degree of compaction and aneurysm orifice area.

Main Results:

Single compacted FD achieved 57%, 47%, and 22% compaction coverage in fusiform, large saccular, and medium saccular aneurysms, respectively.
Compaction coverage showed a linear increase with aneurysm orifice area.
The single compacted FD outperformed the other strategies in flow reduction for the fusiform aneurysm.
For saccular aneurysms, two overlapped FDs provided the most flow reduction, followed by the single compacted FD.

Conclusions:

A single compacted FD can be more effective than two overlapped FDs for aneurysmal flow reduction.
Optimal performance requires the compacted mesh to be denser than overlapped FDs and cover at least 50% of the aneurysm orifice.
This technique is particularly beneficial for aneurysms with large orifices, such as fusiform aneurysms.