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How Flow Reduction Influences the Intracranial Aneurysm Occlusion: A Prospective 4D Phase-Contrast MRI Study.

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Flow-diverter stents reduce intracranial blood flow, aiding aneurysm thrombosis. Quantitative MR imaging reveals a trend linking greater flow reduction to improved aneurysm occlusion outcomes after treatment.

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Area of Science:

  • Medical Imaging
  • Biomedical Engineering
  • Neurosurgery

Background:

  • Flow-diverter stents are standard for wide-neck intracranial aneurysms.
  • Aneurysm thrombosis is key, with flow reduction a suspected driver.
  • Detailed intra-aneurysmal flow data is lacking to confirm this impact.

Purpose of the Study:

  • To quantitatively measure intra-aneurysmal flow changes post-stent implantation.
  • To clarify the relationship between flow reduction and aneurysm thrombosis.
  • To provide new insights into flow-diversion treatment response.

Main Methods:

  • Acquired 4D phase-contrast MR imaging pre- and post-stent in 23 patients.
  • Combined velocity data with 3D angiograms for aneurysm extraction and correction.
  • Compared intra-aneurysmal hemodynamics with 6- and 12-month occlusion outcomes.

Main Results:

  • Averaged systolic velocities decreased significantly post-stenting (21.7 to 7.2 cm/s).
  • Greater velocity reduction correlated with higher rates of aneurysm thrombosis at 6 months (68.8%).
  • A trend of decreasing flow reduction was observed for 12-month thrombosis vs. no thrombosis (P=.08).

Conclusions:

  • An innovative method for measuring intracranial flow changes after stent implantation was developed.
  • A trend suggests flow reduction is linked to aneurysm thrombosis outcomes.
  • This study offers new understanding of flow-diversion treatment efficacy.