Perforator-sparing basilar artery reconstruction normalizes pathological hemodynamics in vertebrobasilar...

Area of Science:

• Biomedical Engineering
• Vascular Surgery
• Computational Fluid Dynamics

Background:

• Vertebrobasilar dolichoectasia (VBD) presents significant risks of stroke and hemorrhage.
• Current treatments for VBD are often suboptimal and can damage critical pontine perforators (PPs).

Purpose of the Study:

• To evaluate a novel hemodynamically-guided reconstruction strategy for VBD.
• To assess the feasibility of a perforator-sparing approach using computational fluid dynamics (CFD).

Main Methods:

• Patient-specific CFD models were created for 24 VBD patients and 24 controls.
• Simulations analyzed hemodynamics (pressure, velocity, wall shear stress, OSI, RRT) in the basilar artery (BA) and PPs.
• Virtual reconstruction models simulated partial BA lumen reduction to optimize hemodynamics while preserving PPs.

Main Results:

• Untreated VBD showed significantly altered hemodynamics, including elevated pressure, flow stasis, and increased oscillatory shear index (OSI) and relative residence time (RRT).
• Virtual reconstruction normalized aneurysmal hemodynamics toward physiological levels without negatively impacting PP hemodynamics.
• Strong correlations were found between BA volume and adverse hemodynamics, with benefits plateauing around 250 mm³.

Conclusions:

• Perforator-sparing partial reconstruction can normalize pathological hemodynamics in VBD.
• This study establishes a quantitative framework for developing new endovascular devices for VBD.
• Clinical validation through experimental models and prospective trials is necessary.