Recent developments in minimally invasive approach to cerebrovascular diseases include the placement of stents in arteries for treatment of aneurysms. Preliminary clinical observations and experimental studies have shown that intravascular stents traversing the orifice may lead to thrombosis and subsequent occlusion of the aneurysm. The alterations in vessel local hemodynamics due to the introduction of a stent are not yet well understood. We investigated changes in local hemodynamics resulting from stent implantation. Pulsatile flow patterns in an experimental flow apparatus were visualized using laser-induced fluorescence of rhodamine dye. The test cells were constructed in a rectangular shape to facilitate an undisturbed longitudinal view of flow patterns in parent vessel and aneurysm models with and without porous stents. Woven nitinol stents of various porosities (76%, 80%, 82%, and 85%) were investigated. The selected fluid dynamic similarity parameters (Reynolds and Womersley numbers) represented conditions usually found in high-flow, larger arteries in humans (such as the carotid artery) and low-flow, smaller arteries (such as the vertebral artery). The mean Reynolds number for the larger arteries was 180, with maximum/minimum values of 490/-30 and the Womersley number was 5.3. The mean Reynolds number for the smaller arteries was 90, with maximum/minimum values of 230/2, and the Womersley number was 2.7. For the larger arteries modeled, placement of a stent of the lowest porosity across the aneurysm orifice resulted in reduction of aneurysmal vortex speed and decreased interaction with parent vessel flow. For smaller arteries, a stent of the same porosity led to a substantial reduction of parent vessel/aneurysmal flow interaction and the appearance of a nonrecirculating crescent of fluid rich in rhodamine dye in the aneurysm dome. Our results can help explain in vivo thrombus formation within an aneurysm after placement of a stent that is compatible with local hemodynamics.

We investigated the changes of flow patterns in a blood vessel with a side wall aneurysm resulting from placement of a stent. Local hemodynamics can be markedly altered by placing an intravascular stent, which covers the orifice of the aneurysm. The alternations in flow patterns can lead to flow stasis in the aneurysmal pouch and promote the formation of a stable thrombus. Furthermore, a porous stent can serve as substrate for neointimal growth and subsequently induce a remodeling of the diseased arterial segment. To examine changes in local hemodynamics due to stent placement, a stented and nonstented aneurysm model was investigated computationally in a three-dimensional configuration using a finite element fluid dynamics program. The finite element model was studied under incompressible, pulsatile, viscous, Newtonian conditions. The fluid dynamic similarity parameter, i.e., the maximum/minimum Reynolds number, was set at about 240/25 based on cross-sectional average instantaneous flow. The Womersley number was set to 2.5. These values are representative of large cerebral arteries. The results of the stented versus the nonstented model show substantial difference sin flow patterns inside the aneurysmal pouch. Flow activity inside the stented aneurysm model is significantly diminished and flow inside the parent vessel is less undulated and is directed past the orifice. A high-pressure zone at the distal neck and the dome of the aneurysm prior to stenting decreases after stent placement. However, elevated pressure values are found at the stent filaments facing the current. Higher shear rates are observed at the distal aneurysmal neck after stenting, but are confined to a smaller region and are unidirectional compared to the nonstented model.

Conventional angiographic techniques are limited by their ability to provide only streaklines of flow patterns and does not render quantitative analysis of the flow. In this study we examined the possibility of obtaining quantitative flow information by injecting insoluble droplets of contrast material into an aneurysm phantom. The phantom was connected to a recirculating flow apparatus. Pulsatile flow was employed with a working fluid mixture of 1:1 water glycerine solution. The flow patterns in the phantom were investigated using a fluoroscopic unit. Calibrated droplets of insoluble contrast media, Ethiodol, were injected at different locations in the channel carrying the aneurysm. Droplet paths were recorded at a rate of 30 frames per second. Peak flow velocity of the droplets was determined from displacement of the droplets between successive video frames and the known geometry of the model. The results of the video velocity analysis compared reasonably well with velocity values calculated from the measured flow rate by an electromagnetic flow meter.