Association between hemodynamic conditions and occlusion times after flow diversion in cerebral aneurysms

Mut, Fernando; Raschi, Marcelo; Scrivano, Esteban; Bleise, Carlos; Chudyk, Jorge; Ceratto, Rosana; Lylyk, Pedro; Cebral, Juan R.

doi:10.1136/neurintsurg-2013-011080

Cited by 92 publications

(108 citation statements)

References 23 publications

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“…Mut et al 5 analyzed 23 aneurysms treated by FDs, and also discovered the same trend-that lower posttreatment aneurysmal flow velocity and inflow rate correlated with faster aneurysm occlusion. In this study, as Dr. Macdonald pointed out, even though these 3 aneurysms are very different lesions, we still demonstrated a similar trend.…”

Section: Editorialmentioning

confidence: 82%

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Editorial: Flow diverters: one device does not fit all

Macdonald

2015

JNS

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Section: Editorialmentioning

confidence: 82%

“…This was based on data from 131 patients studied between 2007 and 2009. 1,5 The indication for use was for large or giant, wide-necked aneurysms of the internal carotid artery (ICA) in patients older than 22 years. Use has expanded widely beyond this, with spectacular results in some of these off-label indications.…”

mentioning

confidence: 99%

Editorial: Flow diverters: one device does not fit all

Macdonald

2015

JNS

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“…Flow diverter (FD) has become an attractive alternative for management of unruptured intracranial aneurysms (4); a FD reconstructs the parent artery and stimulates thrombus within the aneurysm (5). Presence of FD also redirects the intra-aneurysmal flow, reduces hemodynamic stresses on the aneurysmal wall, and lowers rupture risk (6). Reports on the short-and long-term outcome of these devices are encouraging (7)(8)(9).…”

Section: Introductionmentioning

confidence: 89%

In vitro investigation of contrast flow jet timing in patient-specific intracranial aneurysms

Jou

Desai

Britz

2016

Quant. Imaging Med. Surg.

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Background: The direction and magnitude of intra-aneurysmal flow jet are significant risk factors of subarachnoid hemorrhage, and the change of flow jet during an endovascular procedure has been used for prediction of aneurysm occlusion or whether an additional flow diverter (FD) is warranted. However, evaluation of flow jets is often unreliable due to a large variation of flow jet on the digital subtraction angiograms, and this flow pattern variation may result in incorrect clinical diagnosis Therefore, factors contributing to the variation in flow jet are examined at an in vitro setting, and the findings can help us to understand the nature of flow jet and devise a better plan to quantify the aneurysmal hemodynamics accurately.Methods: Intra-aneurysmal flows in three patient-specific aneurysms between 11 and 25 mm were investigated in vitro, and a FD was deployed in each aneurysm model. X-ray imaging of these models were performed at injection rates between 0.2 and 2 mL/s. Pulsatile blood pump and aneurysm model were imaged together to determine the timing of flow jet. Results:The contrast bolus arrives at the aneurysm early at high contrast injection rates. The flow patterns with slow injection rates exhibit strong inertia that is associated with the systole flow. Flow jets arrive at the aneurysms at the peak systole when the bolus is injected at 0.2 mL/s. The contrast-to-signal ratio is the highest at the injection rate of 0.5 mL/s. Effect of flow diversion can only be assessed at an injection rate greater than 0.5 mL/s.Conclusions: Intra-aneurysmal flow jet is highly dependent on the injection rate of the contrast agent.For the internal carotid artery (ICA) aneurysms, the systolic flows can be visualized at slow injection rates (<0.5 mL/s), while the diastolic flow jets are visible at higher injection rates (>1 mL/s). Dependence of flow jet on the contrast injection rate has serious clinical implications and needs to be considered during diagnostic procedures; a protocol with a consistent injection rate is highly recommended.

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“…Finally, our method also provides crucial information such as the filament location and neck porosity for further hemodynamic evaluation with computational fluid dynamics simulations. [13][14][15][16] …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, hemodynamic simulations have shown high potential in predicting intracranial aneurysm thrombosis. [14][15][16] These hemodynamic simulations require reliable and fast virtual stentdeployment methodologies. Therefore, we have recently proposed 17 a virtual stent-deployment method able to predict the local properties of braided stents (wire location, angles, porosities) and implantation parameters (stent length, landing zone) with minimal computational cost.…”

mentioning

confidence: 99%

Virtual-versus-Real Implantation of Flow Diverters: Clinical Potential and Influence of Vascular Geometry

Bouillot

Brina

Yılmaz

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Intracranial stents have become extremely important in the endovascular management of complex intracranial aneurysms. Sizing and landing zone predictions are still very challenging steps in the procedure. Virtual stent deployment may help therapeutic planning, device choice, and hemodynamic simulations. We aimed to assess the predictability of our recently developed virtual deployment model by comparing in vivo and virtual stents implanted in a consecutive series of patients presenting with intracranial aneurysms.

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Association between hemodynamic conditions and occlusion times after flow diversion in cerebral aneurysms

Abstract: The occlusion time of cerebral aneurysms treated with flow diverters can be predicted by the hemodynamic conditions created immediately after device implantation. Specifically, low post-implantation flow velocity, inflow rate, and shear rate are associated with fast occlusion times.

Cited by 92 publications

References 23 publications

Editorial: Flow diverters: one device does not fit all

Editorial: Flow diverters: one device does not fit all

In vitro investigation of contrast flow jet timing in patient-specific intracranial aneurysms

Virtual-versus-Real Implantation of Flow Diverters: Clinical Potential and Influence of Vascular Geometry

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