Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices

Campos, Jessica K.; Cheaney, Barry; Lien, Brian V.; Zarrin, David A.; Vo, Chau D.; Colby, Geoffrey P.; Lin, Li-Mei; Coon, Alexander L.

doi:10.1136/svn-2020-000347

Cited by 14 publications

(15 citation statements)

References 105 publications

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“…Braided devices such as Flow-Diverters (FDs, see Fig. 1b) are an excellent option in particular to tackle complex aneurysmal geometries (wide neck or small dome-to-neck ratio) [6] . As shown in Fig.…”

Section: Introductionmentioning

confidence: 99%

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A heterogeneous model of endovascular devices for the treatment of intracranial aneurysms

Bérod

Chnafa²,

Mendez

et al. 2022

Numer Methods Biomed Eng

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Numerical computations of hemodynamics inside intracranial aneurysms treated by endovascular braided devices such as flow‐diverters contribute to understanding and improving such treatment procedures. Nevertheless, these simulations yield high computational and meshing costs due to the heterogeneity of length scales between the dense weave of the fine struts of the device and the arterial volume. Homogeneous strategies developed over the last decade to circumvent this issue substitute local dissipations due to the wires with a global effect in the form of a pressure‐drop across the device surface. However, these methods cannot accurately reproduce the flow‐patterns encountered near the struts, the latter strongly dictating the intra‐saccular flow environment. In this work, a versatile theoretical framework which aims at correctly reproducing the local flow heterogeneities due to the wires while keeping memory consumption, meshing and computational times as low as possible is introduced. This model reproduces the drag forces exerted by the device struts onto the fluid, thus producing local and heterogeneous effects on the flow. Extensive validation for various flow and geometric configurations using an idealized device is performed. To further illustrate the method capabilities, a real patient‐specific aneurysm endovascularly treated with a flow‐diverter is used, enabling quantitative comparisons with classical approaches for both intra‐saccular velocities and computational costs reduction. The proposed heterogeneous model endeavors to bridge the gap between computational fluid dynamics and clinical applications and ushers in a new era of numerical treatment planning with minimally costing computational tools.

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Section: Introductionmentioning

confidence: 99%

“…As shown in Fig. 1c, these devices consist of a very dense weave of thin metallic wires with diameters around 30 µm, generally made of Nitinol or Cobalt-Chromium [6] . They redirect blood into the parent artery and impede the flow at the aneurysm neck, thus reducing intra-aneurysmal velocities.…”

Section: Introductionmentioning

confidence: 99%

A heterogeneous model of endovascular devices for the treatment of intracranial aneurysms

Bérod

Chnafa²,

Mendez

et al. 2022

Numer Methods Biomed Eng

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“…Coil embolization is an effective treatment procedure with a low complication rate of 3.7% but a high rate of incomplete obliteration (up to more than 40% of the cases [38,41]). Implantation of flow diverting stents yield an occlusion rate between 62.8 and 93.9% at 1 year with a mortality rate up to 5.5% [42]. Microsurgical clipping results in very low aneurysm recurrences (1.5%) of completely clipped aneurysms, however in much more frequent recurrences in cases with incomplete clipping [39,40,43].…”

Section: Clinical Management Of Iamentioning

confidence: 97%

CADA: Clinical Background and Motivation

Spuler

Goubergrits

2021

Cerebral Aneurysm Detection

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Imaging of cerebral aneurysms using DSA, MRI or CTA plays a key role in diagnosis, decision for treatment or observation, treatment planning either as microsurgical clipping or as endovascular intervention including filling of the aneurysm with coils, implantation of flow diverter in the parent vessel or filling the aneurysm with liquid embolic agents. Additionally, imaging is used in long-term follow-up of treated and untreated aneurysms. Imaging tasks and challenges include detection of aneurysms especially of aneurysms smaller than 3 mm, accurate quantitative analysis of geometric parameters assessing size and shape necessary for rupture risk assessment as well as treatment decision and eventually the type of treatment. Finally, image-based computational fluid dynamics analysis of hemodynamic risk parameters requires accurate segmentation and reconstruction of anatomical structures. These objectives motivated us to initiate the Cerebral Aneurysm Detection and Analysis (CADA) challenge. It is based on datasets of 3D rotational angiographies, the "gold standard" for clinical management of cerebral aneurysms. Datasets stem from patients with unruptured and ruptured aneurysms.

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“…The most common neurological manifestations include headache and dizziness, followed by delirium, that often is the first manifestation of COVID-19 in older adults [ 3 , 4 ]. However, similar to other viruses, some literature has reported the presence of cerebrovascular events (such as stroke), Guillain–Barre syndrome, acute transverse myelitis, and acute encephalitis in people affected by COVID-19 [ 5 ]. Of importance, it is has been reported that neurological manifestations may precede the typical features of COVID-19 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Neurological diseases and COVID-19: prospective analyses using the UK Biobank

et al. 2021

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COVID-19 (Coronavirus disease-19) may present with neurological signs, but whether people already affected by neurological conditions are at a higher risk of contracting COVID-19 is still not known. We, therefore, aimed to investigate the association of previously diagnosed neurological conditions with COVID-19. 502,536 community-dwelling UK Biobank participants (54.4% male, mean age 56.6 ± 10.3 years) were included. Among these, 57,463 participants had a diagnosis of neurological conditions (11.43%) and a total of 1326 COVID-19-positive cases were identified (0.26%). Neurological conditions were identified through medical history and linkage to data on hospital admissions (ICD-10 code G00–G99). COVID-19 presence was diagnosed using the data provided by Public Health England. The association of previous diagnosis of neurological conditions with COVID-19 was evaluated through logistic regressions, adjusted for potential confounders, reported as odds ratios (ORs) with their 95% confidence intervals (CIs). Nerve, nerve root and plexus disorders (G50–G59) were the most common conditions identified. The presence of COVID-19 was almost doubled in neurological conditions compared to the general population (0.45 vs. 0.24%, p < 0.0001). Previously diagnosed neurological conditions were associated with 60% higher odds of COVID-19 positive in the multivariable-adjusted model (OR = 1.6, 95% CI 1.4–1.8). Other degenerative diseases of the nervous system, extrapyramidal and movement disorders, polyneuropathies and other disorders of the peripheral nervous system, cerebral palsy and other paralytic syndromes were significantly associated with a higher odds of COVID-19. The presence of neurological conditions was associated with a significantly higher likelihood of COVID-19 compared to the general population.

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Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices

Abstract: Flow diverters and flow disruption technology, alongside nuanced endovascular techniques, have ushered in a new era of treating cerebral aneurysms. Here, we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.

Cited by 14 publications

References 105 publications

A heterogeneous model of endovascular devices for the treatment of intracranial aneurysms

A heterogeneous model of endovascular devices for the treatment of intracranial aneurysms

CADA: Clinical Background and Motivation

Neurological diseases and COVID-19: prospective analyses using the UK Biobank

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