Aneurysm Rupture Following Treatment with Flow-Diverting Stents: Computational Hemodynamics Analysis of Treatment

Cebral, Juan R.; Mut, Fernando; Raschi, Marcelo; Scrivano, Esteban; Ceratto, Rosana; Lylyk, Pedro; Putman, Christopher M.

doi:10.3174/ajnr.a2398

Cited by 317 publications

(319 citation statements)

References 15 publications

(17 reference statements)

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“…8,26 Although hearing is not ubiquitously sacrificed, it is now well known that this approach does pose a significant threat to postoperative hearing function. 9,52 In contrast, the modern posterior petrosal approach entails a presigmoid retrolabyrinthine exposure with exceedingly high rates of preservation of postoperative hearing, as demonstrated in this report and many others. 1,33,48,50 In comparison with the anterior petrosal approach, an anatomical study revealed that the posterior petrosal approach afforded an additional 6 mm of caudal exposure below the floor of the sella, essentially to the level of the upper jugular tubercle.…”

Section: Posterior Petrosal Approachmentioning

confidence: 84%

“…9,34 Employed as a necessary means to curb thromboembolic complications, requisite dual antiplatelet therapy relatively contraindicates usage of endovascular stent placement in instances of acute subarachnoid hemorrhage. 58,60 In this setting, plagued by the specter of early rerupture, the cerebrovascular neurosurgeon must safely expose these complex aneurysms and adjacent vital perforators while navigating an edematous, "angry" brain.…”

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confidence: 99%

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Petrosal approaches to posterior circulation aneurysms

Gross

Tavanaiepour²,

Du³

et al. 2012

FOC

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Complex posterior circulation aneurysms are formidable lesions with an abysmal natural history. Their management continues to present a challenge to both endovascular and open microsurgical approaches. Affording an expansive, combined supra- and infratentorial exposure, the petrosal approaches are well suited for these challenging lesions when located along the basilar trunk or at a low-lying basilar apex. This report evaluates the evolution and application of petrosal approaches to these lesions. Excluding transsigmoid, infratentorial, or labyrinth-sacrificing approaches, the authors found 23 reports with 61 posterior circulation aneurysms treated via a petrosal approach. Although early morbidity was not negligible, rates of aneurysm occlusion (95% overall) and long-term outcome were quite laudable in light of the challenge posed by these lesions. Moreover, with accumulating experience with petrosal approaches, rates of complications are likely to wane, as neurosurgeons capitalize on the expansive exposure afforded by these indispensable approaches.

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Section: Posterior Petrosal Approachmentioning

confidence: 84%

mentioning

confidence: 99%

Petrosal approaches to posterior circulation aneurysms

Gross

Tavanaiepour²,

Du³

et al. 2012

FOC

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“…For example, the authors in [6] ordered the equations element by element. In the Jacobian matrix we use the symbols K for the kinematic equation (15) in the solid and on the fluid-solid interface, A for the kinematic ALE displacement equation (22) in the fluid, S for the momentum equation (7) in the solid, I for the momentum equation (9) on the fluid-solid interface, F for the momentum equation (16) in the fluid, V for the continuity equation (8) in the solid, W for the continuity equation (17) in the fluid. The Jacobian has the following block structure, and the order of the variables is listed at the top of the matrix.…”

Section: Structure Of the Jacobianmentioning

confidence: 99%

“…To resolve such meshing difficulties, two possible options can be explored: adaptive embedding techniques and porous medium modeling. With the former approach, vessel walls are treated with body-fitted unstructured grids, and stents are embedded in the grids; moreover, adaptive meshing refinement is performed near the stents ( [10], [8]). A more recent technique simulates the effect of a FD through the use of a porous medium layer ( [3], [33], [19]).…”

Section: Introductionmentioning

confidence: 99%

Fluid-Structure Simulations and Benchmarking of Artery Aneurysms Under Pulsatile Blood Flow

Aulisa¹,

Bornia²,

Calandrini³

2017

Proceedings of the 6th International Conference on Computational Methods in Structural Dynamics and Earthquake Engineering (COM

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Abstract. In this paper Fluid-structure interaction (FSI) simulations of artery aneurysms are carried out where both the fluid flow and the hyperelastic material are incompressible. We focus on time-dependent formulations adopting a monolithic approach, where the deformation of the fluid domain is taken into account according to an Arbitrary Lagrangian Eulerian (ALE) scheme. The exact Jacobian matrix is implemented by using automatic differentiation tools. The system is modeled using a specific equation shuffling that assures an optimal pivoting. We propose to solve the resulting linearized system at each nonlinear outer iteration with a GMRES solver preconditioned by a geometric multigrid algorithm with an Additive Schwarz Method (ASM) smoother.In order to test our numerical method on possible hemodynamics applications, we describe several benchmark settings. The configurations consist of realistic artery aneurysms where hybrid meshes are employed. Both two and three-dimensional benchmarks are considered. We show numerical results for the described aneurysm geometries focusing on pulsatile inflow conditions. Parallel implementation is addressed and a case of endovascular stent implantation on a cerebral aneurysm is presented. 955Available online at www.eccomasproceedia.org Eccomas Proceedia COMPDYN (2017) 955-974

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“…Within the last decades, several groups have been using computational methods in order to extract parameters explaining aneurysmal formation or predicting rupture probabilities [16]- [18]. However, those investigations mainly focus on single aneurysm models using various assumptions and leading to controversial discussions [19].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamics in Multiple Intracranial Aneurysms: The Role of Shear Related to Rupture

Berg¹,

Janiga²,

Beuing³

et al. 2013

IJBBB

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Abstract-Wall shear stress is the most prominent hemodynamic parameter associated with intracranial aneurysm rupture. Since low as well as high shear theories still coexist, the aim of this study was to investigate several shear related variables on datasets with multiple intracranial aneurysms.Therefore, two patient-specific anterior circulations of the human cerebral vascular system were reconstructed, containing two and three intracranial aneurysms, respectively. The hemodynamic simulations are based on flow rates measured by means of 7-Tesla PC-MRI. Since a rupture occurred in both cases and the affected aneurysms could be identified, the evaluation of time-averaged wall shear stresses, their gradients as well as the oscillatory shear indices mainly focuses on a comparison between ruptured and unruptured aneurysms.Areas of low and elevated shear were found in all cases and no correlation with rupture was identified. However, the ruptured aneurysms feature significantly higher directional changes of the shear vector associated to a stronger flow oscillation. This observation suggests that a combination of low average shear stresses wit increased oscillations is present in ruptured aneurysms. In that case, wall shear stress cannot be used exclusively in order to predict the rupture probability and the oscillatory shear index should be taken into account, probably as one of several additional indicators.

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Aneurysm Rupture Following Treatment with Flow-Diverting Stents: Computational Hemodynamics Analysis of Treatment

Cited by 317 publications

References 15 publications

Petrosal approaches to posterior circulation aneurysms

Petrosal approaches to posterior circulation aneurysms

Fluid-Structure Simulations and Benchmarking of Artery Aneurysms Under Pulsatile Blood Flow

Hemodynamics in Multiple Intracranial Aneurysms: The Role of Shear Related to Rupture

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