Enhanced Aneurysmal Flow Diversion Using a Dynamic Push-Pull Technique: An Experimental and Modeling Study

Ma, Dawei; Xiang, Jianping; Choi, Hoon; Dumont, Travis M.; Natarajan, Sabareesh K.; Siddiqui, Adnan H.; Meng, Hui

doi:10.3174/ajnr.a3933

Cited by 49 publications

(50 citation statements)

References 13 publications

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“…This is of critical importance, because we have previously demonstrated that a single device when packed can result in greater than 50% metal surface coverage, and 2 devices seriously threaten the patency of the critical perforators that are typically crowded around the necks of these aneurysms. 10 By using a single device over perforator segments, we have significantly reduced the occurrence of large, devastating perforator strokes.…”

Section: Number Of Pedsmentioning

confidence: 99%

The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

Natarajan

Lin

Sonig

et al. 2016

JNS

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OBJECT Pessimism exists regarding flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures. The authors report the results of patients who underwent Pipeline Embolization Device (PED) flow diversion using novel strategies for treatment of fusiform posterior circulation aneurysms, and compare these results with those from previously reported series. METHODS The authors conducted a retrospective review of data from consecutive patients with fusiform vertebrobasilar artery aneurysms treated with the PED. RESULTS This review resulted in the identification of 12 such patients (mean [± SD] age 55.1 ± 14.1 years). Eleven patients had symptoms; 1 had a dissecting aneurysm identified on imaging for neck pain. The average aneurysm size was 13.25 ± 4.5 mm. None of the aneurysms were ruptured or previously treated. The average clinical follow-up duration was 22.1 ± 10.7 months and radiological follow-up was 14.5 ± 11.1 months from the index PED treatment. One patient suffered a perforator stroke and had a modified Rankin Scale (mRS) score of 4 at last follow-up. Another patient had a retained stent pusher requiring retrieval via surgical cut-down but recovered to an mRS score of 0 at last follow-up. Eleven (91.7%) of 12 patients recovered to an mRS score of 0 or 1. Two patients had aneurysmal remnants at 7 and 10 months, respectively, after the index PED, which were retreated with PEDs. At last follow-up, all 12 aneurysms were occluded and PEDs were patent. The minimum follow-up duration was 12 months from the index PED treatment; no patient experienced delayed hemorrhage, stroke, or in-stent stenosis. CONCLUSIONS Flow diversion with selective adjunctive techniques is evolving to become a safer treatment option for posterior circulation aneurysms. This is the longest clinical follow-up duration reported for a single-center experience of flow-diversion treatment of these aneurysms.

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Section: Number Of Pedsmentioning

confidence: 99%

The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

Natarajan

Lin

Sonig

et al. 2016

JNS

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“…27 Parent vessel diameter measurement and location of aneurysmal flow impingement will help clinicians to better choose and place stents 5,13,21 and flow diverters. 7,17,28 However, calculation of morphometrics and hemodynamics is typically done retrospectively away from the interventional suite, and it typically requires welltrained engineers/researchers to perform image-based modeling based on existing methods. In developing AView, we have sought the input of neurosurgeons and neurointerventionalists as the main source for workflow design and system specifications, with the aim of hiding the engineering complexity with an intuitive interface and minimal user interaction.…”

Section: Discussionmentioning

confidence: 99%

AView: An Image-based Clinical Computational Tool for Intracranial Aneurysm Flow Visualization and Clinical Management

Xiang

Antiga²,

Varble

et al. 2015

Ann Biomed Eng

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Intracranial aneurysms (IAs) occur in around 3% of the entire population. IA rupture is responsible for the most devastating type of hemorrhagic strokes, with high fatality and disability rates as well as healthcare costs. With increasing detection of unruptured aneurysms, clinicians are routinely faced with the dilemma whether to treat IA patients and how to best treat them. Hemodynamic and morphological characteristics are increasingly considered in aneurysm rupture risk assessment and treatment planning, but currently no computational tools allow routine integration of flow visualization and quantitation of these parameters in clinical workflow. In this paper, we introduce AView, a prototype of a clinician-oriented, integrated computation tool for aneurysm hemodynamics, morphology, and risk and data management to aid in treatment decisions and treatment planning in or near the procedure room. Specifically, we describe how we have designed the AView structure from the end-user's point of view, performed a pilot study and gathered clinical feedback. The positive results demonstrate AView's potential clinical value on enhancing aneurysm treatment decision and treatment planning.

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“…4). 15) This is expected to promote thrombus formation. Also, the possibility that persistence of a jet flow is involved in delayed rupture has been proposed, and the risk of delayed rupture may be reduced if the jet flow can be controlled by such a placement method.…”

Section: Effects Of the Procedures Of Fd Placement On Cfdmentioning

confidence: 99%

Fluid Analysis of the Flow Diverter Stent: Clinical Significance

Kono

2017

JNET

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Flow diverter stents have been used widely for treatment of cerebral aneurysms in the US and EU. Although flow diverter stents are very promising, there are a few clinical concerns such as delayed rupture or incomplete occlusion. Engineers have been addressing these issues using computational fluid dynamics simulations (CFD). Because flow diverter stents have "flow diverting" effects, as the name indicates, we consider that the effects could be predicted by CFD. In this review, I will describe CFD research on clinical aspects of flow diverter stents.

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Enhanced Aneurysmal Flow Diversion Using a Dynamic Push-Pull Technique: An Experimental and Modeling Study

Cited by 49 publications

References 13 publications

The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

AView: An Image-based Clinical Computational Tool for Intracranial Aneurysm Flow Visualization and Clinical Management

Fluid Analysis of the Flow Diverter Stent: Clinical Significance

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