Geometrical characteristics after Y-stenting of the basilar bifurcation

Sağlam, Muzaffer; Kızılkılıç, Osman; Anagnostakou, Vania; Yildiz, Bulent; Koçer, Naci; Işlak, Civan

doi:10.5152/dir.2015.14523

Cited by 17 publications

(11 citation statements)

References 14 publications

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“…This finding might suggest that the larger the pre-stenting angle and the larger the vessel size, the smaller the angular change of δ 1 , δ 2 and also inflow angle α [ 11 ]. Other studies on angle remodeling of bifurcation aneurysm after SACE also found this inverse relation between extent of vascular modification and vessel diameter or pretreatment angle, latter corresponding with angle δ 1 of our study [ 11 , 24 ]. In our study we could only show a significant inverse relationship between angular change and presenting angle for angle δ 1 and δ 2 but not between angular change and vessel diameter.…”

Section: Discussionsupporting

confidence: 87%

“…Previous studies mainly focused on vascular remodeling of either bifurcation aneurysms [ 11 , 24 , 25 ] or sidewall aneurysms only [ 8 , 26 ]. In this study we compared bifurcation to sidewall aneurysms, demonstrating that stent-assisted coiling led to a greater change in the angle of bifurcation aneurysms of the anterior communicating artery compared to sidewall aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies on vascular remodeling effects of SACE have focused on straightening of the parent vessel [ 20 , 22 , 24 , 25 ]. In our study we could show that SACE did not only lead to effective straightening but also showed a trend towards an increasing diameter of the parent vessel, suggesting not only a bending [ 11 ] but also a radial force exerted by the deployed stent.…”

Section: Discussionmentioning

confidence: 99%

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Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

et al. 2016

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BackgroundStent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms.Methods31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections.ResultsStent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤ .001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤ .001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤ .01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05).ConclusionStent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

et al. 2016

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“…Y-stenting is a feasible treatment option for bifurcation aneurysms when safe coil embolization cannot be achieved by a single stent 3. It has already been shown that Y-stenting using the crossing technique, in which a second stent is advanced through the interstices of the first deployed stent, straightens the bifurcation and narrows the effective aneurysm neck immediately after stent deployment 10. The kissing-Y technique is an alternative treatment option.…”

Section: Discussionmentioning

confidence: 99%

Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms

Melber

Meila

Draheim

et al. 2016

J NeuroIntervent Surg

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“…Several recent studies investigated local modifications of the cerebral vascular anatomy due to stent deployment based on clinical findings of up to 102 data sets [1][2][3][4][5][6][7]. The deformation was quantified in 2D or 3D angiography before and after stenting.…”

Section: Introductionmentioning

confidence: 99%

Variability of intra-aneurysmal hemodynamics caused by stent-induced vessel deformation

Voß¹,

Berg²,

Janiga³

et al. 2017

Current Directions in Biomedical Engineering

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Clinical observation revealed deformations of the local vasculature due to implanted devices related to treatment of intracranial aneurysms. Pre-and postinterventional image data is reviewed and segmented. Based on Computational Fluid Dynamics (CFD) the effect of the vessel deformation on the intra-aneurysmal hemodynamics is investigated. The simulations incorporate the vessel trees with aneurysm excluding the device itself in order to consider the isolated effect of geometric modifications. As a result, the aneurysm inflow jet is redirected, changing the local flow quantities. Finally, a neck inflow rate reduction of 52.5 % is archived. Thus, a targeted vessel straightening as a novel tool for treatment planning appear to be an idea worth to discuss in the community.

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Geometrical characteristics after Y-stenting of the basilar bifurcation

Cited by 17 publications

References 14 publications

Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms

Variability of intra-aneurysmal hemodynamics caused by stent-induced vessel deformation

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