Hemodynamic Comparison of Treatment Strategies for Intracranial Vertebral Artery Fusiform Aneurysms

Abstract

ObjectiveThis study comparatively analyzed the hemodynamic changes resulting from various simulated stent-assisted embolization treatments to explore an optimal treatment strategy for intracranial vertebral artery fusiform aneurysms. An actual vertebral fusiform aneurysm case treated by large coil post-stenting (PLCS) was used as a control.Materials and MethodsA single case of an intracranial vertebral artery fusiform aneurysm underwent a preoperative and eight postoperative finite element treatment simulations: PLCS [single and dual Low-profile Visualized Intraluminal Support (LVIS)], Jailing technique (single and dual LVIS both simulated twice, Pipeline Embolization Device (PED) with or without large coils (LCs). Qualitative and quantitative assessments were performed to analyze the most common hemodynamic risk factors for recurrence.ResultsJailing technique and PED-only had a high residual flow volume (RFV) and wall shear stress (WSS) on the large curvature of the blood flow impingement region. Quantitative analysis determined that PLSC and PED had a lower RFV compared to preoperative than did the jailing technique [PED+LC 2.46% < PLCS 1.2 (dual LVIS) 4.75% < PLCS 1.1 (single LVIS) 6.34% < PED 6.58% < Jailing 2.2 12.45% < Jailing 1.2 12.71% < Jailing 1.1 14.28% < Jailing 2.1 16.44%]. The sac-averaged flow velocity treated by PLCS, PED and PED+LC compared to preoperatively was significantly lower than the jailing technique [PED+LC = PLCS 1.2 (dual LVIS) 17.5% < PLCS 1.1 (single LVIS) = PED 27.5% < Jailing 1.2 = Jailing 2.2 32.5% < Jailing 1.1 37.5% < Jailing 2.1 40%]. The sac-averaged WSS for the PLCS 1.2 (dual LVIS) model was lower than the PED+LC, while the high WSS area of the Jailing 1 model was larger than for Jailing 2 [PLCS 1.2 38.94% (dual LVIS) < PED+LC 41% < PLCS 1.1 43.36% (single LVIS) < PED 45.23% < Jailing 2.1 47.49% < Jailing 2.2 47.79% < Jailing 1.1 48.97% < Jailing 1.2 49.85%].ConclusionsFor fusiform aneurysms, post large coil stenting can provide a uniform coil configuration potentially reducing the hemodynamic risk factors of recurrence. Flow diverters also may reduce the recurrence risk, with long-term follow-up required, especially to monitor branch blood flow to prevent postoperative ischemia.

How does the recurrence-related morphology characteristics of the Pcom aneurysms correlated with hemodynamics?

“…The vascular, stent and coil models were imported into ANSYS ICEM CFD version 16.2 (ANSYS Inc., Canonsburg, PA, United States) for meshing, with a global mesh size of 0.16 mm. The surface mesh size of the Enterprise and Neuroform EZ stents was set to 0.03 mm, the mesh size of the LVIS stent was set to 1/6 of the wire circumference, which was 0.03 mm, and the mesh size of the coils was set to 0.1 mm ( 18 ). The CFD simulation was based on the Navier–Stokes equations and was performed using ANSYS CFX version 2019 (ANSYS Inc., Canonsburg, PA, United States).…”

Classification and hemodynamic characteristics of delayed intracerebral hemorrhage following stent-assisted coil embolism in unruptured intracranial aneurysms

“…The method of virtual implantation for stent and coil established in the previous research was adopted in this study (16) Canonsburg, Pennsylvania, United States) to mesh in a global mesh size of 0.16 mm. The surface mesh size of the stent (Enterprise 2 and Neuroform EZ) was set to 0.03 mm, and the mesh size of the coils was set to 0.1 mm (17). ANSYS CFX version 2019 (ANSYS Inc., Canonsburg, Pennsylvania, United States) was used to perform the CFD simulation on the basis of the Navier-Stokes equations.…”

Fusiform versus Saccular Intracranial Aneurysms—Hemodynamic Evaluation of the Pre-Aneurysmal, Pathological, and Post-Interventional State

“…Image-based blood flow simulations using computational fluid dynamics (CFD) and virtual treatment approaches provide a great opportunity to model the hemodynamics and the treatment effect without requiring any extra procedure or inconvenience to the patient [ 26 , 27 , 28 ].…”