The effects of stent porosity on the endovascular treatment of intracranial aneurysms located near a bifurcation

Tang, Abraham Yik-Sau; Chan, Hiu-Ning; Tsang, Arthur; Leung, Gilberto Ka-Kit; Leung, Kwok-Sui; Yu, Alfred Cheuk-Hang; Chow, K. W.

doi:10.4236/jbise.2013.68099

Cited by 11 publications

(5 citation statements)

References 55 publications

(71 reference statements)

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“…Stent configuration, porosity, and position are all believed to be crucial determining factors of treatment efficacy [ 4 , 22 , 23 ]. In general, a stent with low porosity can reduce the flow entering the aneurysm substantially [ 23 , 24 ]. However, the flow dynamics associated with changing side branch vessel diameter was not analyzed quantitatively in these earlier works.…”

Section: Introductionmentioning

confidence: 99%

Computational Fluid Dynamics Study of Bifurcation Aneurysms Treated with Pipeline Embolization Device: Side Branch Diameter Study

et al. 2015

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An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters. The condition after the deployment of a pipeline embolization device is also simulated. Hemodynamic factors such as flow velocity, pressure, and wall shear stress are studied. Aneurysms with a larger side branch vessel might have greater risk after treatment in terms of hemodynamics. Although a stent could lead to flow reduction entering the aneurysm, it would drastically alter the flow rate inside the side branch vessel. This may result in side-branch hypoperfusion subsequent to stenting. In addition, two patient-specific bifurcation aneurysms are tested, and the results show good agreement with the idealized models. Furthermore, the peripheral resistance of downstream vessels is investigated by varying the outlet pressure conditions. This quantitative analysis can assist in treatment planning and therapeutic decision-making.

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Section: Introductionmentioning

confidence: 99%

Computational Fluid Dynamics Study of Bifurcation Aneurysms Treated with Pipeline Embolization Device: Side Branch Diameter Study

et al. 2015

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“…2,20,24 In vitro studies have shown that the flow diverting effect is increased in devices with low porosity like FDs compared to high-porosity intracranial stents. 25,26 Moreover, a multicentre study of Wang et al detected that lower metal coverage is an independent risk factor for aneurysm recurrence that enables a more effective flow lamination by FD than multilayer stents. 27 Endovascular treatment by flow diversion is increasingly used in ruptured intracranial aneurysms, with lower mortality and morbidity compared to open surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

“…In vitro studies have shown that the flow diverting effect is increased in devices with low porosity like FDs compared to high-porosity intracranial stents. 25,26 Moreover, a multicentre study of Wang et al. detected that lower metal coverage is an independent risk factor for aneurysm recurrence that enables a more effective flow lamination by FD than multilayer stents.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

et al. 2019

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IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

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“…For coronary artery, the flow rate (∼2.35 ml/s) is generally higher [24]. For brain aneurysm, the flow rate (∼0.03 ml/s) is generally lower [25]. The flow rates can be adjusted by changing the pressing condition of the impedance pump, the position of pressing site relative to the elastic tube and the ID of the flow loop.…”

Section: Discussionmentioning

confidence: 99%

A portable device for studying the effects of fluid flow on degradation properties of biomaterials inside cell incubators

Jiang¹,

Lin²,

Chen

et al. 2018

Regenerative Biomaterials

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A portable device was designed and constructed for studying the properties of biomaterials in physiologically relevant fluids under controllable flow conditions that closely simulate fluid flow inside the body. The device can fit entirely inside a cell incubator; and, thus, it can be used directly under standard cell culture conditions. An impedance-driven pump was built in the sterile flow loop to control the flow rates of fluids, which made the device small and portable for easy deployment in the incubator. To demonstrate the device functions, magnesium (Mg) as a representative biodegradable material was tested in the flow device for immersion degradation under flow versus static conditions, while the flow module was placed inside a standard cell incubator. The flow rate was controlled at 0.17 ± 0.06 ml/s for this study; and, the flow rate is adjustable through the controller module outside of incubators for simulating the flow rates in the ranges of blood flow in human artery (0.05 ∼0.43 ml/s) and vein (0.02 ∼0.08 ml/s). Degradation of Mg under flow versus static conditions was characterized by measuring the changes of sample mass and thickness, and Mg2+ ion concentrations in the immersion media. Surface chemistry and morphology of Mg after immersion under flow versus static conditions were compared. The portable impedance-driven flow device is easy to fit inside an incubator and much smaller than a peristaltic pump, providing a valuable solution for studying biomaterials and implants (e.g. vascular or ureteral stents) in body fluids under flow versus static conditions with or without cells.

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The effects of stent porosity on the endovascular treatment of intracranial aneurysms located near a bifurcation

Cited by 11 publications

References 55 publications

Computational Fluid Dynamics Study of Bifurcation Aneurysms Treated with Pipeline Embolization Device: Side Branch Diameter Study

Computational Fluid Dynamics Study of Bifurcation Aneurysms Treated with Pipeline Embolization Device: Side Branch Diameter Study

Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

A portable device for studying the effects of fluid flow on degradation properties of biomaterials inside cell incubators

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