Assessment of intra-aneurysmal flow modification after flow diverter stent placement with four-dimensional flow MRI: a feasibility study

Pereira, Vítor Mendes; Brina, Olivier; Delattre, Bénédicte; Ouared, Rafik; Bouillot, Pierre; Erceg, Gorislav; Schaller, Karl; Lövblad, Karl-Olof; Vargas, Maria Isabel

doi:10.1136/neurintsurg-2014-011348

Cited by 35 publications

(50 citation statements)

References 30 publications

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“…An interesting 4D flow MRI study by Pereira et al (51) studied IAs post-treatment with flow diverter stent (FDS). Unlike traditional endovascular coil embolization techniques, a FDS reduces intra-aneurysmal flow and promotes progressive and stable thrombosis.…”

Section: Evaluation Of Intracranial Aneurysmsmentioning

confidence: 99%

Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?

Schnell

Ansari

2016

Current Opinion in Neurology

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Purpose of review To evaluate the feasibility of 4D flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease. Recent findings 4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intra-aneurysmal and parent artery blood flow after flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy subjects over a broad age range. Summary 4D flow MRI is a useful tool for the non-invasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultra-high field strengths to achieve higher spatial resolution, and streamlined post-processing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.

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Section: Evaluation Of Intracranial Aneurysmsmentioning

confidence: 99%

Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?

Schnell

Ansari

2016

Current Opinion in Neurology

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“…Pereira et al have extensively applied this approach to measure intracranial flow and assess flow diverter stents efficiency. [15][16][17][18][19] An optical flow algorithm was performed on DSA time series to track locally the temporal and spatial CA density variations between the successive images of the run, hence providing the direction and magnitude of the so-called detector velocity fields 18 (DVFs). Figure 3 shows the directions of the DVF as short streamlines superimposed with their magnitude color map.…”

Section: Data Processingmentioning

confidence: 99%

Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging

Pérez

Henkes

Bouillot

et al. 2015

J NeuroIntervent Surg

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BackgroundImplantation of self-expanding stents from the parent artery into the sac of a bifurcation aneurysm is regularly used to facilitate endovascular coil occlusion with the so-called waffle cone technique (WCT). Self-expanding aneurysm bridging stents like Solitaire AB, can be used; however, bifurcation devices like pCONus and pCANvas are especially designed for WCT. These devices provide additional support for coil implantation owing to intraluminal nylon fibers (pCONus) or membranes (pCANvas) covering the intracranial aneurysm neck.ObjectiveAssessment of the intra-aneurysmal hemodynamic impact of these three devices: a regular intracranial stent (Solitaire AB) and two bifurcation devices (pCONus and pCANvas).Material and methodsAn in vitro experiment was set up using a silicone model of a basilar tip aneurysm filled with blood mimicking fluid under a pulsatile circulation. Solitaire AB, pCONus, and pCANvas were successively implanted in the model for hemodynamic evaluation. High frame rate DSA series were acquired under various conditions. Intra-aneurysmal flow changes, including mean aneurysm flow amplitude ratio (R), were subsequently assessed by the optical flow method, measuring the detector velocity field before and after device implantations.ResultspCONus and Solitaire minimally reduced the intra-aneurysmal flow (R=0.96, p=0.17 and R=0.91, p=0.01, respectively), whereas pCANvas strongly diminished the intra-aneurysmal flow (R=0.41, p=5×10−12).ConclusionsWaffle cone deployment of stents and technique-specific devices had no undesirable effect on the intra-aneurysmal flow. In particular, no increased flow was redirected into the aneurysm sac. The intraluminal membrane of the pCANvas strongly reduced the intra-aneurysmal flow, potentially preventing recanalization problems.

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“…2) are two of the more common adverse technical events reported with FDS [26,29,60,82,[86][87][88][89][90]. Prolapse of an FDS into the aneurysm sac has also been reported with different frequencies [59,86,88,91]. Certain conditions require expeditious and sometimes creative remediation to correct a malposition [92].…”

Section: Thromboembolic and Ischemic Complicationsmentioning

confidence: 99%

Bailout Strategies and Complications Associated with the Use of Flow-Diverting Stents for Treating Intracranial Aneurysms

et al. 2018

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Background: Flow-diverting stents (FDS) have revolutionized the endovascular management of unruptured, complex, wide-necked, and giant aneurysms. There is no consensus on management of complications associated with the placement of these devices. This review focuses on the management of complications of FDS for the treatment of intracranial aneurysms. Summary: We performed a systematic, qualitative review using electronic databases MEDLINE and Google Scholar. Complications of FDS placement generally occur during the perioperative period. Key Message: Complications associated with FDS may be divided into periprocedural complications, immediate postprocedural complications, and delayed complications. We sought to review these complications and novel management strategies that have been reported in the literature.

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Assessment of intra-aneurysmal flow modification after flow diverter stent placement with four-dimensional flow MRI: a feasibility study

Cited by 35 publications

References 30 publications

Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?

Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?

Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging

Bailout Strategies and Complications Associated with the Use of Flow-Diverting Stents for Treating Intracranial Aneurysms

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