Basic Fluid Dynamics and Tribia Related to Flow Diverter

Shojima, Masaaki

doi:10.5797/jnet.ra-diverter.2016-0012

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Flow diverters inducing a shear driven flow as opposed to pressure-driven flow have also shown a more efficacious reduction of blood flow. 8,16 These data reinforce the principle of flow diverters leading to effective disconnection of intra-aneurysmal flow from the parent artery.…”

supporting

confidence: 58%

Mechanism of Action and Biology of Flow Diverters in the Treatment of Intracranial Aneurysms

et al. 2019

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Flow diverters have drastically changed the landscape of intracranial aneurysm treatment and are now considered first-line therapy for select lesions. Their mechanism of action relies on intrinsic alteration in hemodynamic parameters, both at the parent artery and within the aneurysm sac. Moreover, the device struts act as a nidus for endothelial cell growth across the aneurysm neck ultimately leading to aneurysm exclusion from the circulation. In silico computational analyses and investigations in preclinical animal models have provided valuable insights into the underlying biological basis for flow diverter therapy. Here, we review the present understanding pertaining to flow diverter biology and mechanisms of action, focusing on stent design, induction of intra-aneurysmal thrombosis, endothelialization, and alterations in hemodynamics.

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supporting

confidence: 58%

Mechanism of Action and Biology of Flow Diverters in the Treatment of Intracranial Aneurysms

et al. 2019

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“…Figure 2 shows examples of the velocity field u in the aneurysmal sac for a subset of conditions at four time points of the cycle (Re PV = 414, Q PV = 300 ml min −1 ). A single counter-rotating vortex exists for the entire cycle, consistent with previous studies (Aenis et al 1997;Meng et al 2006;Liou et al 2008;Rayepalli et al 2013;Shojima 2017;Moriwaki et al 2020;Chassagne et al 2021;Nagargoje et al 2022). This counter-rotating vortex is the result of the separation of the flow at the proximal edge.…”

Section: Flow Topologysupporting

confidence: 89%

“…Previous research has highlighted the important role of the parent vessel curvature (Xu et al. 2015; Shojima 2017; Barbour et al. 2021; Chassagne et al.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, the haemodynamics in the sac also depends on the geometry of the parent vessel (Imai et al 2008). Previous research has highlighted the important role of the parent vessel curvature (Xu et al 2015;Shojima 2017;Barbour et al 2021;Chassagne et al 2021;Mandrycky et al 2023). Curvature and bending angles of the artery impact not only the pre-treatment haemodynamics, but also the success of treatment (Larrabide et al 2015;Rinaldo et al 2019).…”

Section: Introductionmentioning

confidence: 99%

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Fluid dynamics in intracranial aneurysms treated with flow-diverting stents: effect of multiple geometrical parameters

Chassagne,

Barbour,

Levitt

et al. 2023

J. Fluid Mech.

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Characterizing the haemodynamics in intracranial aneurysms is of high interest as it impacts aneurysm growth, rupture and treatment, especially with flow-diverting stents (FDS). Flow in these geometries is known to depend on the Dean, Reynolds and Womersley numbers, $De$ , $Re$ , $Wo$ , but is also influenced by geometrical parameters such as the sac shape or the size of the opening. Via particle image velocimetry, this parametric study aimed at evaluating the combined effects of $Re$ , $De$ , $Wo$ and the geometry of the aneurysmal sac on the haemodynamics before and after treatment with FDS. Eight ellipsoidal idealized aneurysm models were created with two curvatures of the parent vessel, two aspect ratios of the sac and two neck sizes. Before treatment, a single counter-rotating vortex, whose strength increases with $Re$ and $De$ , as well as with the neck size and the aspect ratio, was observed in the sac for all but one geometry. After treatment with FDS, four different flow topologies were observed, depending on the geometry: no separation, separation for part of the cycle, two opposing vortices or a single counter-rotating vortex. A linear model with interaction revealed the predominant effect of $De$ and the curvature of the parent vessel on the haemodynamics before and after treatment. This work once more demonstrated the primary role of haemodynamics in the treatment of intracranial aneurysms with FDS. Future work will consider the complexity of patient-specific geometries, and their effects on both the haemodynamics in the sac and the porosity of the FDS.

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“…Conversely, an inertia-driven flow is perceived when the angle between the parent vessel and aneurysm ostium sharpens, generating flow instability and disruption. This difference in flow dynamics may widely interfere with the effect of flow diverter placement, as exemplified by sidewall aneurysms along ICA tortuosities, which demonstrate an inertia-driven flow attenuating the effect of flow diverters 29 30. This is particularly important when interpreting the results of the SCENT trial, as it consistently included large and giant aneurysms in the carotid communicating segment (22%) and along the curvature of the carotid siphon.…”

Section: Discussionmentioning

confidence: 99%

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

Hanel

Cortez

Coon

et al. 2022

J NeuroIntervent Surg

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BackgroundTo report the 3-year safety and effectiveness of the Surpass Streamline flow diverter in the SCENT trial (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms).MethodsThe Surpass Streamline flow diverter device was evaluated in a multicenter, prospective, single-arm, non-randomized interventional trial including patients with uncoilable or previously treated but failed aneurysms of the intracranial internal carotid artery. 3-year outcomes were tabulated with descriptive statistics and compared with 1-year outcomes.ResultsOf 180 patients in the modified intent-to-treat (mITT) cohort, 36-month clinical and angiographic follow-up was available in 134 and 117 cases, respectively. Effectiveness endpoint of complete aneurysm occlusion without clinically significant stenosis or retreatment was met in 71.8% (79/110, 95% CI 62.4% to 80.0%) of cases. Safety composite endpoint was 12.2% (22/180) over the 3-year period, with two major safety events (ipsilateral ischemic strokes) occurring between 12–36 months. Complete aneurysm occlusion was noted in 77.8% (91/117), and 99.1% (116/117) of the patients demonstrated adequate aneurysm occlusion (complete occlusion or neck residual). There were four cases (2.2%) of aneurysm rupture, all occurring within the first month of the index procedure. Target aneurysm retreatment rate was 2.8% (5/180).ConclusionThe present findings support the long-term safety and effectiveness of the Surpass Streamline flow diverter device.Trial registrationNCT01716117.

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Basic Fluid Dynamics and Tribia Related to Flow Diverter

Cited by 8 publications

References 13 publications

Mechanism of Action and Biology of Flow Diverters in the Treatment of Intracranial Aneurysms

Mechanism of Action and Biology of Flow Diverters in the Treatment of Intracranial Aneurysms

Fluid dynamics in intracranial aneurysms treated with flow-diverting stents: effect of multiple geometrical parameters

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

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