Computational Hemodynamics Analysis of Intracranial Aneurysms Treated with Flow Diverters: Correlation with Clinical Outcomes

Chong, Winston; Zhang, Yu; Qian, Yi; Lai, Leon T.; Parker, Glendon J.; Mitchell, K.

doi:10.3174/ajnr.a3790

Cited by 78 publications

(64 citation statements)

References 13 publications

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“…The homogeneity of the covered surface at the IA neck increased while increasing strut density, hence justifying the use of a porous media approach (e.g. FDS) 9 13…”

Section: Discussionmentioning

confidence: 99%

Computational fluid dynamics with stents: quantitative comparison with particle image velocimetry for three commercial off the shelf intracranial stents

Bouillot

Brina

Ouared

et al. 2015

J NeuroIntervent Surg

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“…The homogeneity of the covered surface at the IA neck increased while increasing strut density, hence justifying the use of a porous media approach (e.g. FDS) 9 13…”

Section: Discussionmentioning

confidence: 99%

Computational fluid dynamics with stents: quantitative comparison with particle image velocimetry for three commercial off the shelf intracranial stents

Bouillot

Brina

Ouared

et al. 2015

J NeuroIntervent Surg

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“…Therefore, CFD analysis by regarding the FD as a porous medium is also performed. [15][16][17] In CFD analysis by assuming the FD as a porous medium, individual filaments constituting the FD are ignored, the FD is regarded as a plane, and the fluid resistance in the plane is expressed as simple values. While this can markedly reduce the number of grids and save the trouble of CFD, whether or not the assumption of the FD as a porous medium is valid remains questionable.…”

Section: Mesh Dependencementioning

confidence: 99%

Basic Fluid Dynamics and Tribia Related to Flow Diverter

Shojima

2017

JNET

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To enrich our understanding of endovascular treatment of cerebral aneurysm in the era of flow diverters (FD), related literature dealing with fluid dynamic engineering is reviewed and elaborated on here.The intra-aneurysmal flow patterns could be classified into shear-driven flow and inertia-driven flow. The flow reduction effects of FD are better anticipated among aneurysms with a shear-driven flow pattern.The FDs with lower porosity reduce more blood flow into aneurysms. Under certain porosity, FDs with thinner filaments reduce more blood flow.The flow reductions of side-branches after FD are estimated as less than 20% by computer simulation. Thus, other factors such as anti-platelet drugs and neo-intimal hyperplasia may also be involved in the ischemic complications in the territory of side-branch after FD placement.Pulsatility of blood flow, which is considerably decreased in the parent artery downstream to large aneurysms, recovers shortly after FD deployment and the peak systolic velocity becomes higher after FD. The peripheral brain circulation might be changed after FD deployment in cases of large aneurysms.Blood flow simulation for FD is not easy but it would provide useful information for selecting the proper cases for FD as well as selecting the proper devices for a certain case.

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“…Flow jets on the DSA are the streak lines of dyes, different from the streamlines presented in most CFD studies. In most virtual angiography studies, contrast administration is not explicitly modeled, and the contrast agent is moving with the blood and is not mixed with the blood flow in the parent artery (20,23,24). Thus, simulated contrast influx reflects the original blood flow pattern and cannot validate the timing of flow jet observed in our study.…”

Section: B C D E Amentioning

confidence: 50%

“…The diastolic flow jet at higher injection rates cannot fully represent the true effect of flow diversion due to its low inertia. Clinicians favor a central flow jet with peripheral stasis, as in Figure 6B-D (20); this type of flow pattern is highly influenced by the inertia and appears only during the acceleration phase of the systole. A flow jet can be used for diagnosis only during this period.…”

Section: Discussionmentioning

confidence: 99%

In vitro investigation of contrast flow jet timing in patient-specific intracranial aneurysms

Jou

Desai

Britz

2016

Quant. Imaging Med. Surg.

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Background: The direction and magnitude of intra-aneurysmal flow jet are significant risk factors of subarachnoid hemorrhage, and the change of flow jet during an endovascular procedure has been used for prediction of aneurysm occlusion or whether an additional flow diverter (FD) is warranted. However, evaluation of flow jets is often unreliable due to a large variation of flow jet on the digital subtraction angiograms, and this flow pattern variation may result in incorrect clinical diagnosis Therefore, factors contributing to the variation in flow jet are examined at an in vitro setting, and the findings can help us to understand the nature of flow jet and devise a better plan to quantify the aneurysmal hemodynamics accurately.Methods: Intra-aneurysmal flows in three patient-specific aneurysms between 11 and 25 mm were investigated in vitro, and a FD was deployed in each aneurysm model. X-ray imaging of these models were performed at injection rates between 0.2 and 2 mL/s. Pulsatile blood pump and aneurysm model were imaged together to determine the timing of flow jet. Results:The contrast bolus arrives at the aneurysm early at high contrast injection rates. The flow patterns with slow injection rates exhibit strong inertia that is associated with the systole flow. Flow jets arrive at the aneurysms at the peak systole when the bolus is injected at 0.2 mL/s. The contrast-to-signal ratio is the highest at the injection rate of 0.5 mL/s. Effect of flow diversion can only be assessed at an injection rate greater than 0.5 mL/s.Conclusions: Intra-aneurysmal flow jet is highly dependent on the injection rate of the contrast agent.For the internal carotid artery (ICA) aneurysms, the systolic flows can be visualized at slow injection rates (<0.5 mL/s), while the diastolic flow jets are visible at higher injection rates (>1 mL/s). Dependence of flow jet on the contrast injection rate has serious clinical implications and needs to be considered during diagnostic procedures; a protocol with a consistent injection rate is highly recommended.

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Computational Hemodynamics Analysis of Intracranial Aneurysms Treated with Flow Diverters: Correlation with Clinical Outcomes

Cited by 78 publications

References 13 publications

Computational fluid dynamics with stents: quantitative comparison with particle image velocimetry for three commercial off the shelf intracranial stents

Computational fluid dynamics with stents: quantitative comparison with particle image velocimetry for three commercial off the shelf intracranial stents

Basic Fluid Dynamics and Tribia Related to Flow Diverter

In vitro investigation of contrast flow jet timing in patient-specific intracranial aneurysms

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