Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device

Abstract

BackgroundThe aim of this study was to quantify the effect of the new Low-profile Visualized Intraluminal Support (LVIS®D) device and the difference of fluid diverting effect compared with the Pipeline device and the Enterprise stent using computational fluid dynamics (CFD).MethodsIn this research, we simulated three aneurysms constructed from 3D digital subtraction angiography (DSA). The Enterprise, LVIS and the Pipeline device were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice. Computational fluid dynamics analysis was performed to compare the hemodynamic differences such as WSS, Velocity and Pressure among these stents.ResultsControl referred to the unstented model, the percentage of hemodynamic changes were all compared to Control. A single LVIS stent caused more wall shear stress reduction than double Enterprise stents (39.96 vs. 30.51 %) and velocity (23.13 vs. 18.64 %). Significant reduction in wall shear stress (63.88 %) and velocity (46.05 %) was observed in the double-LVIS stents. A single Pipeline showed less reduction in WSS (51.08 %) and velocity (37.87 %) compared with double-LVIS stent. The double-Pipeline stents resulted in the most reduction in WSS (72.37 %) and velocity (54.26 %). Moreover, the pressure increased with minuscule extent after stenting, compared with the unstented model.ConclusionsThis is the first study analyzing flow modifications associated with LVIS stents. We found that the LVIS stent has certain hemodynamic effects on cerebral aneurysms: a single LVIS stent caused more flow reductions than the double-Enterprise stent but less than a Pipeline device. Nevertheless, the double-LVIS stent resulted in a better flow diverting effect than a Pipeline device.

Preliminary experience with the use of low profile visualized intraluminal support device in basilar artery for aneurysm treatment

“…Compromise of perforating arteries and consequent infarction because of struts coverage and delayed neointimal proliferation over the perforator ostia were the most common complications. Generally, porosity of the stent induces neck coverage and the possibility of flow stasis in the aneurysm, which plays an important role in thrombosis 14. The metal coverage rate of FDs was reported to be 30–40%.…”

A Case of Traumatic Vertebral Arteriovenous Fistula Treated by Coil Embolization Using Braided-stent for Preservation of Parental Artery

“…However, it is higher than that (8%) of an Enterprise (Cordis, Neurovascular, Miami, Florida, USA) as a laser-cut stent. 15) As the use of an LVIS stent in the cervical region is not covered by health insurance, it must be carefully operated. However, it has a high metallic coverage rate as a currently available stent.…”

“…However, it has a high metallic coverage rate as a currently available stent. Wang et al 15) quantified hemodynamic changes related to stenting using computational fluid dynamics (CFD), and reported that the wall shear stress and velocity reduction rates when two LVIS stents were used were 63% and 46%, respectively, being higher than those of a Pipeline (51% and 37%, respectively). In addition, an LVIS stent makes it possible to intentionally increase the density of a cell on deployment.…”

Flow Diversion with Low-Profile Braided Stents for the Treatment of Very Small or Uncoilable Intracranial Aneurysms at or Distal to the Circle of Willis

“…5 Tateshima et al 19 investigated the alterations in intra-aneurysmal hemodynamics with the placement of high-porosity open-cell stents across the necks of aneurysms and found that the placement of a single Neuroform stent (Stryker Neurovascular) reduced the intra-aneurys- mal flow velocity by 22%-64%. In another study, Wang et al 20 assessed the hemodynamic changes inside aneurysms induced by the implantation of conventional stents and found that the velocity of the jet flow entering the aneurysm and wall shear stresses on the aneurysm were significantly reduced by the placement of a stent. 20 These authors suggested that the hemodynamic changes induced by stents promote thrombus formation inside the aneurysm and reduce the risk of aneurysm growth and rupture.…”

“…In another study, Wang et al 20 assessed the hemodynamic changes inside aneurysms induced by the implantation of conventional stents and found that the velocity of the jet flow entering the aneurysm and wall shear stresses on the aneurysm were significantly reduced by the placement of a stent. 20 These authors suggested that the hemodynamic changes induced by stents promote thrombus formation inside the aneurysm and reduce the risk of aneurysm growth and rupture. Blankena et al 21 studied the correlation between wall shear stress and wall thickness of aneurysms with 7T MR imaging.…”