Hemodynamic Changes Caused by Multiple Stenting in Vertebral Artery Fusiform Aneurysms: A Patient-Specific Computational Fluid Dynamics Study

Lv, Nan; Cao, Wei; Larrabide, Ignacio; Karmonik, Christof; Zhu, Deyuan; Liu, J.; Huang, Qinghai; Fang, Yibin

doi:10.3174/ajnr.a5452

Cited by 27 publications

(10 citation statements)

References 19 publications

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“…This is especially important in the case of complex stenting, where post-treatment flow alterations are difficult to predict. Hence, Lv et al [30] have recently studied hemodynamics in vertebral artery fusiform aneurysms treated with three overlapping self-expanding Enterprise stents and found favorable changes in hemodynamic parameters, leading to thrombosis formation after the stenting. However, the effect of telescopic flow-diverter placement in a giant fusiform aneurysm of the vertebrobasilar junction on blood flow was not studied yet, which is an objective of the present study.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction

et al. 2019

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Background The use of flow-diverters for non-saccular cerebral posterior circulation aneurysms requires complex deployment techniques and is associated with high mortality and morbidity. Therefore, further studies are required to clarify the effect of stenting on post-treatment hemodynamics in such aneurysms. In this study, we evaluated flow alterations in a treated giant fusiform aneurysm of the vertebrobasilar junction and correlated them with the clinical outcome. Methods A patient-specific aneurysm model was acquired by rotational angiography, and three SILK flow-diverters (4.5 × 40, 5 × 40 and 5.5 × 40 mm) were virtually deployed in series along the basilar and right vertebral arteries. Image-based blood flow simulations before and after the treatment were performed under realistic pulsatile flow conditions. The flow reduction, velocity and wall shear stress (WSS) distribution, streamlines and WSS-derived parameters were evaluated before and after the treatment. Results The computed velocity streamlines showed substantial alterations of the flow pattern in the aneurysm and successful redirection of blood flow along the series of flow-diverters with no flow through the overlapping stents. The obtained flow reduction of 86% was sufficient to create thrombogenic flow conditions. Moreover, a 6.2-fold increase in relative residence time and a decrease by 87% of time-averaged WSS contributed to a successful treatment outcome observed during the follow-up. Conclusions We found a correlation between the numerically predicted flow alterations and the available treatment outcome. This shows the potential of image-based simulations to be used in clinical practice for treatment planning and estimation of possible risk factors associated with a complex stent deployment in fusiform aneurysms of the posterior circulation.

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Section: Discussionmentioning

confidence: 99%

Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction

et al. 2019

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“…The technical and therapeutic merits of MSs in the treatment of visceral branched aneurysms were preliminarily revealed by some research from both a clinical and computational perspective, 9,34,35 and our study offers more detailed hemodynamic evidence, such as less disturbed flow in the vessel, and low velocity, low TAWSS, high OSI, and high RRT in the aneurysm sac, verifying that MS can channel flow in the main vessel, foster a relatively secluded hemodynamic environment for aneurysm sac to stimulate curative clot to form and synchronously guarantee proper perfusion to vital organs to avoid infarction. Moreover, our study also supports that at least three layers can prompt a favorable hemodynamic environment for any aneurysm degeneration.…”

Section: Discussionmentioning

confidence: 99%

“…It is capable of remodeling vessel walls, initiating a self-healing thrombus formation and thereby degenerating aneurysm as well as allowing blood flow through its mesh, so we can reach a good compromise between TAAAs repair and the maintenance of patency in visceral vessels. [7][8][9] It has been documented that MS has become a promising therapeutic alternative for the repair of complex TAAAs cases due to its low-cost, off-the-shelf nature, compared to a custom-made chimney, fenestrated or branched EVAR. [10][11][12] Recently, many studies have engaged in uncovering the potential role of MS in aneurysm treatment.…”

Section: Introductionmentioning

confidence: 99%

The hemodynamic effect of eccentricity in visceral branched aneurysms with multilayer stents

Wang

Chen

et al. 2022

Proc Inst Mech Eng H

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It is preliminarily acknowledged that multilayer stent (MS) is a promising alternative technology in the treatment of visceral branched aneurysms, but hemodynamic consequences of eccentricity in such aneurysms with MS are less examined. In this work, we performed a time-dependent simulation of branched aneurysms of various eccentricities with different stent layers, and thrombosis-related parameters, such as time-averaged wall shear stress (TAWSS), oscillating shear index (OSI), and relative residence time (RRT), were also analyzed. Our results revealed that MS can generally restore laminar flow inside the stent, and allow proper perfusion to vital organs while also fostering a relatively secluded hemodynamic environment for thrombosis formation. Particularly, a flow in the aneurysm sac communicating between the main artery and side branch forms at early systole. However, MS fails to completely eliminate detrimental flow impingement after peak systole, which may hinder aneurysm recovery, especially in the cases of eccentric aneurysms. Therefore, saccular aneurysms should be treated with more caution than fusiform aneurysms. And further therapeutic attempts to keep both perfusion in the proximal region of the aneurysm and isolation in the distal region of the aneurysm should be considered.

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“…Third, stent placement provides a scaffolding that supports neointimal overgrowth and promotes aneurysm thrombosis. Two previous studies have independently reported that stent placement modifies hemodynamic patterns in VAFAs such that thrombosis is favored and that the flow diversion effect of stenting is more significant when multiple overlapping stents are used ( 5 , 23 ). Another study ( 21 ) reported that flow-diverter stents cause a better flow-diverting effect than conventional stents and result in greater reductions in flow, wall shear stress, and flow velocity.…”

Section: Discussionmentioning

confidence: 99%

“…SAT was available only in special cases, such as the aneurysm without adequate dilation for coil placement, the aneurysm with important branches, or the blood flow was well established by the placement of a single or multiple stent(s) alone without the need for further coiling. The relevant literature concerning the VAFAs treated with SAT are case reports or small case series (5)(6)(7). With the improvements in stents, flow diverter stent is efficient, while they are associated with the risk of ischemia, especially when vital arterial branches are covered (8).…”

Section: Introductionmentioning

confidence: 99%

Stent-alone treatment of unruptured vertebral artery fusiform aneurysms: A comparison of flow diverter and conventional stents

Zhu²,

Wang³

et al. 2022

Front. Neurol.

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BackgroundTreatment of vertebral artery fusiform aneurysms (VAFAs) is complex and controversial. This study aimed to compare the safety and efficacy between flow diverter and conventional stents in patients with VAFAs undergoing endovascular stent-alone treatment (SAT).MethodsThirty-six patients with 36 VAFAs who underwent SAT between January 2014 and December 2018 were retrospectively analyzed. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical outcomes were compared between flow diverter stent patients (n = 22) and conventional stent patients (n = 14).ResultsMore branches covered with stent were found in the conventional stent group (88.9 vs. 33.3%; p = 0.008). The number of stents placed was significantly higher in the conventional stent group (1.57 ± 0.76 vs. 1.09 ± 0.29; p = 0.016). The proportion of patients with significant or moderate stasis within the aneurysm immediately after stent placement was higher in the flow diverter stent group (95.5 vs. 57.1%; p = 0.004). The proportion of patients with complete obliteration or only a residual neck on follow-up angiography was significantly higher in the flow diverter stent group (86.3 vs 50.0%; p = 0.047). However, the incidence of parent artery stenosis or occlusion was also higher in the flow diverter stent group (27.3% vs. zero; p = 0.032). The rate of complications did not significantly differ between the groups.ConclusionsSAT was safe and effective in patients with VAFAs. Flow diverter stents are associated with a significantly better complete occlusion rate than conventional stents; however, they are also associated with an increased risk of parent artery stenosis.

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Hemodynamic Changes Caused by Multiple Stenting in Vertebral Artery Fusiform Aneurysms: A Patient-Specific Computational Fluid Dynamics Study

Cited by 27 publications

References 19 publications

Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction

Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction

The hemodynamic effect of eccentricity in visceral branched aneurysms with multilayer stents

Stent-alone treatment of unruptured vertebral artery fusiform aneurysms: A comparison of flow diverter and conventional stents

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