In vitro, contrast agent-based evaluation of the influence of flow diverter size and position on intra-aneurysmal flow dynamics using syngo iFlow

Cattaneo, Giorgio; Ding, Andreas; Jost, Tobias; Ley, Désirée; Mühl-Bennighaus, Ruben; Yılmaz, Ümüt; Körner, Heiko; Reith, Wolfgang; Simgen, Andreas

doi:10.1007/s00234-017-1903-2

Cited by 16 publications

(22 citation statements)

References 30 publications

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“…The phenomenon of paradoxical increased intraaneurysmal flow post-FDS has been associated with the different locations of pipeline landing and the size of the device itself. [23][24][25] Devices that are in locations that alter the structure of the stent, such as bends in the vessel, may modify the stent's flow diversion capabilities. Additionally, oversizing can cause the cells of the stent to expand, allowing more fluid transudation.…”

Section: Discussionmentioning

confidence: 99%

2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

et al. 2020

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Objective Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs. partial aneurysm occlusion is poorly defined. Here, we evaluate the angiographic contrast time-density as a predictor of aneurysm occlusion rate at six months’ post-flow diversion stents. Methods Patients with unruptured cerebral aneurysms proximal to the internal carotid artery terminus treated with single flow diversion stents were included. 2D parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) was used to calculate contrast time-density within the aneurysm and in the proximal adjacent internal carotid artery. The area under the curve ratio between the two regions of interests was assessed at baseline and after flow diversion stents deployment. The area under the curve ratio between completely vs. partially occluded aneurysms at six months’ follow-up was compared. Results Thirty patients with 31 aneurysms were included. Mean aneurysm diameter was 8 mm (range 2–28 mm). Complete occlusion was obtained in 19 aneurysms. Younger patients ( P = 0.006) and smaller aneurysms ( P = 0.046) presented higher chance of complete obliteration. Incomplete occlusion of the aneurysm was more likely if the area under the curve contrast time-density ratio showed absolute ( P = 0.001) and relative percentage ( P = 0.001) decrease after flow diversion stents deployment. Area under ROC curve was 0.85. Conclusion Negative change in the area under the curve ratio indicates less contrast stagnation in the aneurysm and lower chance of occlusion. These data provide a real-time analysis after aneurysm treatment. If validated in larger datasets, this can prompt input to the surgeon to place a second flow diversion stents.

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Section: Discussionmentioning

confidence: 99%

2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

et al. 2020

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“…Proper mixing of the contrast with flowing blood may be a prerequisite to contrast-transport based flow assessment, and this mixing is potentially dependent on the ratio of fluid momentums of the contrast and blood as well as the distance of the catheter-tip from the region of interest 21. Several angiographic techniques have been developed (especially to assess performance of aneurysm treatment devices) ranging from washout grading scales,23 24 measurement of contrast time of arrival, peak intensity or intensity fractions,25–27 optical flow methods,28 29 to quantification of time-density curves with gamma-variate or exponential curves 22 30. To the extent that these studies, including ours, limit the angiographic quantification to relative measures (comparison of device performance or pre- to post-device assessment) while maintaining all other variables constant, they provide valuable information.…”

Section: Discussionmentioning

confidence: 99%

Preliminary in vitro angiographic comparison of the flow diversion behavior of Evolve and Pipeline devices

Sadasivan

Fiorella

2019

J NeuroIntervent Surg

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Background and purposeFlow diverters are increasingly used to treat a broad category of cerebral aneurysms. We conducted an in vitro study to angiographically compare the flow diversion effect of Surpass Evolve from Stryker Neurovascular with the Pipeline Shield Embolization Device from Medtronic Neurovascular.MethodsThree copies each of three carotid aneurysm geometries were manufactured from silicone. Evolve and Pipeline flow diverters were deployed in one copy of each geometry; the third copy was used as Control. High-speed angiography was acquired under pulsatile flow in each replica, contrast concentration-time curves within the aneurysms were recorded, and the curves were quantified with six parameters. The parameters were statistically evaluated to compare the flow diversion effect of both devices.ResultsThe Evolve showed greater flow diversion trends in almost all intra-geometry comparisons than the Pipeline. When aggregated over the three geometries, the Evolve was statistically significantly better than the Pipeline in four of the six parameters, and about the same or better (not statistically significant) than the Pipeline in the other two parameters.ConclusionsThe Evolve device demonstrated greater in vitro flow diversion effects than Pipeline. Comparative efficacy of the devices will need to be adjudicated based on clinical outcomes.

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“…In the past decade, flow diversion (FD) has been well-established as a functional treatment option for cerebral aneurysms. The distinct architecture of fine-meshed flow diverter stents (FDS), characterized by an optimized ratio of porosity and surface area metal coverage, allows maintained perfusion of covered arteries while decreasing aneurysmal perfusion below the threshold required for intra-aneurysmal thrombosis (1). Following the immediate reduction of aneurysmal inflow with subsequent thrombosis, the FDS serves as scaffolding for the development of an increasingly resilient neo-intima (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating

et al. 2021

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Background: In the last decade, flow diversion (FD) has been established as hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral arteries. However, two significant limitations remain—the need for 0.027” microcatheters required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost of increasing the risk for hemorrhage. This study reports the experience of three neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that is implantable via a 0.021” microcatheter.Materials and methods: Three neurovascular centers contributed to this retrospective analysis of patients that had been treated with the p64MW-HPC between March 2020 and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including procedural and post-procedural complications, were recorded. The hemodynamic effect was assessed using the O'Kelly–Marotta Scale (OKM).Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms (27 anterior circulation and six posterior circulation) were successfully treated with the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly reduced immediately post implantation. Follow-up imaging was available for 23 aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size (OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9 months. In two cases, device thrombosis after early discontinuation of DAPT occurred. One delayed rupture caused a caroticocavernous fistula. The complications were treated sufficiently and all patients recovered without permanent significant morbidity.Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves good early aneurysm occlusion rates in the proximal intracranial circulation, which are comparable to those of well-established FDS. Sudden interruption of DAPT in the early post-interventional phase can cause in-stent thrombosis despite the HPC surface modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging vascular anatomies.

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In vitro, contrast agent-based evaluation of the influence of flow diverter size and position on intra-aneurysmal flow dynamics using syngo iFlow

Cited by 16 publications

References 30 publications

2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

Preliminary in vitro angiographic comparison of the flow diversion behavior of Evolve and Pipeline devices

First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating

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