Quantitative assessment of parent vessel and distal intracranial hemodynamics following pipeline flow diversion

Aletich, Victor; Amin‐Hanjani, Sepideh; Hussein, Ahmed E.; Charbel, Fady T.; Alaraj, Ali

doi:10.1177/1591019916668842

Cited by 21 publications

(41 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The presence of an aneurysm might modify the physiological hemodynamic patterns in the parent artery, which may, in turn, affect the cellular function in the surrounding vasculature. Furthermore, FD treatment in the internal carotid artery has shown to alter the hemodynamics by increasing flow velocities and wall shear stress, while lowering resistance in the ipsilateral middle cerebral artery 19. Further studies are needed to substantiate the mechanism for the changes in contractility of the distal vessel wall and its potential pathophysiological impact.…”

Section: Discussionmentioning

confidence: 99%

Downstream vascular changes after flow-diverting device deployment in a rabbit model

Parameswaran

Dai

Ding

et al. 2018

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundFlow diverters (FDs) are increasingly used in the treatment of intracranial aneurysms, and carry the risk of thromboembolic complications, even in patients treated with dual antiplatelet therapy. The effect of FDs on the downstream vascular is unknown. The aim of the study was to investigate vascular wall pulse wave velocity (PWV) and contractility changes following FD treatment in a rabbit model.MethodsFDs (Pipeline Embolic Device, Medtronic Inc., Irvine, California, USA) were implanted in the aorta of normal rabbits and sham-operated aorta were used as controls (n=6 per group). Pulse wave imaging with ultra-fast ultrasound at 1600 frames per second (Vantage, Verasonics, Inc., Kirkland, WA) was performed in the vessel wall distal to FD prior to device implantation and at 8- week follow-up to measure the PWV. Force contraction vascular reactivity studies were conducted in the aortic rings using an organ bath.ResultsThe difference in mean PWV in the follow-up compared with pre-implantation was significantly higher in the distal vessels compared with sham controls (1.18 m/s [SD=0.54] vs. 0.37 m/s [SD=1.09], P=0.03). Conversely, the aortic segments distal to the FD exhibited a 55% increase in vascular contractility compared with proximal segments (P=0.002). We observed a significant positive correlation between mean PWV and mean vascular contractility.ConclusionImplantation of FD was associated with increased PWV and vascular contractility, suggesting that FD implantation causes changes to the vascular wall. Further studies are needed to understand the clinical implication of changes in vascular PWV and contractility.

show abstract

Section: Discussionmentioning

confidence: 99%

Downstream vascular changes after flow-diverting device deployment in a rabbit model

Parameswaran

Dai

Ding

et al. 2018

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…Considering the complex flow pattern, deployment of a flow diverter to the aneurysm might result in unfavorable outcome. Shakur et al as well as other authors had reported that after PED placement, the hemodynamics in distal arteries will be disrupted and contribute to delayed ipsilateral intraparenchymal hemorrhage [21,22]. In our Case NO.…”

Section: Discussionmentioning

confidence: 48%

Reconsiderations on the use of pipeline embolization device in the treatment of intracerebral aneurysms with special angioarchitecture: fetal PCA, AVM, V-B junction and DAVF

Zhang

Peng

Di³

et al. 2018

Chin Neurosurg Jl

View full text Add to dashboard Cite

Background: Pipeline embolization device (PED) has proved its safety and efficacy in the treatment of intracranial large and giant side-wall aneurysms. With the accumulation of treatment experience, it is an inevitable trend to expand its off-label use on aneurysms. Whether flow diversion is safe and efficient in cases with special angioarchitecture has rarely been explored. Methods: We performed a retrospective analysis of 210 consecutive patients treated by PED for intracerebral aneurysms in our center. Except for aneurysm, those patients also presented with special angioarchitecture: Fetal PCA, AVM, V-B junction and DAVF. Results: Nine patients were qualified for the study. 1 was with fetal PCA, the aneurysm remained patent on 4-month follow-up. 2 with ipsilateral AVMs, one patient died due to brain hemorrhage 20 days after the operation, the other one was only partially embolised on 6 month follow up. 3 aneurysms located at V-B junction, angiographic follow up on 3 months demonstrated no complete occlusion of both the aneurysms, the other patients were still on follow up. All of the 3 cases with concomitant DAVF are completely occluded during short to midterm follow up. Conclusions: PED for aneurysms incorporated the fetal PCA and V-B junction might meet a high propensity for incomplete occlusion during short term follow up. Aneurysm with ipsilateral AVM is not suitable for PED treatment due to the risk of hemorrhage and incomplete occlusion during midterm follow up. For aneurysm with concurrent DAVF, PED treatment is safe and efficient relatively in one session or by staged operation.

show abstract

“…In addition, once aneurysms or stenoses have formed, the pathology may cause further changes to local and more significantly to the global blood flow distribution patterns. Adverse distal effects such as remote ipsilateral hemorrhage may be detected and pinpointed with the proposed global hemodynamic analysis. The proposed parametric structured meshing technique extends rigorous CFD analysis from a single site to large portions of the cerebrovascular network.…”

Section: Discussionmentioning

confidence: 99%

Quantification of near‐wall hemodynamic risk factors in large‐scale cerebral arterial trees

Ghaffari

Alaraj

et al. 2018

Numer Methods Biomed Eng

Self Cite

View full text Add to dashboard Cite

Detailed hemodynamic analysis of blood flow in pathological segments close to aneurysm and stenosis has provided physicians with invaluable information about the local flow patterns leading to vascular disease. However, these diseases have both local and global effects on the circulation of the blood within the cerebral tree. The aim of this paper is to demonstrate the importance of extending subject-specific hemodynamic simulations to the entire cerebral arterial tree with hundreds of bifurcations and vessels, as well as evaluate hemodynamic risk factors and waveform shape characteristics throughout the cerebral arterial trees. Angioarchitecture and in vivo blood flow measurement were acquired from healthy subjects and in cases with symptomatic intracranial aneurysm and stenosis. A global map of cerebral arterial blood flow distribution revealed regions of low to high hemodynamic risk that may significantly contribute to the development of intracranial aneurysms or atherosclerosis. Comparison of pre-intervention and post-intervention of pathological cases further shows large angular phase shift (~33.8°), and an augmentation of the peak-diastolic velocity. Hemodynamic indexes of waveform analysis revealed on average a 16.35% reduction in the pulsatility index after treatment from lesion site to downstream distal vessels. The lesion regions not only affect blood flow streamlines of the proximal sites but also generate pulse wave shift and disturbed flow in downstream vessels. This network effect necessitates the use of large-scale simulation to visualize both local and global effects of pathological lesions.

show abstract

Quantitative assessment of parent vessel and distal intracranial hemodynamics following pipeline flow diversion

Cited by 21 publications

References 14 publications

Downstream vascular changes after flow-diverting device deployment in a rabbit model

Downstream vascular changes after flow-diverting device deployment in a rabbit model

Reconsiderations on the use of pipeline embolization device in the treatment of intracerebral aneurysms with special angioarchitecture: fetal PCA, AVM, V-B junction and DAVF

Quantification of near‐wall hemodynamic risk factors in large‐scale cerebral arterial trees

Contact Info

Product

Resources

About