In vitro and in silico assessment of flow modulation after deploying the Contour Neurovascular System in intracranial aneurysm models

• Published in: Journal of neurointerventional surgery Vol. 16; no. 8; p. 815
• Main Authors: Korte, Jana, Gaidzik, Franziska, Larsen, Naomi, Schütz, Erik, Damm, Timo, Wodarg, Fritz, Hövener, Jan-Bernd, Jansen, Olav, Janiga, Gábor, Berg, Philipp, Pravdivtseva, Mariya S
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.08.2024; BMJ Publishing Group LTD
• Subjects: 3-D printers; Aneurysm; Aneurysms; Blood Flow; Blood Flow Velocity - physiology; CAD; Cerebrovascular Circulation - physiology; Computer aided design; Computer Simulation; Device; Embolization; Endovascular Procedures - methods; Fluid dynamics; Hemodynamics; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - physiopathology; MRI; New devices and techniques; Posterior Cerebral Artery - diagnostic imaging; Posterior Cerebral Artery - physiopathology; Sensors; Simulation; Transplants & implants; Veins & arteries; Velocity; Switzerland; Netherlands; CT; Blood Flow; MRI; Device; Aneurysm
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/jnis-2023-020403

BackgroundThe novel Contour Neurovascular System (Contour) has been reported to be efficient and safe for the treatment of intracranial, wide-necked bifurcation aneurysms. Flow in the aneurysm and posterior cerebral arteries (PCAs) after Contour deployment has not been analyzed in detail yet. However, this information is crucial for predicting aneurysm treatment outcomes.MethodsTime-resolved three-dimensional velocity maps in 14 combinations of patient-based basilar tip aneurysm models with and without Contour devices (sizes between 5 and 14 mm) were analyzed using four-dimensionsal (4D) flow MRI and numerical/image-based flow simulations. A complex virtual processing pipeline was developed to mimic the experimental shape and position of the Contour together with the simulations.ResultsOn average, the Contour significantly reduced intra-aneurysmal flow velocity by 67% (mean w/ = 0.03m/s; mean w/o = 0.12m/s; p-value=0.002), and the time-averaged wall shear stress by more than 87% (mean w/ = 0.17Pa; mean w/o = 1.35Pa; p-value=0.002), as observed both by numerical simulations and 4D flow MRI. Furthermore, a significant reduction in flow (P<0.01) was confirmed by the neck inflow rate, kinetic energy, and inflow concentration index after Contour deployment. Notably, device size has a stronger effect on reducing flow than device positioning. However, positioning affected flow in the PCAs, while being robust in effectively reducing flow.ConclusionsThis study showed the high efficacy of the Contour device in reducing flow within aneurysms regardless of the exact position. However, we observed an effect on the flow in PCAs, which needs to be investigated further.