New Concept of Patient-specific Flow Diversion Treatment of Intracranial Aneurysms Design Aspects and in vitro Fluid Dynamics

• Published in: Clinical neuroradiology (Munich) Vol. 31; no. 3; pp. 671 - 679
• Main Authors: Ding, Andreas, Braschkat, Andrés, Guber, Andreas, Cattaneo, Giorgio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021
• Subjects: Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosurgery; Original Article; Flow diverter; Intracranial aneurysms; Particle image velocimetry; Hemorrhagic stroke; Intra-aneurysmal fluid dynamics
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-020-00930-1

Purpose Current flow diverter (FD) designs limit the possibilities to achieve ideal functional parameters for intra-aneurysmal flow alteration in the implanted state. In this work, we evaluate the technical feasibility of a new patient-specific FD concept and the impact on intra-aneurysmal flow reduction compared to standard FD. Methods Based on a literature review, we defined functional requirements, followed by the design and manufacturing of two different prototypes, which we implanted in a patient-specific phantom model. Functional porosity distributions and contour parameters were evaluated in the implanted state and compared to standard FD. Subsequently, we carried out a series of particle image velocimetry (PIV) measurements, in order to assess the impact on intra-aneurysmal flow. Results With both patient-specific prototypes, it was possible to achieve stronger intra-aneurysmal flow reductions in terms of maximum and mean velocity and vorticity than a standard FD; however, one design showed a strong sensitivity against malpositioning. Overall, fluid dynamics parameters correlated with geometrical aspects such as the porosity and its grade of homogeneity. Beyond that, we found influences by the FD contour projection within the aneurysm, especially connected to the formation of in-jets. Conclusion Our results show that there is a technically feasible concept, which enables a more specific adjustment of functional FD parameters and more effective intra-aneurysmal flow reduction. This could potentially lead to improvements in the efficacy of aneurysm occlusion in cases with challenging fluid dynamics.