Hemodynamic Effect of Flow Diverter and Coils in Treatment of Large and Giant Intracranial Aneurysms

• Published in: World neurosurgery Vol. 89; pp. 199 - 207
• Main Authors: Jing, Linkai, Zhong, Jingru, Liu, Jian, Yang, Xinjian, Paliwal, Nikhil, Meng, Hui, Wang, Shengzhang, Zhang, Ying
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016
• Subjects: Adult; Aneurysm; Angiography, Digital Subtraction; Blood Vessel Prosthesis; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - physiopathology; Carotid Artery Diseases - surgery; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - physiopathology; Carotid Artery, Internal - surgery; Cerebral Angiography; Cerebral Revascularization - instrumentation; Cerebral Revascularization - methods; Cerebrovascular Circulation; Coil; Computational fluid dynamics; Female; Flow diverter; Follow-Up Studies; Hemodynamics; Humans; Hydrodynamics; Imaging, Three-Dimensional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - surgery; Male; Middle Aged; Neurosurgery; Patient-Specific Modeling; Stents; Stress, Mechanical; Treatment Outcome; Flow diverter; CFD; DSA; Computational fluid dynamics; ICA; WSS; Aneurysm; Hemodynamics; LSA; FD; Coil; low wall shear area; digital subtraction angiographic; wall shear stress; internal carotid artery
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2016.01.079

This study aimed to investigate the hemodynamic changes induced by a flow diverter (FD) and coils in the treatment of internal carotid artery aneurysms, as well as to evaluate the effect of this treatment by using angiographic follow-up data. Six large and giant aneurysms were treated by the Tubridge FD and loose packing coils between June 2013 and May 2015. Patient-specific models were constructed and analyzed using a computational fluid dynamics (CFD) method. The virtual FD deployment method was used to implant the Tubridge stent into a 3-dimensional digital subtraction angiographic image of the aneurysms, and the coils were simulated by a porous medium model. Tubridge FD alone can significantly reduce the intra-aneurysmal flow velocity (0.17 ± 0.05 m/s–0.11 ± 0.06 m/s, P < 0.001) and wall shear stress (WSS, 1.39 ± 0.29 Pa–0.77 ± 0.34 Pa, P = 0.001) and increase the low wall shear area (LSA, 6.38% ± 1.49%–34.60% ± 28.90%, P = 0.047). Coils, as a supplementary measure, further reduced the velocity (0.11 ± 0.06 m/s–0.08 ± 0.05 m/s, P = 0.03) and WSS (0.77 ± 0.34 Pa–0.47 ± 0.35 Pa, P = 0.04) and increased the LSA (34.60% ± 28.90%–63.33% ± 34.82%, P = 0.044). Aneurysm with sustained strong inflow after treatment (case 3, 25% reduction in velocity, 12% reduction in WSS, and 16% increment in LSA) showed partial patency, whereas others with a weaker inflow jet (mean 56% reduction in velocity, 74% reduction in WSS, and 1081% increment in LSA) showed complete occlusion at follow-up. On the basis of using the CFD method, adjunctive coiling with the Tubridge FD placement may significantly reduce intra-aneurysmal flow velocity and WSS, promoting thrombosis formation and occlusion of aneurysms.