Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction.

Autor: Sindeev S; Department of Biomedical Engineering, Tambov State Technical University, Tambov, Russia., Kirschke JS; Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany., Prothmann S; Department of Neuroradiology, Helios Klinikum München West, Munich, Germany., Frolov S; Department of Biomedical Engineering, Tambov State Technical University, Tambov, Russia., Liepsch D; Department of Building Services Engineering, Munich University of Applied Sciences, Munich, Germany., Berg P; Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany., Zimmer C; Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany., Friedrich B; Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany. benjamin.friedrich@tum.de.
Jazyk: angličtina
Zdroj: Biomedical engineering online [Biomed Eng Online] 2019 Jul 24; Vol. 18 (1), pp. 82. Date of Electronic Publication: 2019 Jul 24.
DOI: 10.1186/s12938-019-0699-1
Abstrakt: Background: The use of flow-diverters for non-saccular cerebral posterior circulation aneurysms requires complex deployment techniques and is associated with high mortality and morbidity. Therefore, further studies are required to clarify the effect of stenting on post-treatment hemodynamics in such aneurysms. In this study, we evaluated flow alterations in a treated giant fusiform aneurysm of the vertebrobasilar junction and correlated them with the clinical outcome.
Methods: A patient-specific aneurysm model was acquired by rotational angiography, and three SILK flow-diverters (4.5 × 40, 5 × 40 and 5.5 × 40 mm) were virtually deployed in series along the basilar and right vertebral arteries. Image-based blood flow simulations before and after the treatment were performed under realistic pulsatile flow conditions. The flow reduction, velocity and wall shear stress (WSS) distribution, streamlines and WSS-derived parameters were evaluated before and after the treatment.
Results: The computed velocity streamlines showed substantial alterations of the flow pattern in the aneurysm and successful redirection of blood flow along the series of flow-diverters with no flow through the overlapping stents. The obtained flow reduction of 86% was sufficient to create thrombogenic flow conditions. Moreover, a 6.2-fold increase in relative residence time and a decrease by 87% of time-averaged WSS contributed to a successful treatment outcome observed during the follow-up.
Conclusions: We found a correlation between the numerically predicted flow alterations and the available treatment outcome. This shows the potential of image-based simulations to be used in clinical practice for treatment planning and estimation of possible risk factors associated with a complex stent deployment in fusiform aneurysms of the posterior circulation.
Databáze: MEDLINE
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