TY - JOUR
T1 - Hemodynamic changes caused by multiple stenting in vertebral artery fusiform aneurysms
T2 - A patient-specific computational fluid dynamics study
AU - Lv, N.
AU - Cao, W.
AU - Larrabide, I.
AU - Karmonik, C.
AU - Zhu, D.
AU - Liu, J.
AU - Huang, Q.
AU - Fang, Y.
N1 - Funding Information:
Received February 14, 2017; accepted after revision August 4. From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China; National Scientific and Technical Research Council of Argentina (I.L.), Buenos Aires, Argentina; and MRI Core (C.K.), Houston Methodist Research Institute, Houston, Texas. Nan Lv and Wei Cao contributed equally to this work and should be regarded as co-first authors. This work was supported by the National Natural Science Foundation of China (grant Nos. 81571118 and 81301004), the National Research and Development Project of Key Chronic Diseases (grant No. 2016YFC1300700), and National Scientific and Technical Research Council of Argentina (grant Nos. PICT 2014-1730 and PICT 2015-0006). Please address correspondence to Qinghai Huang, MD, and Yibin Fang, MD, Department of Neurosurgery, Changhai Hospital, Changhai Rd 168, Shanghai, 200433, China; e-mail: [email protected]; [email protected] Indicates open access to non-subscribers at www.ajnr.org
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background and Purpose: The multiple stent placement technique has largely improved the long-term outcomes of intracranial fusiform aneurysms, but the hemodynamic mechanisms remain unclear. In this study, we analyzed the hemodynamic changes caused by different stent-placement strategies in patient-specific models using the computational fluid dynamics technique, aiming to provide evidence for clinical decision-making. MATERIALS AND METHODS: Ten vertebral artery fusiform aneurysms were included, and their patient-specific computational fluid dynamics models were reconstructed. A fast virtual stent placement technique was used to simulate sequential multiple stent placements (from a single stent to triple stents) in the vertebral artery fusiform aneurysm models. Hemodynamic parameters, including wall shear stress, pressure, oscillatory shear index, relative residence time, and flow pattern, were calculated and compared among groups with different numbers of stents. RESULTS: Virtual stents were deployed in all 10 cases successfully, consistent with the real stent configuration. Wall shear stress decreased progressively by 7.2%, 20.6%, and 25.8% as the number of stents increased. Meanwhile, relative residence time and pressure increased on average by 11.3%, 15.4%, and 45.0% and by 15.7%, 21.5%, and 28.2%. The oscillatory shear index showed no stable variation trend. Flow patterns improved by weakening the intensity of the vortices and displacing the vortex center from the aneurysmal wall. CONCLUSIONS: Stent placement modifies hemodynamic patterns in vertebral artery fusiform aneurysms, which might favor thrombosis formation in the aneurysmal sac. This effect is amplified with the number of stents deployed. However, a potential risk of rupture or recanalization exists and should be considered when planning to use the multiple stent placement technique in vertebral artery fusiform aneurysms.
AB - Background and Purpose: The multiple stent placement technique has largely improved the long-term outcomes of intracranial fusiform aneurysms, but the hemodynamic mechanisms remain unclear. In this study, we analyzed the hemodynamic changes caused by different stent-placement strategies in patient-specific models using the computational fluid dynamics technique, aiming to provide evidence for clinical decision-making. MATERIALS AND METHODS: Ten vertebral artery fusiform aneurysms were included, and their patient-specific computational fluid dynamics models were reconstructed. A fast virtual stent placement technique was used to simulate sequential multiple stent placements (from a single stent to triple stents) in the vertebral artery fusiform aneurysm models. Hemodynamic parameters, including wall shear stress, pressure, oscillatory shear index, relative residence time, and flow pattern, were calculated and compared among groups with different numbers of stents. RESULTS: Virtual stents were deployed in all 10 cases successfully, consistent with the real stent configuration. Wall shear stress decreased progressively by 7.2%, 20.6%, and 25.8% as the number of stents increased. Meanwhile, relative residence time and pressure increased on average by 11.3%, 15.4%, and 45.0% and by 15.7%, 21.5%, and 28.2%. The oscillatory shear index showed no stable variation trend. Flow patterns improved by weakening the intensity of the vortices and displacing the vortex center from the aneurysmal wall. CONCLUSIONS: Stent placement modifies hemodynamic patterns in vertebral artery fusiform aneurysms, which might favor thrombosis formation in the aneurysmal sac. This effect is amplified with the number of stents deployed. However, a potential risk of rupture or recanalization exists and should be considered when planning to use the multiple stent placement technique in vertebral artery fusiform aneurysms.
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U2 - 10.3174/ajnr.A5452
DO - 10.3174/ajnr.A5452
M3 - Article
C2 - 29097416
AN - SCOPUS:85040447573
SN - 0195-6108
VL - 39
SP - 118
EP - 122
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 1
ER -