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Fu Y, Bian X, Zou R, Jin R, Leng X, Fan F, Wei S, Cui X, Xiang J, Guan S. Hemodynamic alterations of flow diverters on aneurysms at the fetal posterior communicating artery: A simulation study using CFD to compare the surpass streamline, pipeline flex, and tubridge devices. J Neuroradiol 2024; 51:74-81. [PMID: 37442272 DOI: 10.1016/j.neurad.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Traditional flow diverters (FDs) for treating aneurysms at the fetal posterior communicating artery are unsatisfactory. Surpass Streamline is a novel FD with different mesh characteristics; however, the outcomes for such aneurysms remain unclear. This study aimed to compare hemodynamic alterations induced by Surpass Streamline, Pipeline Flex, and Tubridge devices and explore possible strategies for aneurysms at the fetal posterior communicating artery. METHODS Two simulated aneurysms (Case 1, Case 2) were constructed from digital subtraction angiography (DSA). The three FDs were virtually deployed, and hemodynamic analysis based on computational fluid dynamics was performed. Hemodynamic parameters, including the sac-averaged velocity magnitude (Velocity), high-flow volume (HFV), and wall shear stress (WSS), were compared between each FD and the untreated model (control). Surpass Streamline was performed in real life for two aneurysms and the clinical outcomes were collected for analysis. RESULTS Compared to the control, the Surpass resulted in the most significant reduction in flow. In Case 1, the Velocity, HFV, and WSS were reduced by 51.6%, 78.1%, and 64.3%, respectively. In Case 2, the Velocity, HFV, and WSS were reduced by 48.0%, 81.1%, and 65.3%, respectively. Tubridge showed slightly larger changes in hemodynamic parameters than Pipeline. In addition, our analysis suggested that metal coverage was correlated with the WSS, Velocity, and HFV. The postoperative DSA showed that the aneurysm was nearly occluded in Case 1 and decreased in Case 2. CONCLUSION Compared to that with the Pipeline and Tubridge, the Surpass resulted in the greatest reduction in hemodynamic parameters and might be effective for aneurysms at the fetal posterior communicating artery. Virtual FD deployment and computational fluid dynamics analysis may be used to predict the treatment outcomes.
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Affiliation(s)
- Yu Fu
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Bian
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Rongbo Jin
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | - Feng Fan
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Wei
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuan Cui
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Sheng Guan
- Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Gupta G, Sreenivasan S, Kane I, Salguiero L, Saifuddin A, Sundararajan S, Khandelwal P, Nourallah-Zadeh E, Sun H, Sonig A, Singla A, Nanda A, Roychowdhury S. Surpass embolization of intracranial aneurysms: Perspective from a 2-year longitudinal follow-up study across high volume comprehensive stroke centers. Interv Neuroradiol 2023:15910199231188760. [PMID: 37464776 DOI: 10.1177/15910199231188760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Surpass Streamline (SS; Stryker©) is an over-the-wire first-generation flow diverter (FD). There is a scarcity of data on real-world outcomes and complications of this FD. METHODS A retrospective review of consecutive cases between January 2019 and July 2021 at two high-volume comprehensive stroke centers, involving SS was conducted. RESULTS Fifty-five patients harbored 69 treated aneurysms, of which 96% were in the internal carotid petrous to terminus segments and 88% were <10 mm in size, and 12% measuring 10-24 mm. Raymond Roy Grade 1 occlusion was noted in 55 aneurysms (79.7%) at 1 year. Median follow-up duration was 26 months (mean = 26.06). Major complications were seen in eight patients (14.5%; 95% CI 6.5-26.7) and mortality attributable to SS stenting complications occurred in two (4.3%) patients. Four (7.2%) had ophthalmologic thromboembolic complications and two had (3.6%) ischemic complications. Procedural complications occurred in 10 patients (18.18%; 95% CI 9.1-30.9). Technical complications during procedure (n = 3, 5.3%) were: "confirmed" distal middle cerebral artery (MCA) guidewire perforation; "suspected" distal MCA guidewire perforation causing post-procedural subarachnoid hemorrhage and internal carotid artery dissection causing ischemic stroke. Seizures were seen in 5 (9.09%) and carotid-cavernous fistula in 1 (1.8%). Multivariate regression analysis showed technical challenges significantly predicted occurrence of major complications (p = 0.001; R2 = 0.39, F(13,43) = 2.15, p = 0.029). Univariate analysis showed technical challenges significantly predicted ophthalmological complications (R2 = 0.06, F(1,55) = 4.04, p = 0.049) and major complications (R2 = 0.21, F(1,55) = 15.11, p = 0.0002). CONCLUSION Large-scale future registry should focus on national data regarding SS safety, technical challenges, and procedural complications. We present one of the longest follow-ups for SS in literature.
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Affiliation(s)
- Gaurav Gupta
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sanjeev Sreenivasan
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ian Kane
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Lauren Salguiero
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ali Saifuddin
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Emad Nourallah-Zadeh
- Department of Neurology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Hai Sun
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ashish Sonig
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Amit Singla
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
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Altındağ B, Bahadır Olcay A, Furkan Tercanlı M, Bilgin C, Hakyemez B. Determining flow stasis zones in the intracranial aneurysms and the relation between these zones and aneurysms' aspect ratios after flow diversions. Interv Neuroradiol 2023:15910199231162878. [PMID: 36945841 DOI: 10.1177/15910199231162878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Flow diverter stents (FDSs) are widely used to treat aneurysms in the clinic. However, even the same flow diverter (FD) use on different patients' aneurysm sites can cause unexpected hemodynamics at the aneurysm region yielding low success rates for the overall treatment. Therefore, the present study aims to unfold why FDs do not work as they are supposed to for some patients and propose empirical correlation along with a contingency table analysis to estimate the flow stasis zones in the aneurysm sacs. METHODS The present work numerically evaluated the use of FRED4518 FDS on six patients' intracranial aneurysms based on patient-specific aneurysm geometries. Computational fluid dynamics (CFD) simulation results were further processed to identify the time evolution of weightless blood particles for six patients' aneurysms. RESULTS Stagnation zone formation, incoming and outgoing blood flow at the aneurysm neck, and statistical analysis of six patients indicated that FRED4518 showed a large flow stasis zone for an aspect ratio larger than 0.75. However, FRED4518, used for aneurysms with an aspect ratio of less than 0.65, caused small stagnant flow zones based on the number of blood particles that stayed in the aneurysm sac. CONCLUSION A patient-specific empirical equation is derived considering aneurysms' morphological characteristics to determine the amount of stagnated fluid flow zones and magnitude of the mean aneurysm velocity in the aneurysm sac for FRED4518 based on weightless fluid particle results for the first time in the literature. As a result, numerical simulation results and patient data-driven equation can help perceive stagnated fluid zone amount before FRED4518 placement by shedding light on neuro-interventional surgeons and radiologists.
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Affiliation(s)
- Batı Altındağ
- Faculty of Engineering, Department of Mechanical Engineering, 52998Yeditepe University, Istanbul, Turkey
| | - Ali Bahadır Olcay
- Faculty of Engineering, Department of Mechanical Engineering, 52998Yeditepe University, Istanbul, Turkey
| | - Muhammed Furkan Tercanlı
- Faculty of Engineering, Department of Mechanical Engineering, 52998Yeditepe University, Istanbul, Turkey
| | - Cem Bilgin
- Department of Radiology, 4352Mayo Clinic Rochester, Rochester, MN, USA
| | - Bahattin Hakyemez
- Department of Radiology, Uludag University School of Medicine, Gorukle, Bursa, Turkey
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Tercanlı MF, Olcay AB, Mutlu O, Bilgin C, Hakyemez B. Investigation of the effect of anticoagulant usage in the flow diverter stent treatment of the patient-specific cerebral aneurysm using the Lagrangian coherent structures. J Clin Neurosci 2021; 94:86-93. [PMID: 34863468 DOI: 10.1016/j.jocn.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 08/13/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Anticoagulants are prescribed to the flow diverter treated patients to diminish the risk of embolism in the arteries. In the present study, digital subtraction angiography images of a 49-year-old female patient with a left paraophthalmic aneurysm were used to build a numerical model to investigate the effect of an anticoagulant on hemodynamics at the aneurysm site. The Carreau-Yasuda viscosity model was utilized to define blood viscosity, and the coefficients of the viscosity model were updated based on the usage of warfarin. The five-cardiac cycle-long numerical simulations were performed, and Lagrangian coherent structures, hyperbolic time, and fluid particle analyses were also employed in the numerical models. These analyses allowed us to evaluate the formation of stagnated regions, recirculation zones, and the number of jailed particles inside the aneurysm sac following a flow diverter placement. It is realized that anticoagulant use caused blood to be less viscous, yielding a substantial amount of incoming blood flow to enter the aneurysm sac. Only 12% of the nearly 25,000 fluid particles seeded from the artery inlet have stayed inside the sac. Furthermore, the deviation between warfarin added blood and normal blood flow becomes more extensive, with every heartbeat undermining the effectiveness of patient-specific CFD models when the use of anticoagulants is overlooked in the viscosity models.
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Affiliation(s)
| | - Ali Bahadır Olcay
- Yeditepe University, Faculty of Engineering, Department of Mechanical Engineering, Kayisdagi Cad., 34755 Istanbul, Turkey.
| | - Onur Mutlu
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar
| | - Cem Bilgin
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Radiology, Yildirim, Bursa 16310, Turkey
| | - Bahattin Hakyemez
- Uludag University School of Medicine, Department of Radiology, Gorukle, Bursa 16059, Turkey
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Fluid Flow Characteristics of Healthy and Calcified Aortic Valves Using Three-Dimensional Lagrangian Coherent Structures Analysis. FLUIDS 2021. [DOI: 10.3390/fluids6060203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aortic valve calcification is an important cardiovascular disorder that deteriorates the accurate functioning of the valve leaflets. The increasing stiffness due to the calcification prevents the complete closure of the valve and therefore leads to significant hemodynamic alterations. Computational fluid dynamics (CFD) modeling enables the investigation of the entire flow domain by processing medical images from aortic valve patients. In this study, we computationally modeled and simulated a 3D aortic valve using patient-specific dimensions of the aortic root and aortic sinus. Leaflet stiffness is deteriorated in aortic valve disease due to calcification. In order to investigate the influence of leaflet calcification on flow dynamics, three different leaflet-stiffness values were considered for healthy, mildly calcified, and severely calcified leaflets. Time-dependent CFD results were used for applying the Lagrangian coherent structures (LCS) technique by performing finite-time Lyapunov exponent (FTLE) computations along with Lagrangian particle residence time (PRT) analysis to identify unique vortex structures at the front and backside of the leaflets. Obtained results indicated that the peak flow velocity at the valve orifice increased with the calcification rate. For the healthy aortic valve, a low-pressure field was observed at the leaflet tips. This low-pressure field gradually expanded through the entire aortic sinus as the calcification level increased. FTLE field plots of the healthy and calcified valves showed a variety of differences in terms of flow structures. When the number of fluid particles in the healthy valve model was taken as reference, 1.59 and 1.74 times more particles accumulated in the mildly and severely calcified valves, respectively, indicating that the calcified valves were not sufficiently opened to allow normal mass flow rates.
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Wall Shear Stress Topological Skeleton Analysis in Cardiovascular Flows: Methods and Applications. MATHEMATICS 2021. [DOI: 10.3390/math9070720] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A marked interest has recently emerged regarding the analysis of the wall shear stress (WSS) vector field topological skeleton in cardiovascular flows. Based on dynamical system theory, the WSS topological skeleton is composed of fixed points, i.e., focal points where WSS locally vanishes, and unstable/stable manifolds, consisting of contraction/expansion regions linking fixed points. Such an interest arises from its ability to reflect the presence of near-wall hemodynamic features associated with the onset and progression of vascular diseases. Over the years, Lagrangian-based and Eulerian-based post-processing techniques have been proposed aiming at identifying the topological skeleton features of the WSS. Here, the theoretical and methodological bases supporting the Lagrangian- and Eulerian-based methods currently used in the literature are reported and discussed, highlighting their application to cardiovascular flows. The final aim is to promote the use of WSS topological skeleton analysis in hemodynamic applications and to encourage its application in future mechanobiology studies in order to increase the chance of elucidating the mechanistic links between blood flow disturbances, vascular disease, and clinical observations.
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Zhang H, Li L, Miao F, Yu J, Zhou B, Pan Y. Computational fluid dynamics analysis of intracranial aneurysms treated with flow diverters: A case report. Neurochirurgie 2021; 68:235-238. [PMID: 33771614 DOI: 10.1016/j.neuchi.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/05/2021] [Accepted: 03/06/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Intracranial aneurysms (IAs) are localized dilatations of intracranial arteries due to weaknesses of the endothelial layer. IAs may be treated by flow diverters (FDs), alternatively to stents and coils combination. FD is a method for the treatment of IAs especially for large, wide-necked or fusiform aneurysms. In this case report, we described a 65-year-old woman with IA who were treated by FD. CASE PRESENTATION A 65-year-old woman was diagnosed with a giant aneurysm at the posterior inferior cerebellar artery segment of the left internal carotid artery. Then based on the computed tomography data of this woman, aneurysm vascular stent model was constructed before and after FD, and internal pressure, velocity, wall shear stress (WSS) of aneurysms were determined by CFD analysis. Standard boundary conditions were applied. It was found that a single FD stent and double FD stents decreased the blood flow and WSS of aneurysm. The effect of single FD stent+30% filling on blood flow was more obvious, but the aneurysm rupture was caused by excessive coil packing. So, a single stent+10% coil packing rate was the best option for treating aneurysms. CONCLUSIONS CFD analysis for flow velocity and WSS have protection on aneurysms.
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Affiliation(s)
- H Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, 80, Cuiyingmen Road, Chengguan District, 730030 Lanzhou City, Gansu Province, China
| | - L Li
- School of Clinical Medicine, Gansu University of Chinese Medicine, 730030 Lanzhou, China
| | - F Miao
- Department of Neurosurgery, Zhangye People's Hospital Affiliated to Hexi University, 734000 Zhangye, China
| | - J Yu
- College of Petroleum and Chemical Engineering, Lanzhou University of Technology, 730050 Lanzhou, China
| | - B Zhou
- Department of Neurosurgery, Lanzhou University Second Hospital, 80, Cuiyingmen Road, Chengguan District, 730030 Lanzhou City, Gansu Province, China
| | - Y Pan
- Department of Neurosurgery, Lanzhou University Second Hospital, 80, Cuiyingmen Road, Chengguan District, 730030 Lanzhou City, Gansu Province, China.
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K N C, Ogulcan G, Bhat N S, Zuber M, Shenoy B S. Wear estimation of trapezoidal and circular shaped hip implants along with varying taper trunnion radiuses using finite element method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105597. [PMID: 32574903 DOI: 10.1016/j.cmpb.2020.105597] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The hip joint is the vital joint that is responsible for the bodyweight transfer from the upper body to the lower body. Due to age these joints are worn out and need to be replaced by artificial hip implants. Wear is the predominant factor that is responsible for the loosening of hip implants. The wear occurs between the joints due to various reasons. The wear estimation at the design stage gives a clear idea about the life of the implants and also minor changes in the design may also significantly increase the life expectancy of the implant which can further reduce the rate of revision surgery. The linear wear rate is estimated in the taper trunnion surface. METHODS In this study, the circular and trapezoidal-shaped stem implant is designed, and wear studies are performed at the trunnion junction. The femoral head of size 28 mm, acetabular cup thickness of 4 mm, and a backing cup of thickness 2 mm are considered for the study. The neck taper radiuses at the top surface are altered. Ansys is used to perform the simulations. RESULTS At the time of assembly of the femoral head into the stem, the stresses were found to be increasing with an increase in the top surface radius of the neck taper junctions. However, when the walking conditions are considered for wear estimation of implants the circular implants with the 12/14 mm taper exhibited the lesser linear wear rate of 0.003 mm/year. The trapezoidal implants with the 10/14 mm taper exhibited a lesser linear wear rate of 0.032 mm/year. CONCLUSIONS Wear is an important parameter that leads to the revision of implants due to loosening. It is found that with the decrease in the taper radius at the top surface against the standard 12/14 mm taper there is no significant decrease in the wear rate at the taper junction. Overall the circular implants exhibited less wear rate results over the trapezoidal-shaped stem implants. Due to the less linear wear rate, the circular implant has a higher life over the trapezoidal-shaped implant. Further, these implants can be manufactured to test using a hip simulator with the same conditions to validate the obtained results.
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Affiliation(s)
- Chethan K N
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Guldeniz Ogulcan
- Department of Mechanical Engineering, Faculty of Engineering, Yeditepe University, Atasehir, Istanbul, Turkey
| | - Shyamasunder Bhat N
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mohammad Zuber
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Satish Shenoy B
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Guclu G, Gunaydin T, Unsal C, Olcay AB, Bilgin C, Hakyemez B. Investigation of Blood Flow Behavior in an Aneurysm Sac Using Computational Fluid Dynamics. 2019 MEDICAL TECHNOLOGIES CONGRESS (TIPTEKNO) 2019. [DOI: 10.1109/tiptekno.2019.8894954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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