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Briganti F, Tortora M, Loiudice G, Tarantino M, Guida A, Buono G, Marseglia M, Caranci F, Tortora F. Utility of virtual stenting in treatment of cerebral aneurysms by flow diverter devices. LA RADIOLOGIA MEDICA 2023; 128:480-491. [PMID: 37027092 DOI: 10.1007/s11547-023-01620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023]
Abstract
Successful endovascular treatment by stenting of intracranial aneurysms requires proper placement of the device and appropriate choice of its diameter and length. To date, several methods have been employed to achieve these goals, although each has inherent critical issues. Recently developed stent planning software applications can be used to assist interventional neuroradiologists. Based on a 3D-DSA image acquired before stenting, these applications simulate and visualize the final placement of the deployed stent. In this single-centre retrospective study, 27 patients undergoing an intravascular procedure for the treatment of intracranial aneurysms from June 2019 to July 2020 were evaluated according to strict inclusion criteria. Stent virtualization was performed with Syngo 3D Aneurysm Guidance Neuro software. We compared the software-generated stent measurement and measurements taken by the interventional radiologist. Statistical analysis was performed using the STAC web platform. Mean and standard deviations of absolute and relative discrepancies between predicted and implanted stents were recorded. Friedman's nonparametric test was used to refute the null hypotheses, i.e. (I) discrepancies between the size of virtual and implanted stents would occur, and (II) operator influence does not affect the outcome of the virtual stenting process. Based on these observations, it is believed that the virtual stenting process can validly assist interventional neuroradiologists in selecting the appropriate device and reducing peri- and post-procedural complications. The results of our study suggest that virtual reality simulation of devices used for endovascular treatment of intracranial aneurysms is a useful, rapid, and accurate tool for interventional procedure planning.
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Affiliation(s)
- Francesco Briganti
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Mario Tortora
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | - Giovanni Loiudice
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Margherita Tarantino
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Amedeo Guida
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Buono
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Mariano Marseglia
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Ferdinando Caranci
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, NA), Italy
| | - Fabio Tortora
- Interventional Neuroradiology. Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
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Barbour MC, Chassagne F, Chivukula VK, Machicoane N, Kim LJ, Levitt MR, Aliseda A. The effect of Dean, Reynolds and Womersley numbers on the flow in a spherical cavity on a curved round pipe. Part 2. The haemodynamics of intracranial aneurysms treated with flow-diverting stents. JOURNAL OF FLUID MECHANICS 2021; 915:A124. [PMID: 34658417 PMCID: PMC8519511 DOI: 10.1017/jfm.2020.1115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The flow in a spherical cavity on a curved round pipe is a canonical flow that describes well the flow inside a sidewall aneurysm on an intracranial artery. Intracranial aneurysms are often treated with a flow-diverting stent (FDS), a low-porosity metal mesh that covers the entrance to the cavity, to reduce blood flow into the aneurysm sac and exclude it from mechanical stresses imposed by the blood flow. Successful treatment is highly dependent on the degree of reduction of flow inside the cavity, and the resulting altered fluid mechanics inside the aneurysm following treatment. Using stereoscopic particle image velocimetry, we characterize the fluid mechanics in a canonical configuration representative of an intracranial aneurysm treated with a FDS: a spherical cavity on the side of a curved round pipe covered with a metal mesh formed by an actual medical FDS. This porous mesh coverage is the focus of Part 2 of the paper, characterizing the effects of parent vessel Re, De and pulsatility, Wo, on the fluid dynamics, compared with the canonical configuration with no impediments to flow into the cavity that is described in Part 1 (Chassagne et al., J. Fluid Mech., vol. 915, 2021, A123). Coverage with a FDS markedly reduces the flow Re in the aneurysmal cavity, creating a viscous-dominated flow environment despite the parent vessel Re > 100. Under steady flow conditions, the topology that forms inside the cavity is shown to be a function of the parent vessel De. At low values of De, flow enters the cavity at the leading edge and remains attached to the wall before exiting at the trailing edge, a novel behaviour that was not found under any conditions of the high-Re, unimpeded cavity flow described in Part 1. Under these conditions, flow in the cavity co-rotates with the direction of the free-stream flow, similar to Stokes flow in a cavity. As De increases, the flow along the leading edge begins to separate, and the recirculation zone grows with increasing De, until, above De ≈ 180, the flow inside the cavity is fully recirculating, counter-rotating with respect to the free-stream flow. Under pulsatile flow conditions, the vortex inside the cavity progresses through the same cycle - switching from attached and co-rotating with the free-stream flow at the beginning of the cycle (low velocity and positive acceleration) to separated and counter-rotating as De reaches a critical value. The location of separation within the harmonic cycle is shown to be a function of both De and Wo. The values of aneurysmal cavity Re based on both the average velocity and the circulation inside the cavity are shown to increase with increasing values of De, while Wo is shown to have little influence on the time-averaged metrics. As De increases, the strength of the secondary flow in the parent vessel grows, due to the inertial instability in the curved pipe, and the flow rate entering the cavity increases. Thus, the effectiveness of FDS treatment to exclude the aneurysmal cavity from the haemodynamic stresses is compromised for aneurysms located on high-curvature arteries, i.e. vessels with high De, and this can be a fluid mechanics criterion to guide treatment selection.
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Affiliation(s)
- Michael C. Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98107, USA
| | - Fanette Chassagne
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98107, USA
| | - Venkat K. Chivukula
- Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL 32901, USA
| | | | - Louis J. Kim
- Department of Neurological Surgery, University of Washington, Seattle, WA 98107, USA
- Department of Radiology, University of Washington, Seattle, WA 98107, USA
| | - Michael R. Levitt
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98107, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA 98107, USA
- Department of Radiology, University of Washington, Seattle, WA 98107, USA
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98107, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA 98107, USA
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3
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Zhang M, Tupin S, Anzai H, Kohata Y, Shojima M, Suzuki K, Okamoto Y, Tanaka K, Yagi T, Fujimura S, Ohta M. Implementation of computer simulation to assess flow diversion treatment outcomes: systematic review and meta-analysis. J Neurointerv Surg 2020; 13:164-170. [PMID: 33097626 PMCID: PMC7848055 DOI: 10.1136/neurintsurg-2020-016724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
Introduction Despite a decade of research into virtual stent deployment and the post-stenting aneurysmal hemodynamics, the hemodynamic factors which correlate with successful treatment remain inconclusive. We aimed to examine the differences in various post-treatment hemodynamic parameters between successfully and unsuccessfully treated cases, and to quantify the additional flow diversion achievable through stent compaction or insertion of a second stent. Methods A systematic review and meta-analysis were performed on eligible studies published from 2000 to 2019. We first classified cases according to treatment success (aneurysm occlusion) and then calculated the pooled standardized mean differences (SMD) of each available parameter to examine their association with clinical outcomes. Any additional flow diversion arising from the two common strategies for improving the stent wire density was quantified by pooling the results of such studies. Results We found that differences in the aneurysmal inflow rate (SMD −6.05, 95% CI −10.87 to −1.23, p=0.01) and energy loss (SMD −5.28, 95% CI −7.09 to −3.46, p<0.001) between the successfully and unsuccessfully treated groups were indicative of statistical significance, in contrast to wall shear stress (p=0.37), intra-aneurysmal average velocity (p=0.09), vortex core-line length (p=0.46), and shear rate (p=0.09). Compacting a single stent could achieve additional flow diversion comparable to that by dual-stent implantation. Conclusions Inflow rate and energy loss have shown promise as identifiers to discriminate between successful and unsuccessful treatment, pending future research into their diagnostic performance to establish optimal cut-off values.
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Affiliation(s)
- Mingzi Zhang
- Biomedical Flow Dynamics Laboratory, Tohoku University Institute of Fluid Science, Sendai, Miyagi, Japan
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Tohoku University Institute of Fluid Science, Sendai, Miyagi, Japan
| | - Hitomi Anzai
- Biomedical Flow Dynamics Laboratory, Tohoku University Institute of Fluid Science, Sendai, Miyagi, Japan
| | - Yutaro Kohata
- Biomedical Flow Dynamics Laboratory, Tohoku University Institute of Fluid Science, Sendai, Miyagi, Japan
| | - Masaaki Shojima
- Department of Neurosurgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Kosuke Suzuki
- Department of Mechanical and Electrical Engineering, Nagoya Institute of Technology, Nagoya, Aichi, Japan
| | - Yoshihiro Okamoto
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Katsuhiro Tanaka
- Department of Neurosurgery, Mie Central Medical Center, Tsu, Mie, Japan
| | - Takanobu Yagi
- Center for Advanced Biomedical Sciences (TWIns), Waseda University, Shinjuku, Tokyo, Japan
| | - Soichiro Fujimura
- Department of Innovation for Medical Information Technology, Jikei University School of Medicine, Minato, Tokyo, Japan.,Graduate School of Mechanical Engineering, Tokyo University of Science, Shinjuku, Tokyo, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Tohoku University Institute of Fluid Science, Sendai, Miyagi, Japan .,ElyTMaX, CNRS - Université de Lyon - Tohoku University, International Joint Unit, Tohoku University, Sendai, Miyagi, Japan
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Berg P, Saalfeld S, Voß S, Beuing O, Janiga G. A review on the reliability of hemodynamic modeling in intracranial aneurysms: why computational fluid dynamics alone cannot solve the equation. Neurosurg Focus 2020; 47:E15. [PMID: 31261119 DOI: 10.3171/2019.4.focus19181] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022]
Abstract
Computational blood flow modeling in intracranial aneurysms (IAs) has enormous potential for the assessment of highly resolved hemodynamics and derived wall stresses. This results in an improved knowledge in important research fields, such as rupture risk assessment and treatment optimization. However, due to the requirement of assumptions and simplifications, its applicability in a clinical context remains limited.This review article focuses on the main aspects along the interdisciplinary modeling chain and highlights the circumstance that computational fluid dynamics (CFD) simulations are embedded in a multiprocess workflow. These aspects include imaging-related steps, the setup of realistic hemodynamic simulations, and the analysis of multidimensional computational results. To condense the broad knowledge, specific recommendations are provided at the end of each subsection.Overall, various individual substudies exist in the literature that have evaluated relevant technical aspects. In this regard, the importance of precise vessel segmentations for the simulation outcome is emphasized. Furthermore, the accuracy of the computational model strongly depends on the specific research question. Additionally, standardization in the context of flow analysis is required to enable an objective comparison of research findings and to avoid confusion within the medical community. Finally, uncertainty quantification and validation studies should always accompany numerical investigations.In conclusion, this review aims for an improved awareness among physicians regarding potential sources of error in hemodynamic modeling for IAs. Although CFD is a powerful methodology, it cannot provide reliable information, if pre- and postsimulation steps are inaccurately carried out. From this, future studies can be critically evaluated and real benefits can be differentiated from results that have been acquired based on technically inaccurate procedures.
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Affiliation(s)
- Philipp Berg
- 1Department of Fluid Dynamics and Technical Flows.,2Research CampusSTIMULATE, and
| | - Sylvia Saalfeld
- 2Research CampusSTIMULATE, and.,3Department of Simulation and Graphics, University of Magdeburg; and
| | - Samuel Voß
- 1Department of Fluid Dynamics and Technical Flows.,2Research CampusSTIMULATE, and
| | - Oliver Beuing
- 2Research CampusSTIMULATE, and.,4Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Gábor Janiga
- 1Department of Fluid Dynamics and Technical Flows.,2Research CampusSTIMULATE, and
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5
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Chodzyǹski KJ, Uzureau P, Nuyens V, Rousseau A, Coussement G, Zouaoui Boudjeltia K. The impact of arterial flow complexity on flow diverter outcomes in aneurysms. Sci Rep 2020; 10:10337. [PMID: 32587308 PMCID: PMC7316819 DOI: 10.1038/s41598-020-67218-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/28/2020] [Indexed: 12/03/2022] Open
Abstract
The flow diverter is becoming a standard device for treating cerebral aneurysms. The aim of this in vitro study was to evaluate the impact of flow complexity on the effectiveness of flow diverter stents in a cerebral aneurysm model. The flow pattern of a carotid artery was decomposed into harmonics to generate four flow patterns with different pulsatility indexes ranging from 0.72 to 1.44. The effect of flow diverters on the aneurysm was investigated by injecting red dye or erythrocytes as markers. The recorded images were postprocessed to evaluate the maximum filling of the aneurysm cavity and the washout time. There were significant differences in the cut-off flows between the markers, linked to the flow complexity. Increasing the pulsatility index altered the performance of the flow diverter. The red dye was more sensitive to changes in flow than the red blood cell markers. The flow cut-off depended on the diverter design and the diverter deployment step was crucial for reproducibility of the results. These results strongly suggest that flow complexity should be considered when selecting a flow diverter.
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Affiliation(s)
- Kamil Jerzy Chodzyǹski
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium.
| | - Pierrick Uzureau
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
| | - Vincent Nuyens
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
| | - Alexandre Rousseau
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
| | | | - Karim Zouaoui Boudjeltia
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
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Lassila T, Sarrami-Foroushani A, Hejazi S, Frangi AF. Population-specific modelling of between/within-subject flow variability in the carotid arteries of the elderly. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3271. [PMID: 31691518 DOI: 10.1002/cnm.3271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/12/2019] [Accepted: 09/22/2019] [Indexed: 06/10/2023]
Abstract
Computational fluid dynamics models are increasingly proposed for assisting the diagnosis and management of vascular diseases. Ideally, patient-specific flow measurements are used to impose flow boundary conditions. When patient-specific flow measurements are unavailable, mean values of flow measurements across small cohorts are used as normative values. In reality, both the between-subjects and within-subject flow variabilities are large. Consequently, neither one-shot flow measurements nor mean values across a cohort are truly indicative of the flow regime in a given person. We develop models for both the between-subjects and within-subject variability of internal carotid flow. A log-linear mixed effects model is combined with a Gaussian process to model the between-subjects flow variability, while a lumped parameter model of cerebral autoregulation is used to model the within-subject flow variability in response to heart rate and blood pressure changes. The model parameters are identified from carotid ultrasound measurements in a cohort of 103 elderly volunteers. We use the models to study intracranial aneurysm flow in 54 subjects under rest and exercise and conclude that OSI, a common wall shear-stress derived quantity in vascular CFD studies, may be too sensitive to flow fluctuations to be a reliable biomarker.
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Affiliation(s)
- Toni Lassila
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds
| | - Ali Sarrami-Foroushani
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds
| | - SeyedMostafa Hejazi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds
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7
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Yadollahi-Farsani H, Scougal E, Herrmann M, Wei W, Frakes D, Chong B. Numerical study of hemodynamics in brain aneurysms treated with flow diverter stents using porous medium theory. Comput Methods Biomech Biomed Engin 2019; 22:961-971. [DOI: 10.1080/10255842.2019.1609457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Erik Scougal
- School for Engineering of Matter Transport and Energy, Arizona State University, Tempe, AZ, USA
| | - Marcus Herrmann
- School for Engineering of Matter Transport and Energy, Arizona State University, Tempe, AZ, USA
| | - Wei Wei
- School for Engineering of Matter Transport and Energy, Arizona State University, Tempe, AZ, USA
| | - David Frakes
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
- School of Electrical Computer and Energy Engineering, Arizona State University, Tempe, AZ, USA
| | - Brian Chong
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
- Department of Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
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Chua MMJ, Silveira L, Moore J, Pereira VM, Thomas AJ, Dmytriw AA. Flow diversion for treatment of intracranial aneurysms: Mechanism and implications. Ann Neurol 2019; 85:793-800. [PMID: 30973965 DOI: 10.1002/ana.25484] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/31/2019] [Accepted: 04/07/2019] [Indexed: 12/31/2022]
Abstract
Flow diverters are new generation stents that have recently garnered a large amount of interest for use in treatment of intracranial aneurysms. Flow diverters reduce blood flow into the aneurysm, with redirection along the path of the parent vessel. Flow stagnation into the aneurysm and neck coverage with subsequent endothelialization are the important synergistic mechanisms by which the therapy acts. Several studies have examined the mechanisms by which flow diverters subsequently lead to aneurysm occlusion. This review aims to provide a general overview of the flow diverters and their mechanism of action and potential implications. ANN NEUROL 2019;85:793-800.
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Affiliation(s)
| | | | - Justin Moore
- Boston University School of Medicine, Boston, MA.,Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vitor M Pereira
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam A Dmytriw
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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9
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Shimano K, Serigano S, Ikeda N, Yuchi T, Shiratori S, Nagano H. Understanding of boundary conditions imposed at multiple outlets in computational haemodynamic analysis of cerebral aneurysm. ACTA ACUST UNITED AC 2019. [DOI: 10.17106/jbr.33.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kenjiro Shimano
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Shota Serigano
- Graduate School of Integrative Science and Engineering, Tokyo City University
| | - Naoki Ikeda
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Tomoki Yuchi
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Suguru Shiratori
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Hideaki Nagano
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
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10
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Joshi KC, Larrabide I, Saied A, Elsaid N, Fernandez H, Lopes DK. Software-based simulation for preprocedural assessment of braided stent sizing: a validation study. J Neurosurg 2018; 131:1423-1429. [PMID: 30497172 DOI: 10.3171/2018.5.jns18976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to validate the use of a software-based simulation for preassessment of braided self-expanding stents in the treatment of wide-necked intracranial aneurysms. METHODS This was a retrospective, observational, single-center study of 13 unruptured and ruptured intracranial aneurysms treated with braided self-expanding stents. Pre- and postprocedural angiographic studies were analyzed. ANKYRAS software was used to compare the following 3 variables: the manufacturer-given nominal length (NL), software-calculated simulated length (SL), and the actual measured length (ML) of the stent. Appropriate statistical methods were used to draw correlations among the 3 lengths. RESULTS In this study, data obtained in 13 patients treated with braided self-expanding stents were analyzed. Data for the 3 lengths were collected for all patients. Error discrepancy was calculated by mean squared error (NL to ML -22.2; SL to ML -6.14, p < 0.05), mean absolute error (NL to ML 3.88; SL to ML -1.84, p < 0.05), and mean error (NL to ML -3.81; SL to ML -1.22, p < 0.05). CONCLUSIONS The ML was usually less than the NL given by the manufacturer, indicating significant change in length in most cases. Computational software-based simulation for preassessment of the braided self-expanding stents is a safe and effective way for accurately calculating the change in length to aid in choosing the right-sized stent for optimal placement in complex intracranial vasculature.
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Affiliation(s)
| | | | - Ahmed Saied
- 3Department of Neurology, Mansoura University, Mansoura, Egypt; and
| | - Nada Elsaid
- 1Department of Neurosurgery, Rush Medical Center, Chicago, Illinois
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Zetchi MA, Dmytriw AA, Chiu AH, Drake BJ, Alizadeh NV, Bharatha A, Kulkarni AV, Marotta TR. Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure? Interv Neuroradiol 2018; 24:624-630. [PMID: 29871561 DOI: 10.1177/1591019918779229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. METHODS Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC). RESULTS Twenty-four (30%) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53% versus 73% for aneurysms with and without incorporated branches, respectively, were also noted. CONCLUSIONS The presence of an incorporated branch conferred a 20% absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.
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Affiliation(s)
- M Akli Zetchi
- 1 Neurovascular Program, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Adam A Dmytriw
- 2 Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,3 Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Albert H Chiu
- 4 Neurological Intervention & Imaging Service of Western Australia (NIISwa), Sir Charles Gairdner, Fiona Stanley and Royal Perth Hospitals, Perth, Australia
| | - Brian J Drake
- 1 Neurovascular Program, St. Michael's Hospital, University of Toronto, Toronto, Canada.,5 Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Niki V Alizadeh
- 6 Division of Neurosurgery, Sick Kids Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Aditya Bharatha
- 2 Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,3 Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Canada.,5 Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Abhaya V Kulkarni
- 6 Division of Neurosurgery, Sick Kids Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Thomas R Marotta
- 2 Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,3 Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Canada.,5 Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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