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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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Hernandez JL, Woodrow KA. Medical Applications of Porous Biomaterials: Features of Porosity and Tissue-Specific Implications for Biocompatibility. Adv Healthc Mater 2022; 11:e2102087. [PMID: 35137550 PMCID: PMC9081257 DOI: 10.1002/adhm.202102087] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/17/2021] [Indexed: 12/14/2022]
Abstract
Porosity is an important material feature commonly employed in implants and tissue scaffolds. The presence of material voids permits the infiltration of cells, mechanical compliance, and outward diffusion of pharmaceutical agents. Various studies have confirmed that porosity indeed promotes favorable tissue responses, including minimal fibrous encapsulation during the foreign body reaction (FBR). However, increased biofilm formation and calcification is also described to arise due to biomaterial porosity. Additionally, the relevance of host responses like the FBR, infection, calcification, and thrombosis are dependent on tissue location and specific tissue microenvironment. In this review, the features of porous materials and the implications of porosity in the context of medical devices is discussed. Common methods to create porous materials are also discussed, as well as the parameters that are used to tune pore features. Responses toward porous biomaterials are also reviewed, including the various stages of the FBR, hemocompatibility, biofilm formation, and calcification. Finally, these host responses are considered in tissue specific locations including the subcutis, bone, cardiovascular system, brain, eye, and female reproductive tract. The effects of porosity across the various tissues of the body is highlighted and the need to consider the tissue context when engineering biomaterials is emphasized.
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Affiliation(s)
- Jamie L Hernandez
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98195, USA
| | - Kim A Woodrow
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98195, USA
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Tsuji M, Ishida F, Sato T, Furukawa K, Miura Y, Yasuda R, Umeda Y, Toma N, Suzuki H. Computational fluid dynamics using dual-layer porous media modeling to evaluate the hemodynamics of cerebral aneurysm treated with FRED: A technical note. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kaschner MG, Kraus B, Petridis A, Turowski B. Endovascular treatment of intracranial 'blister' and dissecting aneurysms. Neuroradiol J 2019; 32:353-365. [PMID: 31271334 DOI: 10.1177/1971400919861406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Blister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging. PURPOSE The purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms. METHODS We retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004-2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed. RESULTS Thirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy (n = 9), stent-assisted coiling (n = 7), flow diverting stents (n = 13) and coiling + Onyx embolization (n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%. CONCLUSION Treatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.
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Affiliation(s)
- Marius G Kaschner
- 1 Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Bastian Kraus
- 1 Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Athanasios Petridis
- 2 Department of Neurosurgery, University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Bernd Turowski
- 1 Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
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Evaluating the Effectiveness of 2 Different Flow Diverter Stents Based on the Stagnation Region Formation in an Aneurysm Sac Using Lagrangian Coherent Structure. World Neurosurg 2019; 127:e727-e737. [DOI: 10.1016/j.wneu.2019.03.255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
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Karunanithi K, Lee CJ, Chong W, Qian Y. The influence of flow diverter’s angle of curvature across the aneurysm neck on its haemodynamics. Proc Inst Mech Eng H 2015; 229:560-9. [DOI: 10.1177/0954411915593303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Flow diverter stents have provided a new method of endovascular reconstruction for large and complex aneurysms. Understanding the impact of the flow diverter’s angle of curvature across the neck and its metal coverage rate on the haemodynamics of aneurysm is crucial to maximize the mass flow reduction inside the aneurysm, post-deployment. The aim of this study is to understand the correlation between the angle of curvature of flow diverter across the aneurysm neck and the metal coverage rate, and the aneurysm’s haemodynamics, using computational fluid dynamics. Varying the flow diverter angle resulted in varying metal coverage rate across the aneurysm neck for two patient vessel geometries, A (straight artery) and B (curved artery) with aspect ratios of 3.1 and 2.9, respectively. The results indicate that there exists a relationship between the aneurysm’s haemodynamics and the flow diverter’s angle of curvature across its neck. Moreover, the calculations indicated that cases with a moderately curved flow diverter, with an associated metal coverage rate of 50%–60%, achieve maximum flow reduction inside the aneurysm due to a stable flow resistance in the direction normal to the blood flow.
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Affiliation(s)
- Kaavya Karunanithi
- Australian School of Advanced Medicine, Macquarie University, Macquarie Park, NSW, Australia
| | - Chang Joon Lee
- Australian School of Advanced Medicine, Macquarie University, Macquarie Park, NSW, Australia
| | | | - Yi Qian
- Australian School of Advanced Medicine, Macquarie University, Macquarie Park, NSW, Australia
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Tang AYS, Chung WC, Liu ETY, Qu JQ, Tsang ACO, Leung GKK, Leung KM, Yu ACH, Chow KW. Computational Fluid Dynamics Study of Bifurcation Aneurysms Treated with Pipeline Embolization Device: Side Branch Diameter Study. J Med Biol Eng 2015; 35:293-304. [PMID: 26167140 PMCID: PMC4491114 DOI: 10.1007/s40846-015-0046-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/16/2014] [Indexed: 11/17/2022]
Abstract
An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters. The condition after the deployment of a pipeline embolization device is also simulated. Hemodynamic factors such as flow velocity, pressure, and wall shear stress are studied. Aneurysms with a larger side branch vessel might have greater risk after treatment in terms of hemodynamics. Although a stent could lead to flow reduction entering the aneurysm, it would drastically alter the flow rate inside the side branch vessel. This may result in side-branch hypoperfusion subsequent to stenting. In addition, two patient-specific bifurcation aneurysms are tested, and the results show good agreement with the idealized models. Furthermore, the peripheral resistance of downstream vessels is investigated by varying the outlet pressure conditions. This quantitative analysis can assist in treatment planning and therapeutic decision-making.
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Affiliation(s)
- Abraham Yik-Sau Tang
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077 China
| | - Wai-Choi Chung
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077 China
| | - Eric Tian-Yang Liu
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077 China
| | - Jie-Qiong Qu
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077 China
| | - Anderson Chun-On Tsang
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, 999077 China
| | - Gilberto Ka-Kit Leung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, 999077 China
| | - Kar-Ming Leung
- Department of Neurosurgery, Kwong Wah Hospital, Waterloo Road, Hong Kong, 999077 China
| | - Alfred Cheuk-Hang Yu
- Medical Engineering Program, Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077 China
| | - Kwok-Wing Chow
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077 China
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