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The effects of stent porosity on the endovascular treatment of intracranial aneurysms located near a bifurcation

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DOI: 10.4236/jbise.2013.68099    4,045 Downloads   5,876 Views   Citations


Intracranial aneurysm occurs when a cerebral artery develops an abnormal sac-like dilatation, and will cause massive bleeding in the subarachnoid space upon rupture. Endovascular stenting is a minimally invasive procedure in which a flow-diverting stent is deployed to cover the aneurysm neck, thereby restricting blood from entering the aneurysm and reducing the risk of rupture. The stent porosity, a crucial factor determining the intra-aneurysmal hemodynamics following treatment, is investigated by computational fluid dynamics techniques. Based on the computational results, a low porosity stent will dramatically reduce the flow velocity and the flow rate inside the side branch vessel. Conversely, a high porosity stent may not provide adequate flow reduction inside the aneurysm, possibly causing treatment failure. An advisable range of optimal stent porosity would be 60% to 75%, which can drastically reduce the flow rate into the aneurysm while preserving enough blood flow for the side branch vessel. Clinically, deployment of two or more flow-diverting stents may not increase treatment efficacy but can potentially lead to adverse effects due to side-branch hypoperfusion. The present quantitative analysis can also provide practical insight for future stent design.

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The authors declare no conflicts of interest.

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Tang, A. , Chan, H. , Tsang, A. , Leung, G. , Leung, K. , Yu, A. and Chow, K. (2013) The effects of stent porosity on the endovascular treatment of intracranial aneurysms located near a bifurcation. Journal of Biomedical Science and Engineering, 6, 812-822. doi: 10.4236/jbise.2013.68099.


[1] Sforza, D.M., Putman, C.M. and Cebral, J.R. (2009) Hemodynamics of cerebral aneurysms. Annual Review of Fluid Mechanics, 41, 91-107. doi:10.1146/annurev.fluid.40.111406.102126
[2] Humphrey, J.D. and Taylor, C.A. (2008) Intracranial and abdominal aortic aneurysms: Similarities, differences, and need for a new class of computational models. Annual Review of Biomedical Engineering, 10, 221-246. doi:10.1146/annurev.bioeng.10.061807.160439
[3] Sekhar, L.N. and Heros, R.C. (1981) Origin, growth, and rupture of saccular aneurysms: A review. Neurosurgery, 8, 248-260. doi:10.1227/00006123-198102000-00020
[4] Schievink, W.I. (1997) Intracranial aneurysms. New England Journal of Medicine, 336, 28-40. doi:10.1056/NEJM199701023360106
[5] Lasheras, J.C. (2007) The biomechanics of arterial aneurysms. Annual Review of Fluid Mechanics, 39, 293-319. doi:10.1146/annurev.fluid.39.050905.110128
[6] Perktold, K., Kenner, T., Hilbert, D., Spork, B. and Florian, H. (1988) Numerical blood flow analysis: Arterial bifurcation with a saccular aneurysm. Basic Research in Cardiology, 83, 24-31. doi:10.1007/BF01907101
[7] Pierot, L. (2011) Flow diverter stents in the treatment of intracranial aneurysms: Where are we? Journal of Neuroradiology, 38, 40-46. doi:10.1016/j.neurad.2010.12.002
[8] Wanke, I. and Forsting, M. (2008) Stents for intracranial wide-necked aneurysms: More than mechanical protection. Neuroradiology, 50, 991-998. doi:10.1007/s00234-008-0460-0
[9] Puffer, R.C., Kallmes, D.F., Cloft, H.J. and Lanzino, G. (2012) Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms. Journal of Neurosurgery, 116, 892-896. doi:10.3171/2011.11.JNS111612
[10] Cavazzuti, M., Atherton, M., Collins, M. and Barozzi, G. (2010) Beyond the virtual intracranial stenting challenge 2007: Non-newtonian and flow pulsatility effects. Journal of Biomechanics, 43, 2645-2647. doi:10.1016/j.jbiomech.2010.04.042
[11] Byun, H.S. and Rhee, K. (2004) CFD modeling of blood flow following coil embolization of aneurysms. Medical Engineering & Physics, 26, 755-761. doi:10.1016/j.medengphy.2004.06.008
[12] Zhao, S., Li, W. and Gu, L. (2012) Biomechanical prediction of abdominal aortic aneurysm rupture risk: Sensitivity analysis. Journal of Biomedical Science and Engineering, 5, 664-671. doi:10.4236/jbise.2012.511083
[13] Fung, G.S.K., Lam, S.K., Cheng, S.W.K. and Chow, K.W. (2008) On stent-graft models in thoracic aortic endovascular repair: A computational investigation of the hemodynamic factors. Computers in Biology and Medicine, 38, 484-489. doi:10.1016/j.compbiomed.2008.01.012
[14] Cheng, S.W.K., Lam, E.S.K., Fung, G.S.K., Ho, P., Ting, A.C.W. and Chow, K.W. (2008) A computational fluid dynamic study of stent graft remodeling after endovascular repair of thoracic aortic dissections. Journal of Vascular Surgery, 48, 303-310. doi:10.1016/j.jvs.2008.03.050
[15] Liou, T.M., Liou, S.N. and Chu, K.L. (2004) Intra-aneurysmal flow with helix and mesh stent placement across side-wall aneurysm pore of a straight parent vessel. ASME Journal of Biomechanical Engineering, 126, 36-43. doi:10.1115/1.1644566
[16] Seshadhri, S., Janiga, G., Beuing, O., Skalej, M. and Thévenin, D. (2011) Impact of stents and flow diverters on hemodynamics in idealized aneurysm models. ASME Journal of Biomechanical Engineering, 133, 071005-1-9. doi:10.1115/1.4004410
[17] Shobayashi, Y., Tanoue, T., Tateshima, S. and Tanishita, K. (2010) Mechanical design of an intracranial stent for treating cerebral aneurysms. Medical Engineering & Physics, 32, 1015-1024. doi:10.1016/j.medengphy.2010.07.002
[18] Babiker, M.H., Gonzalez, L.F., Ryan, J., Albuquerque, F., Collins, D., Elvikis, A. and Frakes, D.H. (2012) Influence of stent configuration on cerebral aneurysm fluid dynamics. Journal of Biomechanics, 45, 440-447. doi:10.1016/j.jbiomech.2011.12.016
[19] Bernardini, A., Larrabide, I., Morales, H.G., Pennati, G., Petrini, L., Cito, S. and Frangi, A.F. (2011) Influence of different computational approaches for stent deployment on cerebral aneurysm haemodynamics. Interface Focus, 1, 338-348. doi:10.1098/rsfs.2011.0004
[20] Bernardini, A., Larrabide, I., Petrini, L., Pennati, G., Flore, E., Kim, M. and Frangi, A.F. (2012) Deployment of self-expandable stents in aneurysmatic cerebral vessels: Comparison of different computational approaches for interventional planning. Computer Methods in Biomechanics and Biomedical Engineering, 15, 303-311. doi:10.1080/10255842.2010.527838
[21] Meng, H., Wang, Z., Kim, M., Ecker, R.D. and Hopkins, L.N. (2006) Saccular aneurysms on straight and curved vessels are subject to different hemodynamics: Implications of intravascular stenting. American Journal of Neuroradiology, 27, 1861-1865.
[22] Ford, M.D., Lee, S.W., Lownie, S.P., Holdsworth, D.W. and Steinman, D.A. (2008) On the effect of parent-aneurysm angle on flow patterns in basilar tip aneurysms: Towards a surrogate geometric marker of intra-aneurismal hemodynamics. Journal of Biomechanics, 41, 241-248. doi:10.1016/j.jbiomech.2007.09.032
[23] Sato, K., Imai, Y., Ishikawa, T., Matsuki, N. and Yamaguchi, T. (2008) The importance of parent artery geometry in intra-aneurysmal hemodynamics. Medical Engineering & Physics, 30, 774-782. doi:10.1016/j.medengphy.2007.09.006
[24] Valen-Sendstad, K., Mardal, K.A. and Steinman, D.A. (2013) High-resolution CFD detects high-frequency velocity fluctuations in bifurcation, but not sidewall, aneurysms. Journal of Biomechanics, 46, 402-407. doi:10.1016/j.jbiomech.2012.10.042
[25] Yu, S.C.M. and Zhao, J.B. (1999) A steady flow analysis on the stented and non-stented sidewall aneurysm models. Medical Engineering & Physics, 21, 133-141. doi:10.1016/S1350-4533(99)00037-5
[26] Rhee, K., Han, M.H. and Cha, S.H. (2002) Changes of flow characteristics by stenting in aneurysm models: Influence of aneurysm geometry and stent porosity. Annals of Biomedical Engineering, 30, 894-904. doi:10.1114/1.1500406
[27] Lieber, B.B., Stancampiano, A.P. and Wakhloo, A.K. (1997) Alteration of hemodynamics in aneurysm models by stenting: Influence of stent porosity. Annals of Biomedical Engineering, 25, 460-469. doi:10.1007/BF02684187
[28] Augsburger, L., Farhat, M., Reymond, P., Fonck, E., Kulcsar, Z., Stergiopulos, N. and Rüfenacht, D.A. (2009) Effect of flow diverter porosity on intraaneurysmal blood flow. Clinical Neuroradiology, 19, 204-214. doi:10.1007/s00062-009-9005-0
[29] Liou, T.M. and Li, Y.C. (2008) Effects of stent porosity on hemodynamics in a sidewall aneurysm model. Journal of Biomechanics, 41, 1174-1183. doi:10.1016/j.jbiomech.2008.01.025
[30] Kim, M., Levy, E.I., Meng, H. and Hopkins, L.N. (2007) Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery, 61, 1305-1313. doi:10.1227/01.neu.0000306110.55174.30
[31] Janiga, G., Rossl, C., Skalej, M. and Thévenin, D. (2013) Realistic virtual intracranial stenting and computational fluid dynamics for treatment analysis. Journal of Biomechanics, 46, 7-12. doi:10.1016/j.jbiomech.2012.08.047
[32] Sadasivan, C., Cesar, L., Seong, J., Rakian, A., Hao, Q., Tio, F.O., Wakhloo, A.K. and Lieber, B.B. (2009) An original flow diversion device for the treatment of intracranial aneurysms: Evaluation in the rabbit elastase-induced model. Stroke, 40, 952-958. doi:10.1161/STROKEAHA.108.533760
[33] Szikora, I., Berentei, Z., Kulcsar, Z., Marosfoi, M., Vajda, Z.S., Lee, W., Berez, A. and Nelson, P.K. (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: The Budapest experience with the Pipeline Embolization Device. American Journal of Neuroradiology, 31, 1139-1147. doi:10.3174/ajnr.A2023
[34] Tahtinen, O.I., Manninen, H.I., Vanninen, R.L., Seppanen, J., Niskakangas, T., Rinne, J. and Keski-Nisula, L. (2012) The silk flow-diverting stent in the endovascular treatment of complex intracranial aneurysms: Technical aspects and midterm results in 24 consecutive patients. Neurosurgery, 70, 617-624. doi:10.1227/NEU.0b013e31823387d4
[35] Kim, M., Taulbee, D.B., Tremmel, M. and Meng, H. (2008) Comparison of two stents in modifying cerebral aneurysm hemodynamics. Annals of Biomedical Engineering, 36, 726-741. doi:10.1007/s10439-008-9449-4
[36] Benndorf, G., Herbon, U., Sollmann, W.P. and Campi, A. (2001) Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: Case report. American Journal of Neuroradiology, 22, 1844-1848.
[37] Cekirge, H.S., Yavuz, K., Geyik, S. and Saatci, I. (2011) A novel “Y” stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling. American Journal of Neuroradiology, 32, 1262-1268. doi:10.3174/ajnr.A2475
[38] Malek, A.M., Alper, S.L. and Izumo, S. (1999) Hemodynamic shear stress and its role in atherosclerosis. Journal of the American Medical Association, 282, 2035-2042. doi:10.1001/jama.282.21.2035
[39] Shojima, M., Oshima, M., Takagi, K., Torii, R., Hayakawa, M., Katada, K., Morita, A. and Kirino, T. (2004) Magnitude and role of wall shear stress on cerebral aneurysm: Computational fluid dynamic study of 20 middle cerebral artery aneurysms. Stroke, 35, 2500-2505. doi:10.1161/01.STR.0000144648.89172.0f
[40] Boussel, L., Rayz, V., McCulloch, C., Martin, A., Acevedo-Bolton, G., Lawton, M., Higashida, R., Smith, W.S., Young, W.L. and Saloner, D. (2008) Aneurysm growth occurs at region of low wall shear stress: Patient-specific correlation of hemodynamics and growth in a longitudinal study. Stroke, 39, 2997-3002. doi:10.1161/STROKEAHA.108.521617
[41] Jou, L.D. and Mawad, M.E. (2011) Hemodynamic effect of Neuroform stent on intimal hyperplasia and thrombus formation in a carotid aneurysm. Medical Engineering & Physics, 33, 573-580. doi:10.1016/j.medengphy.2010.12.013
[42] Kelly, M.E., Turner IV, R.D., Moskowitz, S.I., Gonugunta, V., Hussain, M.S. and Fiorella, D. (2008) Delayed migration of a self-expanding intracranial microstent. American Journal of Neuroradiology, 29, 1959-1960. doi:10.3174/ajnr.A1224
[43] Lobotesis, K., Gholkar, A. and Jayakrishnan, V. (2010) Early migration of a self expanding intracranial stent: Case report. Neurosurgery, 67, E516-E517. doi:10.1227/01.NEU.0000372094.75062.D4
[44] Ujiie, H., Tamano, Y., Sasaki, K. and Hori, T. (2001) Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery, 48, 495-503. doi:10.1097/00006123-200103000-00007
[45] Nader-Sepahi, A., Casimiro, M., Sen, J. and Kitchen, N.D. (2004) Is aspect ratio a reliable predictor of intracranial aneurysm rupture? Neurosurgery, 54, 1343-1348. doi:10.1227/01.NEU.0000124482.03676.8B
[46] Tang, A.Y.S., Lai, S.K., Leung, K.M., Leung, G.K.K. and Chow, K.W. (2012) Influence of the aspect ratio on the endovascular treatment of intracranial aneurysms: A computational investigation. Journal of Biomedical Science and Engineering, 5, 422-431. doi:10.4236/jbise.2012.58054
[47] Tanemura, H., Ishida, F., Miura, Y., Umeda, Y., Fukazawa, K., Suzuki, H., Sakaida, H., Matsushima, S., Shimosaka, S. and Taki, W. (2013) Changes in hemodynamics after placing intracranial stents. Neurologia Medico-Chirurgica, 53, 171-178. doi:10.2176/nmc.53.171
[48] Marzo, A., Singh, P., Larrabide, I., Radaelli, A., Coley, S., Gwilliam, M., Wilkinson, I.D., Lawford, P., Reymond, P., Patel, U., Frangi, A. and Hose, D.R. (2011) Computational hemodynamics in cerebral aneurysms: The effects of modeled versus measured boundary conditions. Annals of Biomedical Engineering, 39, 884-896. doi:10.1007/s10439-010-0187-z
[49] Fan, Y., Cheng, S.W.K., Qing, K.X. and Chow, K.W. (2010) Endovascular repair of type B aortic dissection: A study by computational fluid dynamics. Journal of Biomedical Science and Engineering, 3, 900-907. doi:10.4236/jbise.2010.39120
[50] Ku, D.N. (1997) Blood flow in arteries. Annual Review of Fluid Mechanics, 29, 399-434. doi:10.1146/annurev.fluid.29.1.399
[51] Reymond, P., Merenda, F., Perren, F., Rüfenacht, D. and Stergiopulos, N. (2009) Validation of a one-dimensional model of the systemic arterial tree. American Journal of Physiology—Heart and Circulatory Physiology, 297, H208-H222. doi:10.1152/ajpheart.00037.2009
[52] Hajjar, I., Selim, M., Novak, P. and Novak, V. (2007) The relationship between nighttime dipping in blood pressure and cerebral hemodynamics in nonstroke patients. The Journal of Clinical Hypertension, 9, 929-936. doi:10.1111/j.1524-6175.2007.07342.x
[53] Steinman, D.A., Milner, J.S., Norley, C.J., Lownie, S.P. and Holdsworth, D.W. (2003) Image-based computational simulation of flow dynamics in a giant intracranial aneurysm. American Journal of Neuroradiology, 24, 559-566.
[54] Isoda, H., Hirano, M., Takeda, H., Kosugi, T., Alley, M.T., Markl, M., Pelc, N.J. and Sakahara, H. (2006) Visualization of hemodynamics in a silicon aneurysm model using time-resolved, 3D, phase-contrast MRI. American Journal of Neuroradiology, 27, 1119-1122.
[55] Stuhne, G.R. and Steinman, D.A. (2004) Finite-element modeling of the hemodynamics of stented aneurysms. ASME Journal of Biomechanical Engineering, 126, 382-387. doi:10.1115/1.1762900
[56] Kokalari, I., Karaja, T. and Guerrisi, M. (2013) Review on lumped parameter method for modeling the blood flow in systemic arteries. Journal of Biomedical Science and Engineering, 6, 92-99. doi:10.4236/jbise.2013.61012
[57] Martins, H., Carreiras, M., Ribeiro, M.M., Sousa, P. and Silva-Fortes, C. (2013) The influence of the blood pressure on the venous cerebral flow measured by magnetic susceptibility (SWI) technique. Journal of Biomedical Science and Engineering, 6, 426-434. doi:10.4236/jbise.2013.63A053

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