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Research ArticleNeurointervention
Open Access

Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape

I. Larrabide, M.L. Aguilar, H.G. Morales, A.J. Geers, Z. Kulcsár, D. Rüfenacht and A.F. Frangi
American Journal of Neuroradiology September 2012, DOI: https://doi.org/10.3174/ajnr.A3288
I. Larrabide
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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M.L. Aguilar
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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H.G. Morales
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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A.J. Geers
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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Z. Kulcsár
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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D. Rüfenacht
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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A.F. Frangi
From the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain; Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain; and Hirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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Abstract

BACKGROUND AND PURPOSE: Effects of blood flow modification by flow diverters are observed to lead often to aneurysm thrombosis and reverse remodeling. For this process, to further understand the potential roles of intra-aneurysmal blood pressure changes and aneurysm morphologies, 23 patients were studied by numeric simulation.

MATERIALS AND METHODS: 3D imaging of aneurysms of different sizes and shapes, all located at the supraclinoid segment of the ICA (n = 23), was prepared for CFD simulations. Hemodynamic variables were calculated for conditions before and after virtual FD implantation, reconstituting a vessel wall scaffold across the aneurysm neck. WSS, velocity, residence time, turnover time, and intra-aneurysmal pressure were assessed statistically.

RESULTS: After placement of FDs, significant reductions inside the aneurysm were observed for most hemodynamic variables (P < .01) except mean intra-aneurysmal pressures. For minimum/maximum intra-aneurysmal pressure values, small but significant changes were found; however, they were considered too small to be of relevance.

CONCLUSIONS: Calculations in 23 cases did not reveal significant intra-aneurysmal mean or peak pressure changes, indicating a minor role of pressure changes in the rare event of secondary ruptures after FD use. Other hemodynamic variables (WSS and velocity) exhibited more significant changes, indicating their role in intra-aneurysmal thrombus formation. Size-dependent, significantly higher reduction in WSS (P = .069) and velocity (P = .013) was observed in small aneurysms compared with larger ones. When it came to shape, there were significantly higher reductions in WSS (P = .055) and velocity (P = .065) and a significantly higher increase in turnover time in fusiform aneurysms compared with saccular aneurysms.

Abbreviations

CFD
computational fluid dynamics
FD
flow diverter
IA
intracranial aneurysm
WSS
wall shear stress

Footnotes

  • Ignacio Larrabide and Martha L. Aguilar contributed equally to this work.

  • © 2013 American Society of Neuroradiology

Indicates open access to non-subscribers at www.ajnr.org

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Cite this article
I. Larrabide, M.L. Aguilar, H.G. Morales, A.J. Geers, Z. Kulcsár, D. Rüfenacht, A.F. Frangi
Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape
American Journal of Neuroradiology Sep 2012, DOI: 10.3174/ajnr.A3288

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Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape
I. Larrabide, M.L. Aguilar, H.G. Morales, A.J. Geers, Z. Kulcsár, D. Rüfenacht, A.F. Frangi
American Journal of Neuroradiology Sep 2012, DOI: 10.3174/ajnr.A3288
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