Analysis of flow dynamics and outcomes of cerebral aneurysms treated with intrasaccular flow-diverting devices

J. R. Cebral, Bong Jae Chung, F. Mut, J. Chudyk, C. Bleise, E. Scrivano, P. Lylyk, R. Kadirvel, D. Kallmes

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Intrasaccular flow diversion offers a promising treatment option for complex bifurcation aneurysms. The purpose of this study was to compare the flow conditions between successfully occluded and incompletely occluded aneurysms treated with intrasaccular devices. MATERIALS AND METHODS: The hemodynamics in 18 completely occluded aneurysms after treatment with intrasaccular devices was compared against 18 that were incompletely occluded at follow-up. Hemodynamic and geometric parameters were obtained from computational fluid dynamics models constructed from 3D angiographies. Models of the intrasaccular devices were created and interactively deployed within the vascular models using posttreatment angiography images for guidance. Hemodynamic and geometric variables were compared using the Mann-Whitney test and univariate logistic regression analysis. RESULTS: Incomplete occlusion was associated with large posttreatment mean aneurysm inflows (P = .02) and small reductions in the mean inflow rate (P=.01) and inflow concentration index (P=.03). Incompletely occluded aneurysms were larger (P=.002) and had wider necks (P = .004) than completely occluded aneurysms and tended to have more complex flow patterns, though this trend was not significant after adjusting for multiple testing. CONCLUSIONS: The outcome of cerebral aneurysm treatment with intrasaccular flow diverters is associated with flow conditions created immediately after device implantation. Flow conditions unfavorable for immediate and complete occlusion seem to be created by improper positioning or orientation of the device. Complete occlusion is more difficult to achieve in larger aneurysms, aneurysms with wider necks, and aneurysms with stronger and more complex flows.

Original languageEnglish
Pages (from-to)1511-1516
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume40
Issue number9
DOIs
StatePublished - 1 Jan 2019

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Intracranial Aneurysm
Aneurysm
Equipment and Supplies
Hemodynamics
Angiography
Neck
Hydrodynamics
Blood Vessels
Logistic Models
Regression Analysis

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Cebral, J. R. ; Chung, Bong Jae ; Mut, F. ; Chudyk, J. ; Bleise, C. ; Scrivano, E. ; Lylyk, P. ; Kadirvel, R. ; Kallmes, D. / Analysis of flow dynamics and outcomes of cerebral aneurysms treated with intrasaccular flow-diverting devices. In: American Journal of Neuroradiology. 2019 ; Vol. 40, No. 9. pp. 1511-1516.
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abstract = "BACKGROUND AND PURPOSE: Intrasaccular flow diversion offers a promising treatment option for complex bifurcation aneurysms. The purpose of this study was to compare the flow conditions between successfully occluded and incompletely occluded aneurysms treated with intrasaccular devices. MATERIALS AND METHODS: The hemodynamics in 18 completely occluded aneurysms after treatment with intrasaccular devices was compared against 18 that were incompletely occluded at follow-up. Hemodynamic and geometric parameters were obtained from computational fluid dynamics models constructed from 3D angiographies. Models of the intrasaccular devices were created and interactively deployed within the vascular models using posttreatment angiography images for guidance. Hemodynamic and geometric variables were compared using the Mann-Whitney test and univariate logistic regression analysis. RESULTS: Incomplete occlusion was associated with large posttreatment mean aneurysm inflows (P = .02) and small reductions in the mean inflow rate (P=.01) and inflow concentration index (P=.03). Incompletely occluded aneurysms were larger (P=.002) and had wider necks (P = .004) than completely occluded aneurysms and tended to have more complex flow patterns, though this trend was not significant after adjusting for multiple testing. CONCLUSIONS: The outcome of cerebral aneurysm treatment with intrasaccular flow diverters is associated with flow conditions created immediately after device implantation. Flow conditions unfavorable for immediate and complete occlusion seem to be created by improper positioning or orientation of the device. Complete occlusion is more difficult to achieve in larger aneurysms, aneurysms with wider necks, and aneurysms with stronger and more complex flows.",
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Cebral, JR, Chung, BJ, Mut, F, Chudyk, J, Bleise, C, Scrivano, E, Lylyk, P, Kadirvel, R & Kallmes, D 2019, 'Analysis of flow dynamics and outcomes of cerebral aneurysms treated with intrasaccular flow-diverting devices', American Journal of Neuroradiology, vol. 40, no. 9, pp. 1511-1516. https://doi.org/10.3174/ajnr.A6169

Analysis of flow dynamics and outcomes of cerebral aneurysms treated with intrasaccular flow-diverting devices. / Cebral, J. R.; Chung, Bong Jae; Mut, F.; Chudyk, J.; Bleise, C.; Scrivano, E.; Lylyk, P.; Kadirvel, R.; Kallmes, D.

In: American Journal of Neuroradiology, Vol. 40, No. 9, 01.01.2019, p. 1511-1516.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Analysis of flow dynamics and outcomes of cerebral aneurysms treated with intrasaccular flow-diverting devices

AU - Cebral, J. R.

AU - Chung, Bong Jae

AU - Mut, F.

AU - Chudyk, J.

AU - Bleise, C.

AU - Scrivano, E.

AU - Lylyk, P.

AU - Kadirvel, R.

AU - Kallmes, D.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND AND PURPOSE: Intrasaccular flow diversion offers a promising treatment option for complex bifurcation aneurysms. The purpose of this study was to compare the flow conditions between successfully occluded and incompletely occluded aneurysms treated with intrasaccular devices. MATERIALS AND METHODS: The hemodynamics in 18 completely occluded aneurysms after treatment with intrasaccular devices was compared against 18 that were incompletely occluded at follow-up. Hemodynamic and geometric parameters were obtained from computational fluid dynamics models constructed from 3D angiographies. Models of the intrasaccular devices were created and interactively deployed within the vascular models using posttreatment angiography images for guidance. Hemodynamic and geometric variables were compared using the Mann-Whitney test and univariate logistic regression analysis. RESULTS: Incomplete occlusion was associated with large posttreatment mean aneurysm inflows (P = .02) and small reductions in the mean inflow rate (P=.01) and inflow concentration index (P=.03). Incompletely occluded aneurysms were larger (P=.002) and had wider necks (P = .004) than completely occluded aneurysms and tended to have more complex flow patterns, though this trend was not significant after adjusting for multiple testing. CONCLUSIONS: The outcome of cerebral aneurysm treatment with intrasaccular flow diverters is associated with flow conditions created immediately after device implantation. Flow conditions unfavorable for immediate and complete occlusion seem to be created by improper positioning or orientation of the device. Complete occlusion is more difficult to achieve in larger aneurysms, aneurysms with wider necks, and aneurysms with stronger and more complex flows.

AB - BACKGROUND AND PURPOSE: Intrasaccular flow diversion offers a promising treatment option for complex bifurcation aneurysms. The purpose of this study was to compare the flow conditions between successfully occluded and incompletely occluded aneurysms treated with intrasaccular devices. MATERIALS AND METHODS: The hemodynamics in 18 completely occluded aneurysms after treatment with intrasaccular devices was compared against 18 that were incompletely occluded at follow-up. Hemodynamic and geometric parameters were obtained from computational fluid dynamics models constructed from 3D angiographies. Models of the intrasaccular devices were created and interactively deployed within the vascular models using posttreatment angiography images for guidance. Hemodynamic and geometric variables were compared using the Mann-Whitney test and univariate logistic regression analysis. RESULTS: Incomplete occlusion was associated with large posttreatment mean aneurysm inflows (P = .02) and small reductions in the mean inflow rate (P=.01) and inflow concentration index (P=.03). Incompletely occluded aneurysms were larger (P=.002) and had wider necks (P = .004) than completely occluded aneurysms and tended to have more complex flow patterns, though this trend was not significant after adjusting for multiple testing. CONCLUSIONS: The outcome of cerebral aneurysm treatment with intrasaccular flow diverters is associated with flow conditions created immediately after device implantation. Flow conditions unfavorable for immediate and complete occlusion seem to be created by improper positioning or orientation of the device. Complete occlusion is more difficult to achieve in larger aneurysms, aneurysms with wider necks, and aneurysms with stronger and more complex flows.

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