title: In vitro reproduction of device deformation leading to thrombotic complications and failure of flow diversion.
abstract: Flow diverters (FDs) are increasingly used for complex intracranial aneurysms. As these self-expanding devices are deployed across an aneurysm neck, they can undergo deformations. The potential clinical consequences of FD deformations remain unclear. We describe an immediate thrombotic complication attributed to a stereotypical stenotic deformation of an FD extremity that can occur when landing zones are of insufficient length. This case is supplemented with in vitro studies showing the relationship between i) the length of the landing zones and ii) discrepancies between the diameter of the device and recipient vessel, and the severity of FD stenosis. In vitro, a shorter landing zone was associated with a progressive stenotic deformation of the terminal ends of all FDs studied. This deformation was more pronounced when the diameter of the device was oversized compared to the size of the recipient tube. In our clinical case, the presence of this deformation led to an immediate thrombotic complication, requiring deployment of a second stent to correct the observed stenosis. In addition, treatment failure ultimately led to a fatal rupture, a failure that can be explained by residual flows through a more porous transition zone, another characteristic FD deformation which occurs when they are oversized as compared to the parent vessel, but free to expand at the level of the aneurysm. Proper selection of device diameter and length of the landing zone is important, and may decrease the incidence of deformation-related complications.
authors.affiliation: Service de Radiologie, CHU de Reims, Hôpital Maison Blanche; Reims, France - jean.raymond@umontreal.ca.
authors.forename: Laurent
authors.initials: L
authors.lastname: Estrade
authors.forename: Alina
authors.initials: A
authors.lastname: Makoyeva
authors.forename: Tim E
authors.initials: TE
authors.lastname: Darsaut
authors.forename: Jimmy
authors.initials: J
authors.lastname: Ghostine
authors.forename: Evgueni
authors.initials: E
authors.lastname: Kouznetsov
authors.forename: Igor
authors.initials: I
authors.lastname: Salazkin
authors.forename: Daniel
authors.initials: D
authors.lastname: Roy
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: aneurysm; complication; deformation; flow diverter; in-stent stenosis