title: Finite element modeling of endovascular coiling and flow diversion enables hemodynamic prediction of complex treatment strategies for intracranial aneurysm.
abstract: Endovascular interventions using coil embolization and flow diversion are becoming the mainstream treatment for intracranial aneurysms (IAs). To help assess the effect of intervention strategies on aneurysm hemodynamics and treatment outcome, we have developed a finite-element-method (FEM)-based technique for coil deployment along with our HiFiVS technique for flow diverter (FD) deployment in patient-specific IAs. We tested four clinical intervention strategies: coiling (1-8 coils), single FD, FD with adjunctive coils (1-8 coils), and overlapping FDs. By evaluating post-treatment hemodynamics using computational fluid dynamics (CFD), we compared the flow-modification performance of these strategies. Results show that a single FD provides more reduction in inflow rate than low packing density (PD) coiling, but less reduction in average velocity inside the aneurysm. Adjunctive coils add no additional reduction of inflow rate beyond a single FD until coil PD exceeds 11%. This suggests that the main role of FDs is to divert inflow, while that of coils is to create stasis in the aneurysm. Overlapping FDs decreases inflow rate, average velocity, and average wall shear stress (WSS) in the aneurysm sac, but adding a third FD produces minimal additional reduction. In conclusion, our FEM-based techniques for virtual coiling and flow diversion enable recapitulation of complex endovascular intervention strategies and detailed hemodynamics to identify hemodynamic factors that affect treatment outcome.
authors.affiliation: Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Damiano
authors.affiliation: Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
authors.forename: Ding
authors.initials: D
authors.lastname: Ma
authors.affiliation: Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
authors.forename: Jianping
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; Department of Biomedical Engineering, University at Buffalo,State University of New York, Buffalo, NY 14203, USA. Electronic address: huimeng@buffalo.edu.
authors.forename: Hui
authors.initials: H
authors.lastname: Meng
mesh_terms: D001807:Blood Vessel Prosthesis; D003198:Computer Simulation; D020342:Finite Element Analysis; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D002532:Intracranial Aneurysm / Q000503:physiopathology* / Q000628:therapy; D008954:Models, Biological; D012039:Regional Blood Flow; D015607:Stents
keywords: Flow diverter; Flow diverter with adjunctive coils; Treatment outcome; Virtual coiling; Virtual stenting