title: Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging.
abstract: BACKGROUND
  Implantation of self-expanding stents from the parent artery into the sac of a bifurcation aneurysm is regularly used to facilitate endovascular coil occlusion with the so-called waffle cone technique (WCT). Self-expanding aneurysm bridging stents like Solitaire AB, can be used; however, bifurcation devices like pCONus and pCANvas are especially designed for WCT. These devices provide additional support for coil implantation owing to intraluminal nylon fibers (pCONus) or membranes (pCANvas) covering the intracranial aneurysm neck.
  
  
  OBJECTIVE
  Assessment of the intra-aneurysmal hemodynamic impact of these three devices: a regular intracranial stent (Solitaire AB) and two bifurcation devices (pCONus and pCANvas).
  
  
  METHODS
  An in vitro experiment was set up using a silicone model of a basilar tip aneurysm filled with blood mimicking fluid under a pulsatile circulation. Solitaire AB, pCONus, and pCANvas were successively implanted in the model for hemodynamic evaluation. High frame rate DSA series were acquired under various conditions. Intra-aneurysmal flow changes, including mean aneurysm flow amplitude ratio (R), were subsequently assessed by the optical flow method, measuring the detector velocity field before and after device implantations.
  
  
  RESULTS
  pCONus and Solitaire minimally reduced the intra-aneurysmal flow (R=0.96, p=0.17 and R=0.91, p=0.01, respectively), whereas pCANvas strongly diminished the intra-aneurysmal flow (R=0.41, p=5×10-12).
  
  
  CONCLUSIONS
  Waffle cone deployment of stents and technique-specific devices had no undesirable effect on the intra-aneurysmal flow. In particular, no increased flow was redirected into the aneurysm sac. The intraluminal membrane of the pCANvas strongly reduced the intra-aneurysmal flow, potentially preventing recanalization problems.
authors.affiliation: Klinik für Neuroradiologie, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Marta Aguilar
authors.initials: MA
authors.lastname: Pérez
authors.affiliation: Klinik für Neuroradiologie, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Henkes
authors.affiliation: Interventional Neuroradiology Unit, University Hospital of Geneva, Geneva, Switzerland Laboratory for Hydraulic Machines (LMH), Ecole Polytechnique Fédérale de Lausanne (EPFL), Avenue de Cour 33bis, CH-1007 Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouillot
authors.affiliation: Interventional Neuroradiology Unit, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Brina
authors.affiliation: Joint Division of Medical Imaging, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Lee-Anne
authors.initials: LA
authors.lastname: Slater
authors.affiliation: Joint Division of Medical Imaging, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Vitor Mendes
authors.initials: VM
authors.lastname: Pereira
mesh_terms: D015901:Angiography, Digital Subtraction / Q000592:standards*; D001807:Blood Vessel Prosthesis / Q000592:standards*; D002560:Cerebrovascular Circulation; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008954:Models, Biological; D015607:Stents / Q000592:standards*
keywords: Aneurysm; Angiography; Blood Flow; Device; Stent