title: Hemodynamic Effect of Flow Diverter and Coils in Treatment of Large and Giant Intracranial Aneurysms.
abstract: This study aimed to investigate the hemodynamic changes induced by a flow diverter (FD) and coils in the treatment of internal carotid artery aneurysms, as well as to evaluate the effect of this treatment by using angiographic follow-up data.
  
  
  
  Six large and giant aneurysms were treated by the Tubridge FD and loose packing coils between June 2013 and May 2015. Patient-specific models were constructed and analyzed using a computational fluid dynamics (CFD) method. The virtual FD deployment method was used to implant the Tubridge stent into a 3-dimensional digital subtraction angiographic image of the aneurysms, and the coils were simulated by a porous medium model.
  
  
  
  Tubridge FD alone can significantly reduce the intra-aneurysmal flow velocity (0.17 ± 0.05 m/s-0.11 ± 0.06 m/s, P < 0.001) and wall shear stress (WSS, 1.39 ± 0.29 Pa-0.77 ± 0.34 Pa, P = 0.001) and increase the low wall shear area (LSA, 6.38% ± 1.49%-34.60% ± 28.90%, P = 0.047). Coils, as a supplementary measure, further reduced the velocity (0.11 ± 0.06 m/s-0.08 ± 0.05 m/s, P = 0.03) and WSS (0.77 ± 0.34 Pa-0.47 ± 0.35 Pa, P = 0.04) and increased the LSA (34.60% ± 28.90%-63.33% ± 34.82%, P = 0.044). Aneurysm with sustained strong inflow after treatment (case 3, 25% reduction in velocity, 12% reduction in WSS, and 16% increment in LSA) showed partial patency, whereas others with a weaker inflow jet (mean 56% reduction in velocity, 74% reduction in WSS, and 1081% increment in LSA) showed complete occlusion at follow-up.
  
  
  
  On the basis of using the CFD method, adjunctive coiling with the Tubridge FD placement may significantly reduce intra-aneurysmal flow velocity and WSS, promoting thrombosis formation and occlusion of aneurysms.
authors: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Linkai
authors: L
authors: Jing
authors: Department of Biomedical Engineering, Capital Medical University, Beijing, China.
authors: Jingru
authors: J
authors: Zhong
authors: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Jian
authors: J
authors: Liu
authors: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Xinjian
authors: X
authors: Yang
authors: Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA.
authors: Nikhil
authors: N
authors: Paliwal
authors: Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA; Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA; Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA.
authors: Hui
authors: H
authors: Meng
authors: Department of Mechanics and Engineering Science, Fudan University, Shanghai, China. Electronic address: szwang@fudan.edu.cn.
authors: Shengzhang
authors: S
authors: Wang
authors: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: yingzhang829@163.com.
authors: Ying
authors: Y
authors: Zhang
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D066230:Patient-Specific Modeling; D015607:Stents; D013314:Stress, Mechanical; D016896:Treatment Outcome
keywords: Aneurysm; Coil; Computational fluid dynamics; Flow diverter; Hemodynamics