title: In vitro investigation of contrast flow jet timing in patient-specific intracranial aneurysms.
abstract: BACKGROUND
  The direction and magnitude of intra-aneurysmal flow jet are significant risk factors of subarachnoid hemorrhage, and the change of flow jet during an endovascular procedure has been used for prediction of aneurysm occlusion or whether an additional flow diverter (FD) is warranted. However, evaluation of flow jets is often unreliable due to a large variation of flow jet on the digital subtraction angiograms, and this flow pattern variation may result in incorrect clinical diagnosis Therefore, factors contributing to the variation in flow jet are examined at an in vitro setting, and the findings can help us to understand the nature of flow jet and devise a better plan to quantify the aneurysmal hemodynamics accurately.
  
  
  METHODS
  Intra-aneurysmal flows in three patient-specific aneurysms between 11 and 25 mm were investigated in vitro, and a FD was deployed in each aneurysm model. X-ray imaging of these models were performed at injection rates between 0.2 and 2 mL/s. Pulsatile blood pump and aneurysm model were imaged together to determine the timing of flow jet.
  
  
  RESULTS
  The contrast bolus arrives at the aneurysm early at high contrast injection rates. The flow patterns with slow injection rates exhibit strong inertia that is associated with the systole flow. Flow jets arrive at the aneurysms at the peak systole when the bolus is injected at 0.2 mL/s. The contrast-to-signal ratio is the highest at the injection rate of 0.5 mL/s. Effect of flow diversion can only be assessed at an injection rate greater than 0.5 mL/s.
  
  
  CONCLUSIONS
  Intra-aneurysmal flow jet is highly dependent on the injection rate of the contrast agent. For the internal carotid artery (ICA) aneurysms, the systolic flows can be visualized at slow injection rates (<0.5 mL/s), while the diastolic flow jets are visible at higher injection rates (>1 mL/s). Dependence of flow jet on the contrast injection rate has serious clinical implications and needs to be considered during diagnostic procedures; a protocol with a consistent injection rate is highly recommended.
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas 77030, USA.
authors.forename: Liang-der
authors.initials: LD
authors.lastname: Jou
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas 77030, USA.
authors.forename: Virendra R
authors.initials: VR
authors.lastname: Desai
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas 77030, USA.
authors.forename: Garvin W
authors.initials: GW
authors.lastname: Britz
keywords: Digital subtraction angiography (DSA); hemodynamics; intracranial aneurysms; stent; subarachnoid hemorrhage