title: Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study.
abstract: Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares with overlapping 2 flow diverters for aneurysmal flow reduction.
  
  
  
  Using a high-fidelity virtual stent placement method, we simulated 3 flow-diverter strategies (single noncompacted, 2 overlapped, and single compacted) in 3 aneurysms (fusiform, large saccular, and medium saccular). Computational fluid dynamics analysis provided posttreatment hemodynamic parameters, including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area.
  
  
  
  Flow-diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other 2 strategies, as indicated by all 5 hemodynamic parameters. In the 2 saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the noncompacted flow diverter.
  
  
  
  Compacting a single flow diverter can outperform overlapping 2 flow diverters in aneurysmal flow reduction, provided that the compaction produces a mesh denser than 2 overlapped flow diverters and this denser mesh covers a sufficient portion of the aneurysm orifice area, for which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.
authors.affiliation: From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).|Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).
authors.forename: R J
authors.identifier: 0000-0003-2256-2154
authors.initials: RJ
authors.lastname: Damiano
authors.affiliation: Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).|Department of Biomedical Engineering (V.M.T., H.M.).
authors.forename: V M
authors.identifier: 0000-0002-1331-2551
authors.initials: VM
authors.lastname: Tutino
authors.affiliation: From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).|Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).
authors.forename: N
authors.identifier: 0000-0002-0396-4409
authors.initials: N
authors.lastname: Paliwal
authors.affiliation: From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.).|Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).
authors.forename: D
authors.identifier: 0000-0002-1121-7876
authors.initials: D
authors.lastname: Ma
authors.affiliation: Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).|Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: J M
authors.identifier: 0000-0002-5225-3072
authors.initials: JM
authors.lastname: Davies
authors.affiliation: Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).|Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: A H
authors.identifier: 0000-0002-9519-0059
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.) huimeng@buffalo.edu.|Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.).|Department of Biomedical Engineering (V.M.T., H.M.).|Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: H
authors.identifier: 0000-0003-3884-499X
authors.initials: H
authors.lastname: Meng
mesh_terms: D000465:Algorithms; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002560:Cerebrovascular Circulation; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design