Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms

Restricted access

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Object. The goal of this study was to quantify the reduction in velocity, vorticity, and shear stresses resulting from the sequential placement of stents across the neck of sidewall cerebral aneurysms.

Methods. A digital particle image velocimetry (DPIV) system was used to measure the pulsatile velocity field within a flexible silicone sidewall intracranial aneurysm model and at the aneurysm neck–parent artery interface in this model. The DPIV system is capable of providing an instantaneous, quantitative two-dimensional measurement of the velocity vector field of “blood” flow inside the aneurysm pouch and the parent vessel, and its changes at varying stages of the cardiac cycle. The corresponding vorticity and shear stress fields are then computed from the velocity field data. Three Neuroform stents (Boston Scientific/Target), each with a strut thickness between 60 and 65 µm, were subsequently placed across the neck of the aneurysm model and measurements were obtained after each stent had been placed.

The authors measured a consistent decrease in the values of the maximal averaged velocity, vorticity, and shear stress after placing one, two, and three stents. Measurements of the circulation inside the sac demonstrated a systematic reduction in the strength of the vortex due to the stent placement. The decrease in the magnitude of the aforementioned quantities after the first stent was placed was remarkable. Placement of two or three stents led to a less significant reduction than placement of the first stent.

Conclusions. The use of multiple flexible intravascular stents effectively reduces the strength of the vortex forming in an aneurysm sac and results in a decrease in the magnitude of stresses acting on the aneurysm wall.

Article Information

Contributor Notes

Address reprint requests to: Gádor Cantón, Ph.D., Department of Mechanical and Aerospace Engineering, University of California, San Diego, 9500 Gilman Drive, MC 0411, La Jolla, California 92093–0411. email: gcanton@mae.ucsd.edu.
Headings
References
  • 1.

    Aenis MStancampiano APWakhloo AKLieber BB: Modeling of flow in a straight stented and nonstented side wall aneurysm model. J Biomech Eng 119:2062121997Aenis M Stancampiano AP Wakhloo AK Lieber BB: Modeling of flow in a straight stented and nonstented side wall aneurysm model. J Biomech Eng 119:206–212 1997

    • Search Google Scholar
    • Export Citation
  • 2.

    Benitez RPSilva MKlem JVeznedaroglu ERosenwasser RH: Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:135913682004Benitez RP Silva M Klem J Veznedaroglu E Rosenwasser RH: Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:1359–1368 2004

    • Search Google Scholar
    • Export Citation
  • 3.

    Benndorf GHerbon USollmann WPCampi A: Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 22:184418482001Benndorf G Herbon U Sollmann WP Campi A: Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 22:1844–1848 2001

    • Search Google Scholar
    • Export Citation
  • 4.

    Cantón GLevy DILasheras JC: Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms. J Neurosurg 103:1461552005Cantón G Levy DI Lasheras JC: Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms. J Neurosurg 103:146–155 2005

    • Search Google Scholar
    • Export Citation
  • 5.

    Doerfler AWanke IEgelhof TStolke DForsting M: Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:1501542004Doerfler A Wanke I Egelhof T Stolke D Forsting M: Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:150–154 2004

    • Search Google Scholar
    • Export Citation
  • 6.

    Fiorella DAlbuquerque FCHan PMcDougall CG: Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54:6172004Fiorella D Albuquerque FC Han P McDougall CG: Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54:6–17 2004

    • Search Google Scholar
    • Export Citation
  • 7.

    Geremia GHaklin MBrennecke L: Embolization of experimentally created aneurysms with intravascular stent devices. AJNR Am J Neuroradiol 15:122312311994Geremia G Haklin M Brennecke L: Embolization of experimentally created aneurysms with intravascular stent devices. AJNR Am J Neuroradiol 15:1223–1231 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Howington JUHanel RAHarrigan MRLevy EIGuterman LRHopkins LN: The Neuroform stent, the first microcatheter-delivered stent for use in the intracranial circulation. Neurosurgery 54:252004Howington JU Hanel RA Harrigan MR Levy EI Guterman LR Hopkins LN: The Neuroform stent the first microcatheter-delivered stent for use in the intracranial circulation. Neurosurgery 54:2–5 2004

    • Search Google Scholar
    • Export Citation
  • 9.

    Kerber CWHeilman CBZanetti PH: Transparent elastic arterial models I: A brief technical note. Biorheology 26:104110491989Kerber CW Heilman CB Zanetti PH: Transparent elastic arterial models I: A brief technical note. Biorheology 26:1041–1049 1989

    • Search Google Scholar
    • Export Citation
  • 10.

    Lanzino GWakhloo AKFessler RDHartney MLGuterman LRHopkins LN: Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:5385461999Lanzino G Wakhloo AK Fessler RD Hartney ML Guterman LR Hopkins LN: Efficacy and current limitations of intravascular stents for intracranial internal carotid vertebral and basilar artery aneurysms. J Neurosurg 91:538–546 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Lanzino GWakhloo AKFessler RDMericle RAGuterman LRHopkins LN: Intravascular stents for intracranial internal carotid and vertebral artery aneurysms: preliminary clinical experience. Neurosurgical Focus 5(4):E31998Lanzino G Wakhloo AK Fessler RD Mericle RA Guterman LR Hopkins LN: Intravascular stents for intracranial internal carotid and vertebral artery aneurysms: preliminary clinical experience. Neurosurgical Focus 5(4):E3 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Lieber BBLivescu VHopkins LNWakhloo AK: Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow. Ann Biomed Eng 30:7687772002Lieber BB Livescu V Hopkins LN Wakhloo AK: Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow. Ann Biomed Eng 30:768–777 2002

    • Search Google Scholar
    • Export Citation
  • 13.

    Lieber BBStancampiano APWakhloo AK: Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 25:4604691997Lieber BB Stancampiano AP Wakhloo AK: Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 25:460–469 1997

    • Search Google Scholar
    • Export Citation
  • 14.

    Liou TMChang WCLiao CC: LDV measurements in lateral model aneurysms of various sizes. Exp Fluids 23:3173241997Liou TM Chang WC Liao CC: LDV measurements in lateral model aneurysms of various sizes. Exp Fluids 23:317–324 1997

    • Search Google Scholar
    • Export Citation
  • 15.

    Lylyk PFerrario APasbón BMiranda CDoroszuk G: Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:2352412005Lylyk P Ferrario A Pasbón B Miranda C Doroszuk G: Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:235–241 2005

    • Search Google Scholar
    • Export Citation
  • 16.

    Sigwart UPuel JMirkovitch VJoffre FKappenberger L: Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 316:7017061987Sigwart U Puel J Mirkovitch V Joffre F Kappenberger L: Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 316:701–706 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Tateshima SViñuela FVillablanca JPMurayama YMorino TNomura Ket al: Three-dimensional blood flow analysis in a wide-necked internal carotid–ophthalmic artery aneurysm. J Neurosurg 99:5265332003Tateshima S Viñuela F Villablanca JP Murayama Y Morino T Nomura K et al: Three-dimensional blood flow analysis in a wide-necked internal carotid–ophthalmic artery aneurysm. J Neurosurg 99:526–533 2003

    • Search Google Scholar
    • Export Citation
  • 18.

    Tominaga RHarasaki HSutton CEmoto HKambic HHollman J: Effects of stent design and serum cholesterol level on the restenosis rate in atherosclerotic rabbits. Am Heart J 126:104910581993Tominaga R Harasaki H Sutton C Emoto H Kambic H Hollman J: Effects of stent design and serum cholesterol level on the restenosis rate in atherosclerotic rabbits. Am Heart J 126:1049–1058 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    Wakhloo AKLanzino GLieber BBHopkins LN: Stents for intracranial aneurysms: the beginning of a new endovascular era? Neurosurgery 43:3773791998Wakhloo AK Lanzino G Lieber BB Hopkins LN: Stents for intracranial aneurysms: the beginning of a new endovascular era? Neurosurgery 43:377–379 1998

    • Search Google Scholar
    • Export Citation
  • 20.

    Yu SCMZhao JB: A steady flow analysis on the stented and non-stented sidewall aneurysm models. Med Eng Phys 21:1331411999Yu SCM Zhao JB: A steady flow analysis on the stented and non-stented sidewall aneurysm models. Med Eng Phys 21:133–141 1999

    • Search Google Scholar
    • Export Citation
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 400 273 7
Full Text Views 179 13 0
PDF Downloads 53 12 0
EPUB Downloads 0 0 0
PubMed
Google Scholar