Document Detail

Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment.
MedLine Citation:
PMID:  21071533     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Flow-diverting approaches to intracranial aneurysm treatment had many promising early results, but recent apparently successful treatments have been complicated by later aneurysm hemorrhage. We analyzed 7 cases of aneurysms treated with flow diversion to explore the possible rupture mechanisms.
MATERIALS AND METHODS: CFD analysis of pre- and posttreatment conditions was performed on 3 giant aneurysms that ruptured after treatment and 4 successfully treated aneurysms. Pre- and posttreatment hemodynamics were compared including WSS, relative blood flows, vascular resistances, and pressures, to identify the effects of flow-diverter placements.
RESULTS: Expected reductions in aneurysm velocity and WSS were obtained, indicating effective flow diversion from the sac into the parent artery, consistent with periprocedural observations. In each case with postaneurysm rupture, the result of flow diversion led to an increase in pressure within the aneurysm. This pressure increase is related to larger effective resistance in the parent artery from placement of the devices and, in 2 cases, the reduction of a preaneurysm stenosis.
CONCLUSIONS: Flow-diversion devices can cause intra-aneurysmal pressure increases, which can potentially lead to rupture, especially for giant aneurysms. This relates both to changes in the parent artery configuration, such as reduction of a proximal stenosis, and to the flow diversion into higher resistance parent artery pathways combined with cerebral autoregulation, leading to higher pressure gradients. These may be important effects that should be considered when planning interventions. Potentially dangerous cases could be identified with angiography and/or patient-specific CFD models.
J R Cebral; F Mut; M Raschi; E Scrivano; R Ceratto; P Lylyk; C M Putman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-11
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  32     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-14     Completed Date:  2011-05-10     Revised Date:  2011-08-02    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-33     Citation Subset:  IM    
Center for Computational Fluid Dynamics, George Mason University, Fairfax, Virginia 22030, USA.
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MeSH Terms
Aneurysm, Ruptured / diagnosis,  etiology*,  physiopathology*
Blood Flow Velocity
Cerebral Arteries / physiopathology
Cerebral Revascularization / adverse effects,  instrumentation
Cerebrovascular Circulation*
Computer Simulation
Diagnosis, Computer-Assisted / methods
Intracranial Aneurysm / complications,  physiopathology*,  surgery*
Middle Aged
Models, Cardiovascular*
Stents / adverse effects*
Treatment Outcome
Comment In:
AJNR Am J Neuroradiol. 2011 Jun-Jul;32(6):981-3   [PMID:  21622579 ]
AJNR Am J Neuroradiol. 2011 May;32(5):E95-7; author reply E98-100   [PMID:  21511857 ]

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