Enhanced aneurysmal flow diversion using a dynamic push-pull technique: An experimental and modeling study

D. Ma, J. Xiang, H. Choi, Travis M Dumont, S. K. Natarajan, A. H. Siddiqui, Hui Meng

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Neurovascular flow diverters are flexible, braided stent-meshes for intracranial aneurysm treatment. We applied the dynamic push-pull technique to manipulate the flow-diverter mesh density at the aneurysm orifice to maximize flow diversion. This study investigated the hemodynamic impact of the dynamic push-pull technique on patient-specific aneurysms by using the developed high-fidelity virtual-stenting computational modeling technique combined with computational fluid dynamics. MATERIALS AND METHODS: We deployed 2 Pipeline Embolization Devices into 2 identical sidewall anterior cerebral artery aneurysm phantoms by using the dynamic push-pull technique with different delivery-wire advancements. We then numerically simulated these deployment processes and validated the simulated mesh geometry. Computational fluid dynamics analysis was performed to evaluate detailed hemodynamic changes by deployed flow diverters in the sidewall aneurysm and a fusiform basilar trunk aneurysm (deployments implemented previously). Images of manipulated flow diverter mesh from sample clinical cases were also evaluated. RESULTS: The flow diverters deployed in silico accurately replicated in vitro geometries. Increased delivery wire advancement (21 versus 11 mm) by using a dynamic push-pull technique produced a higher mesh compaction at the aneurysm orifice (50% metal coverage versus 36%), which led to more effective aneurysmal inflow reduction (62% versus 50% in the sidewall aneurysm; 57% versus 36% in the fusiform aneurysm). The dynamic push-pull technique also caused relatively lower metal coverage along the parent vessel due to elongation of the flow diverter. High and low mesh compactions were also achieved for 2 real patients by using the dynamic push-pull technique. CONCLUSIONS: The described dynamic push-pull technique increases metal coverage of pure braided flow diverters over the aneurysm orifice, thereby enhancing the intended flow diversion, while reducing metal coverage along the parent vessel to prevent flow reduction in nearby perforators.

Original languageEnglish (US)
Pages (from-to)1779-1785
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume35
Issue number9
DOIs
StatePublished - Sep 1 2014

Fingerprint

Aneurysm
Metals
Intracranial Aneurysm
Hydrodynamics
Hemodynamics
Computer Simulation
Stents
Equipment and Supplies

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Enhanced aneurysmal flow diversion using a dynamic push-pull technique : An experimental and modeling study. / Ma, D.; Xiang, J.; Choi, H.; Dumont, Travis M; Natarajan, S. K.; Siddiqui, A. H.; Meng, Hui.

In: American Journal of Neuroradiology, Vol. 35, No. 9, 01.09.2014, p. 1779-1785.

Research output: Contribution to journalArticle

Ma, D. ; Xiang, J. ; Choi, H. ; Dumont, Travis M ; Natarajan, S. K. ; Siddiqui, A. H. ; Meng, Hui. / Enhanced aneurysmal flow diversion using a dynamic push-pull technique : An experimental and modeling study. In: American Journal of Neuroradiology. 2014 ; Vol. 35, No. 9. pp. 1779-1785.
@article{550b247220e942f48c36dc97e1269eb0,
title = "Enhanced aneurysmal flow diversion using a dynamic push-pull technique: An experimental and modeling study",
abstract = "BACKGROUND AND PURPOSE: Neurovascular flow diverters are flexible, braided stent-meshes for intracranial aneurysm treatment. We applied the dynamic push-pull technique to manipulate the flow-diverter mesh density at the aneurysm orifice to maximize flow diversion. This study investigated the hemodynamic impact of the dynamic push-pull technique on patient-specific aneurysms by using the developed high-fidelity virtual-stenting computational modeling technique combined with computational fluid dynamics. MATERIALS AND METHODS: We deployed 2 Pipeline Embolization Devices into 2 identical sidewall anterior cerebral artery aneurysm phantoms by using the dynamic push-pull technique with different delivery-wire advancements. We then numerically simulated these deployment processes and validated the simulated mesh geometry. Computational fluid dynamics analysis was performed to evaluate detailed hemodynamic changes by deployed flow diverters in the sidewall aneurysm and a fusiform basilar trunk aneurysm (deployments implemented previously). Images of manipulated flow diverter mesh from sample clinical cases were also evaluated. RESULTS: The flow diverters deployed in silico accurately replicated in vitro geometries. Increased delivery wire advancement (21 versus 11 mm) by using a dynamic push-pull technique produced a higher mesh compaction at the aneurysm orifice (50{\%} metal coverage versus 36{\%}), which led to more effective aneurysmal inflow reduction (62{\%} versus 50{\%} in the sidewall aneurysm; 57{\%} versus 36{\%} in the fusiform aneurysm). The dynamic push-pull technique also caused relatively lower metal coverage along the parent vessel due to elongation of the flow diverter. High and low mesh compactions were also achieved for 2 real patients by using the dynamic push-pull technique. CONCLUSIONS: The described dynamic push-pull technique increases metal coverage of pure braided flow diverters over the aneurysm orifice, thereby enhancing the intended flow diversion, while reducing metal coverage along the parent vessel to prevent flow reduction in nearby perforators.",
author = "D. Ma and J. Xiang and H. Choi and Dumont, {Travis M} and Natarajan, {S. K.} and Siddiqui, {A. H.} and Hui Meng",
year = "2014",
month = "9",
day = "1",
doi = "10.3174/ajnr.A3933",
language = "English (US)",
volume = "35",
pages = "1779--1785",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "9",

}

TY - JOUR

T1 - Enhanced aneurysmal flow diversion using a dynamic push-pull technique

T2 - An experimental and modeling study

AU - Ma, D.

AU - Xiang, J.

AU - Choi, H.

AU - Dumont, Travis M

AU - Natarajan, S. K.

AU - Siddiqui, A. H.

AU - Meng, Hui

PY - 2014/9/1

Y1 - 2014/9/1

N2 - BACKGROUND AND PURPOSE: Neurovascular flow diverters are flexible, braided stent-meshes for intracranial aneurysm treatment. We applied the dynamic push-pull technique to manipulate the flow-diverter mesh density at the aneurysm orifice to maximize flow diversion. This study investigated the hemodynamic impact of the dynamic push-pull technique on patient-specific aneurysms by using the developed high-fidelity virtual-stenting computational modeling technique combined with computational fluid dynamics. MATERIALS AND METHODS: We deployed 2 Pipeline Embolization Devices into 2 identical sidewall anterior cerebral artery aneurysm phantoms by using the dynamic push-pull technique with different delivery-wire advancements. We then numerically simulated these deployment processes and validated the simulated mesh geometry. Computational fluid dynamics analysis was performed to evaluate detailed hemodynamic changes by deployed flow diverters in the sidewall aneurysm and a fusiform basilar trunk aneurysm (deployments implemented previously). Images of manipulated flow diverter mesh from sample clinical cases were also evaluated. RESULTS: The flow diverters deployed in silico accurately replicated in vitro geometries. Increased delivery wire advancement (21 versus 11 mm) by using a dynamic push-pull technique produced a higher mesh compaction at the aneurysm orifice (50% metal coverage versus 36%), which led to more effective aneurysmal inflow reduction (62% versus 50% in the sidewall aneurysm; 57% versus 36% in the fusiform aneurysm). The dynamic push-pull technique also caused relatively lower metal coverage along the parent vessel due to elongation of the flow diverter. High and low mesh compactions were also achieved for 2 real patients by using the dynamic push-pull technique. CONCLUSIONS: The described dynamic push-pull technique increases metal coverage of pure braided flow diverters over the aneurysm orifice, thereby enhancing the intended flow diversion, while reducing metal coverage along the parent vessel to prevent flow reduction in nearby perforators.

AB - BACKGROUND AND PURPOSE: Neurovascular flow diverters are flexible, braided stent-meshes for intracranial aneurysm treatment. We applied the dynamic push-pull technique to manipulate the flow-diverter mesh density at the aneurysm orifice to maximize flow diversion. This study investigated the hemodynamic impact of the dynamic push-pull technique on patient-specific aneurysms by using the developed high-fidelity virtual-stenting computational modeling technique combined with computational fluid dynamics. MATERIALS AND METHODS: We deployed 2 Pipeline Embolization Devices into 2 identical sidewall anterior cerebral artery aneurysm phantoms by using the dynamic push-pull technique with different delivery-wire advancements. We then numerically simulated these deployment processes and validated the simulated mesh geometry. Computational fluid dynamics analysis was performed to evaluate detailed hemodynamic changes by deployed flow diverters in the sidewall aneurysm and a fusiform basilar trunk aneurysm (deployments implemented previously). Images of manipulated flow diverter mesh from sample clinical cases were also evaluated. RESULTS: The flow diverters deployed in silico accurately replicated in vitro geometries. Increased delivery wire advancement (21 versus 11 mm) by using a dynamic push-pull technique produced a higher mesh compaction at the aneurysm orifice (50% metal coverage versus 36%), which led to more effective aneurysmal inflow reduction (62% versus 50% in the sidewall aneurysm; 57% versus 36% in the fusiform aneurysm). The dynamic push-pull technique also caused relatively lower metal coverage along the parent vessel due to elongation of the flow diverter. High and low mesh compactions were also achieved for 2 real patients by using the dynamic push-pull technique. CONCLUSIONS: The described dynamic push-pull technique increases metal coverage of pure braided flow diverters over the aneurysm orifice, thereby enhancing the intended flow diversion, while reducing metal coverage along the parent vessel to prevent flow reduction in nearby perforators.

UR - http://www.scopus.com/inward/record.url?scp=84907092673&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907092673&partnerID=8YFLogxK

U2 - 10.3174/ajnr.A3933

DO - 10.3174/ajnr.A3933

M3 - Article

C2 - 24763414

AN - SCOPUS:84907092673

VL - 35

SP - 1779

EP - 1785

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 9

ER -