1. Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging
- Author
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Olivier Brina, Marta Aguilar Pérez, Vitor Mendes Pereira, Pierre Bouillot, Lee-Anne Slater, and Hans Henkes
- Subjects
medicine.medical_specialty ,Solitaire Cryptographic Algorithm ,medicine.medical_treatment ,Pulsatile flow ,Hemodynamics ,Models, Biological ,ddc:616.0757 ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Blood vessel prosthesis ,Blood Flow ,Stent ,medicine ,Humans ,Device ,cardiovascular diseases ,medicine.diagnostic_test ,business.industry ,Angiography ,Angiography, Digital Subtraction ,Intracranial Aneurysm ,General Medicine ,Blood flow ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,New Devices ,Cerebrovascular Circulation ,cardiovascular system ,Stents ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Biomedical engineering - Abstract
BackgroundImplantation of self-expanding stents from the parent artery into the sac of a bifurcation aneurysm is regularly used to facilitate endovascular coil occlusion with the so-called waffle cone technique (WCT). Self-expanding aneurysm bridging stents like Solitaire AB, can be used; however, bifurcation devices like pCONus and pCANvas are especially designed for WCT. These devices provide additional support for coil implantation owing to intraluminal nylon fibers (pCONus) or membranes (pCANvas) covering the intracranial aneurysm neck.ObjectiveAssessment of the intra-aneurysmal hemodynamic impact of these three devices: a regular intracranial stent (Solitaire AB) and two bifurcation devices (pCONus and pCANvas).Material and methodsAn in vitro experiment was set up using a silicone model of a basilar tip aneurysm filled with blood mimicking fluid under a pulsatile circulation. Solitaire AB, pCONus, and pCANvas were successively implanted in the model for hemodynamic evaluation. High frame rate DSA series were acquired under various conditions. Intra-aneurysmal flow changes, including mean aneurysm flow amplitude ratio (R), were subsequently assessed by the optical flow method, measuring the detector velocity field before and after device implantations.ResultspCONus and Solitaire minimally reduced the intra-aneurysmal flow (R=0.96, p=0.17 and R=0.91, p=0.01, respectively), whereas pCANvas strongly diminished the intra-aneurysmal flow (R=0.41, p=5×10−12).ConclusionsWaffle cone deployment of stents and technique-specific devices had no undesirable effect on the intra-aneurysmal flow. In particular, no increased flow was redirected into the aneurysm sac. The intraluminal membrane of the pCANvas strongly reduced the intra-aneurysmal flow, potentially preventing recanalization problems.
- Published
- 2016