Kim Sunghan, Yang Hyeondong, Hong Ineui, Oh Je Hoon, Kim Yong Bae
Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Front Neurol. 2021 Aug 2;12:705841. doi: 10.3389/fneur.2021.705841. eCollection 2021.
The flow diversion effect of an intracranial stent is closely related to its metal coverage rate (MCR). In this study, the flow diversion effects of Enterprise and low-profile visualized intraluminal support (LVIS) stents are compared with those of a Pipeline flow diverter, focusing on the MCR change. Moreover, the changes in the flow diversion effect caused by the additional manipulations of overlapping and compaction are verified using computational fluid dynamics (CFD) analysis. CFD analysis was performed using virtually generated stents mounted in an idealized aneurysm model. First, the flow diversion effects of single Enterprise, LVIS, and Pipeline devices were analyzed. The Enterprise and LVIS were sequentially overlapped and compared with a Pipeline, to evaluate the effect of stent overlapping. The effect of compacting a stent was evaluated by comparing the flow diversion effects of a single and two compacted LVIS with those of two overlapped, uncompacted LVIS and uncompacted and compacted Pipeline. Quantitative analysis was performed to evaluate the hemodynamic parameters of energy loss, average velocity, and inflow rate. Statistically significant correlations were observed between the reduction rates of the hemodynamic parameters and MCR. The single LVIS without compaction induced a reduction in all the hemodynamic parameters comparable to those of the three overlapped Enterprise. Moreover, the two overlapped, uncompacted LVIS showed a flow diversion effect as large as that induced by the single uncompacted Pipeline. Compacted stents induced a better flow diversion effect than uncompacted stents. The single compacted LVIS induced a flow diversion effect similar to that induced by the two uncompacted LVIS or single uncompacted Pipeline. The MCR of a stent correlates with its flow diversion effect. Overlapping and compaction can increase the MCR of an intracranial stent and achieve a flow diversion effect as large as that observed with a flow diverter.
颅内支架的血流导向效果与其金属覆盖率（MCR）密切相关。在本研究中，将Enterprise支架和低轮廓可视化腔内支撑（LVIS）支架的血流导向效果与Pipeline血流导向装置的效果进行比较，重点关注MCR的变化。此外，使用计算流体动力学（CFD）分析验证了重叠和压实等额外操作引起的血流导向效果变化。CFD分析是使用安装在理想化动脉瘤模型中的虚拟生成支架进行的。首先，分析了单个Enterprise、LVIS和Pipeline装置的血流导向效果。将Enterprise和LVIS依次重叠并与Pipeline进行比较，以评估支架重叠的效果。通过比较单个压实LVIS和两个压实LVIS与两个重叠、未压实LVIS以及未压实和压实Pipeline的血流导向效果，评估了压实支架的效果。进行了定量分析以评估能量损失率、平均速度和流入率等血流动力学参数。在血流动力学参数的降低率与MCR之间观察到具有统计学意义的相关性。未压实的单个LVIS导致所有血流动力学参数的降低与三个重叠的Enterprise相当。此外，两个重叠、未压实的LVIS显示出与单个未压实的Pipeline诱导的血流导向效果一样大的效果。压实的支架比未压实的支架诱导出更好的血流导向效果。单个压实的LVIS诱导的血流导向效果类似于两个未压实的LVIS或单个未压实的Pipeline诱导的效果。支架的MCR与其血流导向效果相关。重叠和压实可以增加颅内支架的MCR，并实现与血流导向装置观察到的一样大的血流导向效果。
