Stahl Janneck, Marsh Laurel Morgan Miller, Thormann Maximilian, Ding Andreas, Saalfeld Sylvia, Behme Daniel, Berg Philipp
Research Campus STIMULATE, University of Magdeburg, Magdeburg, 39106, Germany; Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, 39106, Germany.
Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
Comput Biol Med. 2023 Apr;156:106720. doi: 10.1016/j.compbiomed.2023.106720. Epub 2023 Feb 28.
Endovascular treatment of intracranial aneurysms with flow diverters (FD) has become one of the most promising interventions. Due to its woven high-density structure they are particularly applicable for challenging lesions. Although several studies have already conducted realistic hemodynamic quantification of the FD efficacy, a comparison with morphologic post-interventional data is still missing. This study analyses the hemodynamics of ten intracranial aneurysm patients treated with a novel FD device. Based on pre- and post-interventional 3D digital subtraction angiography image data, patient-specific 3D models of both treatment states are generated applying open source threshold-based segmentation methods. Using a fast virtual stenting approach, the real stent positions available in the post-interventional data are virtually replicated and both treatment scenarios were characterized using image-based blood flow simulations. The results show FD-induced flow reductions at the ostium by a decrease in mean neck flow rate (51%), inflow concentration index (56%) and mean inflow velocity (53%). Intraluminal reductions in flow activity for time-averaged wall shear stress (47%) and kinetic energy (71%) are present as well. However, an intra-aneurysmal increase in flow pulsatility (16%) for the post-interventional cases can be observed. Patient-specific FD simulations demonstrate the desired flow redirection and activity reduction inside the aneurysm beneficial for thrombosis formation. Differences in the magnitude of hemodynamic reduction exist over the cardiac cycle which may be addressed in a clinical setting by anti-hypertensive treatment in selected cases.
采用血流导向装置（FD）对颅内动脉瘤进行血管内治疗已成为最有前景的干预措施之一。由于其编织的高密度结构，它们特别适用于具有挑战性的病变。尽管已有多项研究对FD疗效进行了实际的血流动力学量化，但与介入后形态学数据的比较仍然缺失。本研究分析了10例接受新型FD装置治疗的颅内动脉瘤患者的血流动力学情况。基于介入前后的三维数字减影血管造影图像数据，应用基于开源阈值的分割方法生成两种治疗状态下的患者特异性三维模型。使用快速虚拟支架置入方法，虚拟复制介入后数据中可用的真实支架位置，并使用基于图像的血流模拟对两种治疗方案进行特征描述。结果显示，FD导致瘤口处血流减少，平均颈部血流速度降低51%，流入浓度指数降低56%，平均流入速度降低53%。时间平均壁面切应力降低47%，动能降低71%，管腔内血流活动也减少。然而，介入后病例的动脉瘤内血流搏动性增加16%。患者特异性FD模拟显示，动脉瘤内血流方向改变和活动减少，有利于血栓形成。心动周期中血流动力学降低幅度存在差异，在临床环境中，部分病例可通过抗高血压治疗来解决这一问题。
