Fu Yu, Bian Xin, Zou Rong, Jin Rongbo, Leng Xiaochang, Fan Feng, Wei Sen, Cui Xuan, Xiang Jianping, Guan Sheng
Department of Neurointervention Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
ArteryFlow Technology Co., Ltd., Hangzhou, China.
J Neuroradiol. 2024 Feb;51(1):74-81. doi: 10.1016/j.neurad.2023.07.002. Epub 2023 Jul 11.
Traditional flow diverters (FDs) for treating aneurysms at the fetal posterior communicating artery are unsatisfactory. Surpass Streamline is a novel FD with different mesh characteristics; however, the outcomes for such aneurysms remain unclear. This study aimed to compare hemodynamic alterations induced by Surpass Streamline, Pipeline Flex, and Tubridge devices and explore possible strategies for aneurysms at the fetal posterior communicating artery.
Two simulated aneurysms (Case 1, Case 2) were constructed from digital subtraction angiography (DSA). The three FDs were virtually deployed, and hemodynamic analysis based on computational fluid dynamics was performed. Hemodynamic parameters, including the sac-averaged velocity magnitude (Velocity), high-flow volume (HFV), and wall shear stress (WSS), were compared between each FD and the untreated model (control). Surpass Streamline was performed in real life for two aneurysms and the clinical outcomes were collected for analysis.
Compared to the control, the Surpass resulted in the most significant reduction in flow. In Case 1, the Velocity, HFV, and WSS were reduced by 51.6%, 78.1%, and 64.3%, respectively. In Case 2, the Velocity, HFV, and WSS were reduced by 48.0%, 81.1%, and 65.3%, respectively. Tubridge showed slightly larger changes in hemodynamic parameters than Pipeline. In addition, our analysis suggested that metal coverage was correlated with the WSS, Velocity, and HFV. The postoperative DSA showed that the aneurysm was nearly occluded in Case 1 and decreased in Case 2.
Compared to that with the Pipeline and Tubridge, the Surpass resulted in the greatest reduction in hemodynamic parameters and might be effective for aneurysms at the fetal posterior communicating artery. Virtual FD deployment and computational fluid dynamics analysis may be used to predict the treatment outcomes.
用于治疗胎儿后交通动脉动脉瘤的传统血流导向装置（FDs）并不理想。Surpass Streamline是一种具有不同网格特征的新型FD；然而，此类动脉瘤的治疗效果仍不明确。本研究旨在比较Surpass Streamline、Pipeline Flex和Tubridge装置引起的血流动力学改变，并探索胎儿后交通动脉动脉瘤的可能治疗策略。
根据数字减影血管造影（DSA）构建两个模拟动脉瘤（病例1、病例2）。虚拟植入三种FD，并基于计算流体动力学进行血流动力学分析。比较每个FD与未治疗模型（对照）之间的血流动力学参数，包括瘤囊平均速度大小（速度）、高流量体积（HFV）和壁面剪应力（WSS）。在现实中对两个动脉瘤进行Surpass Streamline治疗，并收集临床结果进行分析。
与对照相比，Surpass导致的血流减少最为显著。在病例1中，速度、HFV和WSS分别降低了51.6%、78.1%和64.3%。在病例2中，速度、HFV和WSS分别降低了48.0%、81.1%和65.3%。Tubridge显示的血流动力学参数变化略大于Pipeline。此外，我们的分析表明金属覆盖率与WSS、速度和HFV相关。术后DSA显示病例1中的动脉瘤几乎闭塞，病例2中的动脉瘤缩小。
与Pipeline和Tubridge相比，Surpass导致的血流动力学参数降低最大，可能对胎儿后交通动脉动脉瘤有效。虚拟FD植入和计算流体动力学分析可用于预测治疗效果。
