Ünsal Can, Güçlü Görkem, Olcay Ali Bahadir, Hassankhani Amir, Bilgin Cem, Hakyemez Bahattin
Numerical Simulation and Spray Targeting Division, Department of Engineering, Bosch, Bursa, Türkiye.
Department of Mechanical Engineering, Southern Methodist University, Dallas, Texas, United States.
Asian J Neurosurg. 2024 Jun 27;19(3):426-434. doi: 10.1055/s-0044-1787868. eCollection 2024 Sep.
Flow diverter (FD) stents are widely used to treat giant aneurysms by reducing blood flow into the aneurysm sac. However, choosing the optimal FD for a patient can be challenging when a nearby artery, such as the ophthalmic artery (OA), is jailed by the FD placement. This study compares the impact of two FD stents with different effective metal surface area (EMSA) values on OA occlusion. A numerical model of a 59-year-old female patient with a giant aneurysm in the left internal carotid artery and a jailed OA was created based on clinical data. Two FD stents, FRED4017 and FRED4518, with different EMSA values at the aneurysm neck and OA inlet, were virtually deployed in the model. Blood flow and occlusion amount in the OA were simulated and compared between the two FD stents. FRED4017 had higher EMSA values than FRED4518 at the aneurysm neck (35% vs. 24.6%) and lower EMSA values at the OA inlet (15% vs. 21.2%). FRED4017 caused more occlusion in the OA than FRED4518 (40% vs. 28%), indicating a higher risk of ocular ischemic syndrome. The EMSA value of FD stents affects the blood flow and occlusion amount in the jailed OA. Therefore, selecting an FD stent with a low EMSA value at the OA inlet may be beneficial for patients with a nearby jailed artery at the aneurysm neck.
血流导向（FD）支架通过减少流入动脉瘤囊的血流量被广泛用于治疗巨大动脉瘤。然而，当附近的动脉，如眼动脉（OA）被FD支架置入所覆盖时，为患者选择最佳的FD支架可能具有挑战性。本研究比较了两种具有不同有效金属表面积（EMSA）值的FD支架对OA闭塞的影响。
基于临床数据创建了一名59岁患有左侧颈内动脉巨大动脉瘤且眼动脉被覆盖的女性患者的数值模型。在该模型中虚拟植入了两种在动脉瘤颈部和OA入口处具有不同EMSA值的FD支架，即FRED4017和FRED4518。对两种FD支架的OA血流和闭塞量进行了模拟和比较。
FRED4017在动脉瘤颈部处比FRED4518具有更高的EMSA值（35%对24.6%），而在OA入口处具有更低的EMSA值（15%对21.2%）。FRED4017比FRED4518在OA中导致更多的闭塞（40%对28%），表明发生眼部缺血综合征的风险更高。
FD支架的EMSA值会影响被覆盖的OA中的血流和闭塞量。因此，对于动脉瘤颈部附近有被覆盖动脉的患者，选择在OA入口处具有低EMSA值的FD支架可能是有益的。
