Effect of the Effective Metal Surface Area of Two Different Flow Diverter Stents on the Stagnation Region Formation Inside the Aneurysm Sac.

Flow diversion (FD) is a relatively new technique for treating large, wide-necked, or fusiform aneurysms. Although FD is a more preferred option than coiling or clipping techniques in neurosurgery and neuroradiology clinics, the blood flow mechanism inside the aneurysm sac is not fully understood after the treatment. Besides, effective metal surface area (EMSA), a property of an FD related to porosity, shows variation at the patient's aneurysm neck by providing more or less blood flow inside an aneurysm sac than planned, causing nonstagnant or stagnant fluid region formation in the sac, respectively. Thus, the change in FD's EMSA can significantly affect the treatment's effectiveness, making even operation unsuccessful when variation in FD's EMSA at the aneurysm neck is overlooked.  In this study, a large aneurysm of a 52-year-old female patient was numerically investigated by virtually placing two commercially available FDs with different EMSA values one by one into the aneurysm-carrying artery.  While FD stents at the aneurysm site substantially reduced the blood flow into the aneurysm, an FD with a 15.6% EMSA caused blood to flow in the aneurysm sac to have six times more kinetic energy than that of FD with a 29.5% EMSA.  Although FD's EMSA value demonstrated nearly up to 20% reduction at the patient's aneurysm neck based on a product catalog value, numerical model results revealed that the stagnated region's formation inside the aneurysm sac could be determined within a 9% difference based on digital subtraction angiography reformat image.