Can Endovascular Treatment of Fusiform Intracranial Aneurysms Restore the Healthy Hemodynamic Environment?-A Virtual Pilot Study.

Saalfeld, Sylvia; Stahl, Janneck; Korte, Jana; Miller Marsh, Laurel Morgan; Preim, Bernhard; Beuing, Oliver; Cherednychenko, Yurii; Behme, Daniel; Berg, Philipp

doi:10.3389/fneur.2021.771694

by Sylvia Saalfeld, Janneck Stahl, Jana Korte, Laurel Morgan Miller Marsh, Bernhard Preim, Oliver Beuing, Yurii Cherednychenko, Daniel Behme, Philipp Berg

Abstract:

Numerous studies assess intracranial aneurysm rupture risk based on morphological and hemodynamic parameter analysis in addition to clinical information such as aneurysm localization, age, and sex. However, intracranial aneurysms mostly occur with a saccular shape located either lateral to the parent artery or at a bifurcation. In contrast, fusiform intracranial aneurysms (FIAs), i.e., aneurysms with a non-saccular, dilated form, occur in approximately 3-13\% of all cases and therefore have not yet been as thoroughly studied. To improve the understanding of FIA hemodynamics, this pilot study contains morphological analyses and image-based blood flow simulations in three patient-specific cases. For a precise and realistic comparison to the pre-pathological state, each dilation was manually removed and the time-dependent blood flow simulations were repeated. Additionally, a validated fast virtual stenting approach was applied to evaluate the effect of virtual endovascular flow-diverter deployment focusing on relevant hemodynamic quantities. For two of the three patients, post-interventional information was available and included in the analysis. The results of this numerical pilot study indicate that complex flow structures, i.e., helical flow phenomena and the presence of high oscillating flow features, predominantly occur in FIAs with morphologically differing appearances. Due to the investigation of the individual healthy states, the original flow environment could be restored which serves as a reference for the virtual treatment target. It was shown that the realistic deployment led to a considerable stabilization of the individual hemodynamics in all cases. Furthermore, a quantification of the stent-induced therapy effect became feasible for the treating physician. The results of the morphological and hemodynamic analyses in this pilot study show that virtual stenting can be used in FIAs to quantify the effect of the planned endovascular treatment.

Reference:

Can Endovascular Treatment of Fusiform Intracranial Aneurysms Restore the Healthy Hemodynamic Environment?-A Virtual Pilot Study. (Sylvia Saalfeld, Janneck Stahl, Jana Korte, Laurel Morgan Miller Marsh, Bernhard Preim, Oliver Beuing, Yurii Cherednychenko, Daniel Behme, Philipp Berg), In Frontiers in neurology, volume 12, 2021.

Bibtex Entry:

@article{saalfeld_can_2021,
	title = {Can {Endovascular} {Treatment} of {Fusiform} {Intracranial} {Aneurysms} {Restore} the {Healthy}  {Hemodynamic} {Environment}?-{A} {Virtual} {Pilot} {Study}.},
	volume = {12},
	copyright = {Copyright © 2022 Saalfeld, Stahl, Korte, Miller Marsh, Preim, Beuing,  Cherednychenko, Behme and Berg.},
	issn = {1664-2295 1664-2295 1664-2295},
	doi = {10.3389/fneur.2021.771694},
	abstract = {Numerous studies assess intracranial aneurysm rupture risk based on morphological  and hemodynamic parameter analysis in addition to clinical information such as  aneurysm localization, age, and sex. However, intracranial aneurysms mostly occur  with a saccular shape located either lateral to the parent artery or at a  bifurcation. In contrast, fusiform intracranial aneurysms (FIAs), i.e., aneurysms  with a non-saccular, dilated form, occur in approximately 3-13\% of all cases and  therefore have not yet been as thoroughly studied. To improve the understanding  of FIA hemodynamics, this pilot study contains morphological analyses and  image-based blood flow simulations in three patient-specific cases. For a precise  and realistic comparison to the pre-pathological state, each dilation was  manually removed and the time-dependent blood flow simulations were repeated.  Additionally, a validated fast virtual stenting approach was applied to evaluate  the effect of virtual endovascular flow-diverter deployment focusing on relevant  hemodynamic quantities. For two of the three patients, post-interventional  information was available and included in the analysis. The results of this  numerical pilot study indicate that complex flow structures, i.e., helical flow  phenomena and the presence of high oscillating flow features, predominantly occur  in FIAs with morphologically differing appearances. Due to the investigation of  the individual healthy states, the original flow environment could be restored  which serves as a reference for the virtual treatment target. It was shown that  the realistic deployment led to a considerable stabilization of the individual  hemodynamics in all cases. Furthermore, a quantification of the stent-induced  therapy effect became feasible for the treating physician. The results of the  morphological and hemodynamic analyses in this pilot study show that virtual  stenting can be used in FIAs to quantify the effect of the planned endovascular  treatment.},
	language = {eng},
	journal = {Frontiers in neurology},
	author = {Saalfeld, Sylvia and Stahl, Janneck and Korte, Jana and Miller Marsh, Laurel Morgan and Preim, Bernhard and Beuing, Oliver and Cherednychenko, Yurii and Behme, Daniel and Berg, Philipp},
	year = {2021},
	pmid = {35140672},
	pmcid = {PMC8818669},
	keywords = {blood flow patterns, endovascular treatment, fusiform intracranial aneurysm, hemodynamic simulation, virtual stent deployment},
	pages = {771694}
}