Evaluation of embedded modular branched stent graft in treating aortic arch aneurysm using imaging-based computational flow analysis

Abstract

Embedded modular branched stent graft (EMBSG) was a new option for aortic arch aneurysm. However, the therapeutic effect of this innovative stenting technique has not been fully assessed. Computational fluid dynamics and three-dimensional structural analyses were performed on three patients (Patient I, Patient II and Patient III) with aortic arch aneurysm, both before and after EMBSG implantation. Patient-specific alterations from preoperative to postoperative were analyzed via morphological and functional metrics. Patient I and Patient II showed notable curvature changes and area reduction after intervention procedure. Three patients showed an increase in flow velocity after EMBSG implantation, while the pressure drop from ascending aorta to the aortic arch was remarkable in Patient I and Patient II with the value of 7.09 ​mmHg, and 10.95 ​mmHg, respectively. Patient I and Patient II also showed elevated time-averaged wall shear stress (TAWSS) in the stenting region, while Patient III showed a trivial change in TAWSS after intervention procedure. Three patients showed low relative residence time after EMBSG insertion. The short-term results of EMBSG in treating aortic arch aneurysm were promising. Hemodynamic parameters have the potential to assist in the outcome evaluation and might be used to guide the stent graft design and wise selection, thereby improving the long-term therapeutic effect in managing complex vascular disease.

Keywords

• Aortic arch aneurysm
• Embedded modular branched stent graft
• Endovascular aortic arch repair
• Computational fluid dynamics
• Functional evaluation