Hemodynamic Investigation of the Flow Diverter Treatment of Intracranial Aneurysm

Abstract

Flow diverter stents (FDS) are increasingly used for the treatment of complex intracranial aneurysms such as fusiform, giant, or wide-neck aneurysms. The primary goal of these devices is to reconstruct the diseased vascular segment by diverting blood flow from the aneurysm. The resulting intra-aneurysmal flow reduction promotes progressive aneurysm thrombosis and healing of the disease. In the present study, a numerical investigation was performed for modeling blood flow inside a patient-specific intracranial aneurysm virtually treated with FDS. The aim of the study is to investigate the effects of FDS placement prior to the actual endovascular treatment and to compare the effectiveness of devices differing in porosity. Numerical simulations were performed under pulsatile flow conditions, taking into account the non-Newtonian behavior of blood. Two possible post-operative conditions with virtual stent deployment were simulated. Hemodynamic parameters were calculated and compared between the pre-operative (no stent placement) and post-operative (virtual stent placement) aneurysm models. FDS placement significantly reduced intra-aneurysmal flow velocity and increased the Relative Residence Time (RRT) on the aneurysm, thus promoting thrombus formation within the dilatation and aneurysm occlusion. The results highlighted an increase in the effectiveness of FDS as its porosity increased. The proposed analysis provides pre-operative knowledge on the impact of FDS on intracranial hemodynamics, allowing the selection of the most effective treatment for the specific patient.

Keywords

• hemodynamics
• intracranial aneurysm
• flow diverter stent
• image-based computational fluid dynamics (CFD)
• patient-specific modelling
• wall shear stress (WSS)