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Virtual flow-diverter treatment planning: The effect of device placement on bifurcation aneurysm haemodynamics

Peach, T; Spranger, K; Ventikos, Y; (2016) Virtual flow-diverter treatment planning: The effect of device placement on bifurcation aneurysm haemodynamics. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine , 231 (5) pp. 432-443. 10.1177/0954411916673674. Green open access

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Abstract

Bifurcation aneurysms account for a large fraction of cerebral aneurysms and often present morphologies that render traditional endovascular treatments, such as coiling, challenging and problematic. Flow-diverter stents offer a potentially elegant treatment option for such aneurysms, but clinical use of these devices remains controversial. Specifically, the deployment of a flow-diverter device in a bifurcation entails jailing one or more potentially vital vessels with a low-porosity mesh designed to restrict the flow. When multiple device placement configurations exist, the most appropriate clinical decision becomes increasingly opaque. In this study, three bifurcation aneurysm geometries were virtually treated by flow-diverter device. Each aneurysm was selected to offer two possible device deployment positions. Flow-diverters similar to commercially available designs were deployed with a fast-deployment algorithm before transient and steady state computational fluid dynamics simulations were performed. Reductions in aneurysm inflow, mean wall shear stress and maximum wall shear stress, all factors often linked with aneurysm treatment outcome, were compared for different device configurations in each aneurysm. In each of the three aneurysms modelled, a particular preferential device placement was shown to offer superior performance with the greatest reduction in the flow metrics considered. In all the three aneurysm geometries, substantial variations in inflow reduction (up to 25.3%), mean wall shear stress reduction (up to 14.6%) and maximum wall shear stress reduction (up to 12.1%) were seen, which were all attributed to device placement alone. Optimal device placement was found to be non-trivial and highly aneurysm specific; in only one-third of the simulated geometries, the best overall performance was achieved by deploying a device in the daughter vessel with the highest flow rate. Good correspondence was seen between transient results and steady state computations that offered a significant reduction in simulation run time. If accurate steady state computations are combined with the fast-deployment algorithm used, the modest run time and corresponding hardware make a virtual treatment pipeline in the clinical setting a meaningful possibility.

Type: Article
Title: Virtual flow-diverter treatment planning: The effect of device placement on bifurcation aneurysm haemodynamics
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/0954411916673674
Publisher version: http://dx.doi.org/10.1177/0954411916673674
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Technology, Engineering, Biomedical, Engineering, Cardiovascular implants, haemodynamics, tubes and flow: haemodynamics, velocity: haemodynamics, modelling/simulation (Biomechanics), INTRACRANIAL ANEURYSMS, THROMBUS FORMATION, COMPUTATIONAL HEMODYNAMICS, EMBOLIZATION DEVICE, CEREBRAL ANEURYSMS, BASILAR ARTERY, BLOOD-FLOW, MODELS, EXPERIENCE, DYNAMICS
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/1528215
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