Influence of Flow Diverter Implantation on Hemodynamics in Intracranial Aneurysms Treatment

doi:10.3969/j.issn.1673-5765.2018.10.010

Abstract

Abstract:

Flow diverter (FD) is a kind of new device for endovascular treatment of complex intracranial aneurysms. FD is designed to reconstruct parent artery by removing aneurysms from circulatory system through blood flow remodeling. This concept innovation brings new ideas and methods for treating complex aneurysms. It is reported that the complete occlusion rate of aneurysms using FD could achieve over 90%, so currently the FD application is becoming increasingly wider. This article reviewed that the effect of using FD on hemodynamics in treating intracranial aneurysms, and effect of this treatment approach on outcome of intracranial aneurysms, to provide reference for aneurysms treatment decision-making.

Key words: Flow diverter; Intracranial aneurysms; Prognosis; Hemodynamics

摘要：

血流导向装置（flow diverter，FD）是近年来产生的血管内治疗颅内复杂动脉瘤的新材料。 FD设计是通过改建血流的方式将动脉瘤排除在循环系统之外从而重建载瘤动脉，因此FD为复杂动脉瘤的治疗提供了新的思路和手段。临床报道该治疗方式的动脉瘤完全栓塞率可达90%以上。目前 FD应用逐渐广泛，本文从血流动力学角度出发针对FD的血流导向能力，以及颅内动脉瘤经FD治疗后影响预后的因素进行了总结。

关键词: 血流导向装置; 颅内动脉瘤; 预后; 血流动力学

CHEN Jun-Fan, YANG Xin-Jian, LIU Jian. Influence of Flow Diverter Implantation on Hemodynamics in Intracranial Aneurysms Treatment[J]. Chinese Journal of Stroke, 2018, 13(10): 1051-1056.

陈俊凡, 杨新健, 刘健. 血流导向装置在颅内动脉瘤治疗中应用的血流动力学研究进展[J]. 中国卒中杂志, 2018, 13(10): 1051-1056.

References

[1] 杨鹏飞，刘建民，黄清海，等. 新型血流导向装置

Tubridge治疗颅内动脉瘤的初步经验[J]. 介入放射学

杂志，2011，20（5）：357-362.

[2] LUBICZ B，COLLIGNON L，LEFRANC F，et al.

Circumferential and fusiform intracranial aneurysms：

reconstructive endovascular treatment with selfexpandable

stents[J]. Neuroradiology，2008，50（6）：

499-507.

[3] GONZALEZ N R，DUCKWILER G，JAHAN R，et

al. Challenges in the endovascular treatment of giant

intracranial aneurysms[J]. Neurosurgery，2008，62

（6 Suppl 3）：1324-1335.

[4] BECSKE T，POTTS M B，SHAPIRO M，et al.

Pipeline for uncoilable or failed aneurysms：3-year

follow-up results[J]. J Neurosurg，2017，127（1）：81-

88.

[5] KALLMES D F，HANEL R，LOPES D，et al.

International retrospective study of the pipeline

embolization device：a multicenter aneurysm

treatment study[J]. AJNR Am J Neuroradiol，2015，

36（1）：108-115.

[6] KALLMES D F，BRINJIKJI W，BOCCARDI E，et

al. Aneurysm Study of Pipeline in an Observational Registry（ASPIRe）[J]. Interv Neurol，2016，5（1-2）：

89-99.

[7] PIANO M，VALVASSORI L，QUILICI L，et

al. Midterm and long-term follow-up of cerebral

aneurysms treated with flow diverter devices：a

single-center experience[J]. J Neurosurg，2013，118

（2）：408-416.

[8] BERGE J，BIONDI A，MACHI P，et al. Flowdiverter

silk stent for the treatment of intracranial

aneurysms：1-year follow-up in a multicenter

study[J]. AJNR Am J Neuroradiol，2012，33（6）：

1150-1155.

[9] ARRESE I，SARABIA R，PINTADO R，et

al. Flow-diverter devices for intracranial

aneurysms：systematic review and meta-analysis[J].

Neurosurgery，2013，73（2）：193-200.

[10] BRINJIKJI W，MURAD M H，LANZINO G，et al.

Endovascular treatment of intracranial aneurysms

with flow diverters：a meta-analysis[J]. Stroke，2013，

44（2）：442-447.

[11] PHILLIPS T J，WENDEROTH J D，PHATOUROS

C C，et al. Safety of the pipeline embolization device

in treatment of posterior circulation aneurysms[J].

AJNR Am J Neuroradiol，2012，33（7）：1225-1231.

[12] RINGELSTEIN A，SCHLAMANN M，GOERICKE

S L，et al. 3-year follow-up after endovascular

aneurysm treatment with Silk® flow diverter[J].

Rofo，2013，185（4）：328-332.

[13] SAATCI I，YAVUZ K，OZER C，et al. Treatment

of intracranial aneurysms using the pipeline flowdiverter

embolization device：a single-center

experience with long-term follow-up results[J].

AJNR Am J Neuroradiol，2012，33（8）：1436-1446.

[14] LIU J，ZHOU Y，LI Y，et al. Parent artery

reconstruction for large or giant cerebral aneurysms

using the Tubridge flow diverter：a multicenter，

randomized，controlled clinical trial（PARAT）[J].

AJNR Am J Neuroradiol，2018，39（5）：807-816.

[15] HUANG Q，XU J，CHENG J，et al. Hemodynamic

changes by flow diverters in rabbit aneurysm models：

a computational fluid dynamic study based on microcomputed

tomography reconstruction[J]. Stroke，

2013，44（7）：1936-1941.

[16] LARRABIDE I，GEERS A J，MORALES H

G，et al. Effect of aneurysm and ICA morphology

on hemodynamics before and after flow diverter

treatment[J]. J Neurointerv Surg，2015，7（4）：272-

280.

[17] WANG C，TIAN Z，LIU J，et al. Flow diverter effect

of LVIS stent on cerebral aneurysm hemodynamics：

a comparison with Enterprise stents and the Pipeline

device[J]. J Transl Med，2016，14（1）：199.

[18] MA D，XIANG J，CHOI H，et al. Enhanced

aneurysmal flow diversion using a dynamic pushpull

technique：an experimental and modeling

study[J]. AJNR Am J Neuroradiol，2014，35（9）：

1779-1785.

[19] DAMIANO R，TUTINO V，PALIWAL N，et

al. Compacting a single flow diverter versus

overlapping flow diverters for intracranial aneurysms：

a computational study[J]. AJNR Am J Neuroradiol，

2017，38（3）：603-610.

[20] KULCSAR Z，AUGSBURGER L，REYMOND P，et

al. Flow diversion treatment：intra-aneurismal blood

flow velocity and WSS reduction are parameters

to predict aneurysm thrombosis[J]. Acta Neurochir

（Wien），2012，154（10）：1827-1834.

[21] KARMONIK C，CHINTALAPANI G，REDEL

T，et al. Hemodynamics at the ostium of cerebral

aneurysms with relation to post-treatment changes

by a virtual flow diverter：a computational fluid

dynamics study[J/OL]. Conf Proc IEEE Eng Med

Biol Soc，2013，2013：1895-1898. https：//doi.

org/10.1109/EMBC.2013.6609895.

[22] CEBRAL J R，MUT F，RASCHI M，et al. Analysis

of hemodynamics and aneurysm occlusion after

flow-diverting treatment in rabbit models[J]. AJNR

Am J Neuroradiol，2014，35（8）：1567-1573.

[23] CHUNG B，MUT F，KADIRVEL R，et al.

Hemodynamic analysis of fast and slow aneurysm

occlusions by flow diversion in rabbits[J]. J

Neurointerv Surg，2015，7（12）：931-935.

[24] MUT F，RASCHI M，SCRIVANO E，et al.

Association between hemodynamic conditions and

occlusion times after flow diversion in cerebral

aneurysms[J]. J Neurointerv Surg，2015，7（4）：286-

290.

[25] ZHANG Y，CHONG W，QIAN Y. Investigation of

intracranial aneurysm hemodynamics following flow

diverter stent treatment[J]. Med Eng Phys，2013，35

（5）：608-615.

[26] XIANG J，DAMIANO R J，LIN N，et al. Highfidelity

virtual stenting：modeling of flow diverter

deployment for hemodynamic characterization of

complex intracranial aneurysms[J]. J Neurosurg，

2015，123（4）：832-840.

[27] TRIVELATO F，SALLES REZENDE M，

ULHÔA A，et al. Occlusion rates of intracranial

aneurysms treated with the Pipeline embolization

device：the role of branches arising from the sac[J/

OL]. J Neurosurg，2018，6：1-7. http：//thejns.org/

doi/10.3171/2017.10.JNS172175. [28] LIN N，BROUILLARD A M，KRISHNA C，et

al. Use of coils in conjunction with the pipeline

embolization device for treatment of intracranial

aneurysms[J]. Neurosurgery，2015，76（2）：142-149.

[29] CEBRAL J R，MUT F，RASCHI M，et al. Aneurysm

rupture following treatment with flow-diverting

stents：computational hemodynamics analysis of

treatment[J]. AJNR Am J Neuroradiol，2011，32（1）：

27-33.

[30] TULAMO R，FRÖSEN J，HERNESNIEMI J，et

al. Inflammatory changes in the aneurysm wall：a

review[J]. J Neurointerv Surg，2010，2（2）：120-130.

[31] FRÖSEN J，PIIPPO A，PAETAU A，et al.

Remodeling of saccular cerebral artery aneurysm

wall is associated with rupture：histological analysis

of 24 unruptured and 42 ruptured cases[J]. Stroke，

2004，35（10）：2287-2293.

[32] KULCSÁR Z，HOUDART E，BONAFÉ A，et al.

Intra-aneurysmal thrombosis as a possible cause

of delayed aneurysm rupture after flow-diversion

treatment[J]. AJNR Am J Neuroradiol，2011，32（1）：

20-25.

[33] TOMAS C，BENAISSA A，HERBRETEAU D，et

al. Delayed ipsilateral parenchymal hemorrhage

following treatment of intracranial aneurysms with

flow diverter[J]. Neuroradiology，2014，56（2）：155-

161.

[34] CRUZ J，CHOW M，O'KELLY C，et al. Delayed

ipsilateral parenchymal hemorrhage following flow

diversion for the treatment of anterior circulation

aneurysms[J]. AJNR Am J Neuroradiol，2012，33

（4）：603-608.

[35] SHAKUR S，ALETICH V，AMIN-HANJANI S，

et al. Quantitative assessment of parent vessel and

distal intracranial hemodynamics following pipeline

flow diversion[J]. Interv Neuroradiol，2017，23（1）：

34-40.

[36] BRUNOZZI D，SHAKUR S，CHARBEL F，et al.

Middle cerebral artery pressure changes following

Pipeline flow diversion[J]. Interv Neuroradiol，2018，

24（3）：297-302.

[37] BRUNOZZI D，SHAKUR S，HUSSEIN A，et

al. Middle cerebral artery flow velocity increases

more in patients with delayed intraparenchymal

hemorrhage after Pipeline[J]. J Neurointerv Surg，

2018，10（3）：249-251.

[38] JING L，ZHONG J，LIU J，et al. Hemodynamic

effect of flow diverter and coils in treatment of

large and giant intracranial aneurysms[J/OL].

World Neurosurg，2016，89：199-207. https：//doi.

org/10.1016/j.wneu.2016.01.079.

[39] DAMIANO R J，MA D，XIANG J，et al. Finite

element modeling of endovascular coiling and

flow diversion enables hemodynamic prediction

of complex treatment strategies for intracranial

aneurysm[J]. J Biomech，2015，48（12）：3332-3340.