Evaluation of patient-specific intra-aneurysmal hemodynamics after endovascular treatments by CFD models

H. MORALES; I. LARRABIDE; J. M. MACHO; J. BLASCO; L. SAN ROMAN; A. F. FRANGI

Gratz

Workshop; SCATH Joint Workshop on New Technologies for Computer/Robot Assisted Surgery; 2011

Technical University of Graz

Computational models arise as an attractive source of information for clinicians to decide the most suitable treatment for a particular patient. The purpose of this work is to evaluate how intra-aneurysmal hemodynamics is affected by the insertion of endovascular devices (coils and stents), by computational fluid dynamics (CFD) models. One aneurysm located at the right middle cerebral artery (MCA) bifurcation was studied. Three progressive treatments were performed in this case. The first one was treated only with coils, the second one with a Neuroform stent plus coils, and finally, with a double stent (Neuroform and Enterprise), plus coils. CFD simulations were carried out in the untreated and the treated models. After coiling, timeaveraged wall shear stress was reduced about 81%, while adding the two stents only reduced an additional 4%. Aneurysmalinflow was diminished with coils and after the two consecutive stent insertions, about 60%, 56% and 66%, respectively. No visual differences were observed between treatments with virtualangiographic images. The three evaluated treatments induced similar hemodynamic alteration inside the aneurysm, suggesting that the later insertion of the two high-porosity stents after coiling does not modify the intra-aneurysmal hemodynamics and might be only serve as mechanical support for coils.