Effect of flow diverter porosity on intraaneurysmal blood flow

Abstract

Background and purpose: Growth and rupture, the two events that dominate the evolution of an intracranial aneurysm, are both dependent on intraaneurysmal flow. Decrease of intraaneurysmal flow is considered an attractive alternative for treating intracranial aneurysms by minimally invasive techniques. Such modification can be achieved by inserting stents or flow diverters alone. In the present paper, the effect of different commercial and innovative flow diverters' porosity was studied in intracranial aneurysm models.

Material and methods: Single and stent-in-stent combination of Neuroform II as well as single and stent-in-stent combination of a new innovative, low-porosity, intracranial stent device (D1, D2, D1 + D2) were inserted in models of intracranial aneurysms under shear-driven flow and inertia-driven flow configurations. Steady and pulsating flow rates were applied using a blood-like fluid. Particle image velocimetry was used to measure velocity vector fields in the aneurysm midplane along the vessel axis. Flow and vorticity patterns, velocity and vorticity magnitudes were quantified and their value compared with the same flows in absence of the flow diverter.

Results: In absence of flow diverters, a solid-like rotation could be observed in both shear-driven and inertia-driven models under steady and pulsatile flow conditions. The flow effects due to the insertion of low-porous devices such as D1 or D2 provoked a complete alteration of the flow patterns and massive reduction of velocity or vorticity magnitudes, whereas the introduction of clinically adopted high-porous devices provoked less effect in the aneurysm cavity. As expected, results showed that the lower the porosity the larger the reduction in velocity and vorticity within the aneurysm cavity. The lowest-porosity device combination (D1 and D2) reached an averaged reduction of flow parameters of 80% and 88% under steady and pulsatile flow conditions, respectively. The reduction in mean velocity and vorticity was much more significant in the shear-driven flows as compared to the inertia-driven flows.

Conclusion: Although device porosity is the main parameter influencing flow reduction, other parameters such as device design and local flow conditions may influence the level of flow reduction within intracranial aneurysms.