Abstract
Purpose: The flow diversion effect of an intracranial stent is closely related to its metal coverage rate (MCR). In this study, the flow diversion effects of Enterprise and low-profile visualized intraluminal support (LVIS) stents are compared with those of a Pipeline flow diverter, focusing on the MCR change. Moreover, the changes in the flow diversion effect caused by the additional manipulations of overlapping and compaction are verified using computational fluid dynamics (CFD) analysis.Methods: CFD analysis was performed using virtually generated stents mounted in an idealized aneurysm model. First, the flow diversion effects of single Enterprise, LVIS, and Pipeline devices were analyzed. The Enterprise and LVIS were sequentially overlapped and compared with a Pipeline, to evaluate the effect of stent overlapping. The effect of compacting a stent was evaluated by comparing the flow diversion effects of a single and two compacted LVIS with those of two overlapped, uncompacted LVIS and uncompacted and compacted Pipeline. Quantitative analysis was performed to evaluate the hemodynamic parameters of energy loss, average velocity, and inflow rate.Results: Statistically significant correlations were observed between the reduction rates of the hemodynamic parameters and MCR. The single LVIS without compaction induced a reduction in all the hemodynamic parameters comparable to those of the three overlapped Enterprise. Moreover, the two overlapped, uncompacted LVIS showed a flow diversion effect as large as that induced by the single uncompacted Pipeline. Compacted stents induced a better flow diversion effect than uncompacted stents. The single compacted LVIS induced a flow diversion effect similar to that induced by the two uncompacted LVIS or single uncompacted Pipeline.Conclusions: The MCR of a stent correlates with its flow diversion effect. Overlapping and compaction can increase the MCR of an intracranial stent and achieve a flow diversion effect as large as that observed with a flow diverter.
Highlights
Intracranial, self-expanding stents were originally designed as scaffolding to protect aneurysmal necks against coil protrusion or migration [1, 2]
The mechanical properties of a stent affect the results of aneurysm treatment, and the metal coverage rate (MCR) of a stent is closely related to the flow diversion effect [9]
We observed that a single low-profile visualized intraluminal support (LVIS) stent exhibited a flow diversion effect similar to that of three overlapped Enterprise stents
Summary
Intracranial, self-expanding stents were originally designed as scaffolding to protect aneurysmal necks against coil protrusion or migration [1, 2]. The flow diversion effect of intracranial stents has received considerable attention [3]. This effect describes a phenomenon in which the blood flow into an aneurysmal sac is redirected by a stent implanted in the parent artery [4]. The flow diversion effect promotes the potential for postembolization thrombosis, which improves the success rate of aneurysm treatment [5, 6]. The mechanical properties of a stent affect the results of aneurysm treatment, and the metal coverage rate (MCR) of a stent is closely related to the flow diversion effect [9]. Achieving a high MCR is a key factor in the success of stent-assisted aneurysm treatment
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