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Research ArticleNeurointervention
Open Access

Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape

I. Larrabide, M.L. Aguilar, H.G. Morales, A.J. Geers, Z. Kulcsár, D. Rüfenacht and A.F. Frangi
American Journal of Neuroradiology April 2013, 34 (4) 816-822; DOI: https://doi.org/10.3174/ajnr.A3288
I. Larrabide
aFrom the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
bCenter for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain
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M.L. Aguilar
aFrom the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
bCenter for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain
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H.G. Morales
aFrom the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
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A.J. Geers
aFrom the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
bCenter for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain
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Z. Kulcsár
cHirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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D. Rüfenacht
cHirslanden Clinic (Z.K., D.R.), Zürich, Switzerland.
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A.F. Frangi
aFrom the Networking Biomedical Research Center on Bioengineering (I.L., M.L.A., H.G.M., A.J.G., A.F.F.), Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
bCenter for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB) (I.L., M.L.A., A.J.G., A.F.F.), Universitat Pompeu Fabra, Barcelona, Spain
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    Fig. 1.

    A, 3D rotational angiograms of 5 cases with different sizes and shapes (small, small fusiform, medium, medium fusiform, large, and giant). B, Virtually implanted FDs are visualized in blue in the hosting artery.

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    Fig. 2.

    Six of 23 aneurysms studied in this work. For each aneurysm, the first row corresponds to the untreated model, and the second, to the treated one. The different rows correspond to different types (size and shape) of aneurysms. Note streamlines (A), velocity magnitude on a plane across the aneurysm (B), and WSS at peak systole (C). White arrows indicate the flow direction. The asterisk on the right indicates cases in which important changes in flow patterns are observed.

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    Fig. 3.

    The column on the left shows the pressure range and mean intra-aneurysmal pressure, both indicated before (range in blue and mean with a yellow line) and after (range in red and mean with a green line) treatment for the 6 cases shown above. The column on the right shows a zoom into the plot on peak systole (highlighted in green on the left column).

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    Fig. 4.

    A, Hemodynamic variable reduction by group for the studied hemodynamic variables shown in boxplots classified by aneurysm size. The thick vertical line indicates group median, the box delimits Q1 and Q3, and the dotted lines indicate minimum and maximum. Empty dots indicate outliers (>2 times the interquartile distance from the mean). Double plus signs indicate 2 outliers out of plot range (for rrtsa = 1300% and 950%, respectively). P values from the corresponding test are presented on the side of each variable group. The asterisk indicates significant to the 10th percentile; double asterisks indicate significant to the 5th percentile. Brackets on the right side show statistical significance between the small and large/giant groups. B, Hemodynamic variables classified by aneurysm shape following the same representation as in A. Outliers out of range correspond to the same cases as seen in C. Pressure (mean, maximum, minimum, and pressure range) reduction in all aneurysms is expressed in millimeters of mercury.10–13

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    Table 1:

    Hemodynamic variables studied before and after treatment

    wsstasawssta90velsatarrtsatotimepressuresatapressurergta
    P valuea<.001<.001<.001<.001<.001.482<.001
    Medianb55.0958.9152.34−185.77−69.3978.880.72
    • Note:—wsstasa indicates WSS on the aneurysm wall; wssta90, maximum WSS; velsata, time and spatial-average velocity in the aneurysm; rrtsa, spatial average of relative residence time in the aneurysm; totime, aneurysm volume turnover time; pressuressata, spatial average intra-aneurysmal pressure; pressuregta, pressure range.

    • ↵a P values correspond to the Wilcoxon signed-rank test comparing untreated and treated samples.

    • ↵b Median reduction after FD placement.

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    Table 2:

    P values for size (3 groups, Kruskal-Wallis 1-way analysis of variance by rank test) and shape (2 groups, Wilcoxon signed-rank test) versus hemodynamic variables

    wsstasawssta90velsatarrtsatotimepressuresatapressurergta
    Size.069a.015b.013b.244.195.313.202
    Size (S/LG)c.036b.004b.002b.076a.142.304.188
    Shape.055.047a.065a052.047b.278.135
    • Note:—wsstasa indicates WSS on the aneurysm wall; wssta90, maximum WSS; velsata, time and spatial-average velocity in the aneurysm; rrtsa, spatial average of relative residence time in the aneurysm; totime, aneurysm volume turnover time; pressuressata, spatial average intra-aneurysmal pressure; pressuregta, pressure range.

    • ↵a Significant to the 10th percentile.

    • ↵b Significant to the 5th percentile.

    • ↵c Row size (S/LG) corresponds to Wilcoxon signed-rank test between small and large aneurysms.

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American Journal of Neuroradiology: 34 (4)
American Journal of Neuroradiology
Vol. 34, Issue 4
1 Apr 2013
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I. Larrabide, M.L. Aguilar, H.G. Morales, A.J. Geers, Z. Kulcsár, D. Rüfenacht, A.F. Frangi
Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape
American Journal of Neuroradiology Apr 2013, 34 (4) 816-822; DOI: 10.3174/ajnr.A3288

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Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape
I. Larrabide, M.L. Aguilar, H.G. Morales, A.J. Geers, Z. Kulcsár, D. Rüfenacht, A.F. Frangi
American Journal of Neuroradiology Apr 2013, 34 (4) 816-822; DOI: 10.3174/ajnr.A3288
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