High-fidelity virtual stenting: modeling of flow diverter deployment for hemodynamic characterization of complex XXXX .

@entity1 @entity3538 @entity5173 @entity439 @entity715 @entity1642 @entity438
UNASSIGNED: OBJECT Flow diversion via Pipeline Embolization Device (PED) represents the most recent advancement in endovascular therapy of @entity438 . This exploratory study aims at a proof of concept for an advanced device-modeling tool in conjunction with @entity5173 ( @entity5173 ) to evaluate flow modification effects by PED in actual, treated cases. METHODS The authors performed computational modeling of 3 PED-treated complex @entity439 cases. The @entity1 in Case 1 had a fusiform @entity439 treated with a single PED. In Case 2 the @entity1 had a @entity3538 treated with 2 PEDs. Case 3 consisted of tandem ICA @entity439 (III-a and III-b) treated by a single PED. The authors' recently developed high-fidelity virtual stenting (HiFiVS) technique was used to recapitulate the clinical deployment process of PEDs in silico for these 3 cases. Pretreatment and posttreatment aneurysmal hemodynamics studies performed using @entity5173 simulation were analyzed. Changes in aneurysmal flow velocity, inflow rate, @entity1642 ( @entity1642 ), and turnover time were calculated and compared with the clinical outcome. RESULTS In Case 1 (occluded within the first 3 months), the @entity439 had the most drastic flow reduction after PED placement; the aneurysmal average velocity, inflow rate, and average @entity1642 were decreased by 76.3%, 82.5%, and 74.0%, respectively, whereas the turnover time was increased to 572.1% of its pretreatment value. In Case 2 (occluded at 6 months), aneurysmal average velocity, inflow rate, and average @entity1642 were decreased by 39.4%, 38.6%, and 59.1%, respectively, and turnover time increased to 163.0%. In Case 3, @entity439 (occluded at 6 months) had a decrease by 38.0%, 28.4%, and 50.9% in average velocity, inflow rate, and average @entity1642 , respectively, and turnover time increased to 139.6%, which was quite similar to @entity439 . Surprisingly, the adjacent @entity439 III-b had more substantial flow reduction (a decrease by 77.7%, 53.0%, and 84.4% in average velocity, inflow rate, and average @entity1642 , respectively, and an increase to 213.0% in turnover time) than @entity439 , which qualitatively agreed with angiographic observation at 3-month follow-up. However, @entity439 III-b remained patent at both 6 months and 9 months. A closer examination of the vascular anatomy in Case 3 revealed blood draining to the ophthalmic artery off @entity439 III-b, which may have prevented its complete @entity715 . CONCLUSIONS This proof-of-concept study demonstrates that HiFiVS modeling of flow diverter deployment enables detailed characterization of hemodynamic alteration by PED placement. Posttreatment aneurysmal flow reduction may be correlated with @entity439 outcome. However, predicting @entity439 treatment outcome by flow diverters also requires consideration of other factors, including vascular anatomy.
