Top

European Radiology

Published in:

01-02-2015 | Vascular-Interventional

Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results

Authors: Philipp Gölitz, Tobias Struffert, Julie Rösch, Oliver Ganslandt, Frauke Knossalla, Arnd Doerfler

Published in: European Radiology | Issue 2/2015

Abstract

Objectives

After deployment of flow-diverting stents (FDS), complete aneurysm occlusion is not predictable. This study investigated whether parametric colour coding (PCC) could allow in vivo visualization of flow alterations induced by FDS and identify favourable or adverse flow modulations.

Methods

Thirty-six patients treated by FDS were analyzed. Preinterventional and postinterventional DSA-series were postprocessed by PCC and time-density curves (TDCs) were calculated. The parameters aneurysmal inflow, outflow, and relative time-to-peak (rTTP) were calculated. Preinterventional and postinterventional values were compared and related to occlusion rate.

Results

Postinterventional inflow showed a mean reduction of 37 %, outflow of 51 %, and rTTP a prolongation of 82 %. Saccular aneurysm occlusion occurred if a reduction of at least 15 % was achieved for inflow and 35 % for outflow (sensitivity: 89 %, specificity: 82 %). Unchanged outflow and a slightly prolonged rTTP were associated with growth in one fusiform aneurysm.

Conclusions

PCC allows visualization of flow alterations after FDS treatment, illustrating “flow diverting effects” by the TDC shape and indicating mainly aneurysmal outflow and lesser inflow changes. Quantifiable parameters (inflow, outflow, rTTP) can be obtained, thresholds for predicting aneurysm occlusion determined, and adverse flow modulations assumed. As a rapid intraprocedural tool, PCC might support the decision to implant more than one FDS.

Key Points

• After deployment of a flow-diverting stent, complete aneurysm occlusion is unpredictable.

• Parametric colour coding offers new options for visualizing in vivo flow alterations non-invasively.

• Quantifiable parameters, i.e., aneurysmal inflow/outflow can be obtained allowing prognostic stratification.

• Rapid, intraprocedural application allows treatment monitoring, potentially contributing to patient safety.

Fischer S, Vajda Z, Aguilar Perez M et al (2012) Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology 54:369–382PubMedCentralPubMedCrossRef

McAuliffe W, Wycoco V, Rice H, Phatouros C, Singh TJ, Wenderoth J (2012) Immediate and midterm results following treatment of unruptured intracranial aneurysms with the pipeline embolization device. AJNR Am J Neuroradiol 33:164–170PubMedCrossRef

Lubicz B, Collignon L, Raphaeli G, De Witte O (2011) Pipeline flow diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms. World Neurosurg 76:114–119PubMedCrossRef

Szikora I, Berentei Z, Kulcsar Z et al (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the Pipeline embolization device. AJNR Am J Neuroradiol 31:1139–1147PubMedCrossRef

Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D (2011) The Pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 32:34–40PubMedCrossRef

Kulcsar Z, Houdart E, Bonafe A et al (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:20–25PubMed

McAuliffe W, Wenderoth JD (2012) Immediate and midterm results following treatment of recently ruptured intracranial aneurysms with the Pipeline embolization device. AJNR Am J Neuroradiol 33:487–493PubMedCrossRef

Turowski B, Macht S, Kulcsár Z, Hänggi D, Stummer W (2011) Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts? Neuroradiology 53:37–41PubMedCrossRef

Hampton T, Walsh D, Tolias C et al (2011) Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two cases. J Neurointerv Surg 3:167–171PubMedCrossRef

10.

Briganti F, Napoli M, Tortora F et al (2012) Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications-a retrospective data analysis. Neuroradiology 54:1145–1152PubMedCrossRef

11.

Velat GJ, Fargen KM, Lawson MF, Hoh BL, Fiorella D, Mocco J (2012) Delayed intraparenchymal haemorrhage following pipeline embolization device treatment for a giant recanalized ophthalmic aneurysm. J Neurointerv Surg 4:e24PubMedCrossRef

12.

Cebral JR, Mut F, Raschi M et al (2011) Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment. AJNR Am J Neuroradiol 32:27–33PubMed

13.

Hassan T, Ahmed YM, Hassan AA (2011) The adverse effects of flow-diverter stent-like devices on the flow pattern of saccular intracranial aneurysm models: computational fluid dynamics study. Acta Neurochir 153:1633–1640PubMedCrossRef

14.

Seshadhri S, Janiga G, Beuing O, Skalej M, Thevenin D (2011) Impact of stents and flow diverters on hemodynamics in idealized aneurysm models. J Biomech Eng 133:071005PubMedCrossRef

15.

Strother CM, Bender F, Deuerling-Zheng Y et al (2010) Parametric color coding of digital subtraction angiography. AJNR Am J Neuroradiol 31:919–924PubMedCrossRef

16.

Struffert T, Deuerling-Zheng Y, Engelhorn et al (2013) Monitoring of ballon test occlusion of the internal carotid artery by parametric color coding and perfusion imaging within the angio suite: first results. Clin Neuroradiol 23:285–292PubMedCrossRef

17.

Fargen KM, Velat GJ, Lawson MF, Mocco J, Hoh BL (2012) Review of reported complications associated with the Pipeline Embolization Device. World Neurosurg 77:403–404PubMedCrossRef

18.

Cebral JR, Mut F, Weir J, Putman C (2011) Quantitative characterization of the hemodynamic environment in ruptured and unruptured brain aneurysms. AJNR Am J Neuroradiol 32:145–151PubMedCentralPubMedCrossRef

19.

Dorn F, Niedermeyer F, Balasso A, Liepsch D, Liebig T (2011) The effect of stents on intra-aneurysmal hemodynamics: in vitro evaluation of a pulsatile sidewall aneurysm using laser Doppler anemometry. Neuroradiology 53:267–272PubMedCrossRef

20.

Trager AL, Sadasivan C, Seong J, Lieber BB (2009) Correlation between angiographic and particle image velocimetry quantifications of flow diverters in an in vitro model of elastase-induced rabbit aneurysms. J Biomech Eng 131:034506PubMedCentralPubMedCrossRef

21.

Sadasivan C, Cesar L, Seong, Wakhloo AK, Lieber BB (2009) Treatment of rabbit elastase-induced aneurysm models by flow diverters: development of quantifiable indexes of device performance using digital subtraction angiography. IEEE Trans Med Imaging 28:1117–1125PubMedCentralPubMedCrossRef

22.

Struffert T, Ott S, Kowarschik M et al (2013) Measurement of quantifiable parameters by time-density curves in the elastase-induced aneurysm model: first results in the comparison of a flow diverter and a conventional aneurysm stent. Eur Radiol 23:521–527PubMedCrossRef

23.

O'kelly CJ, Krings T, Fiorella D, Marotta TR (2010) A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol 16:133–137PubMedCentralPubMed

24.

Kamran M, Yarnold J, Grunwald IQ, Byrne JV (2011) Assessment of angiographic outcomes after flow diversion treatment of intracranial aneurysms: a new grading schema. Neuroradiology 53:501–508PubMedCrossRef

25.

De Barros Faria M, Castro RN, Lundquist J et al (2011) The role of the pipeline embolization device for the treatment of dissecting intracranial aneurysms. AJNR Am J Neuroradiol 32:2192–2195PubMedCrossRef

26.

Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF (2013) Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 44:442–447PubMedCrossRef

Title: Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results
Authors: Philipp Gölitz
Tobias Struffert
Julie Rösch
Oliver Ganslandt
Frauke Knossalla
Arnd Doerfler
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3411-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 2/2015

Effect of radiologists’ experience on breast cancer detection and localization using digital breast tomosynthesis

Computed tomography assessment of bone lesions in patients with POEMS syndrome

Cross-sectional area measurements versus volumetric assessment of the quadriceps femoris muscle in patients with anterior cruciate ligament reconstructions

Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography

Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer

Detailed analysis of the density change on chest CT of COPD using non-rigid registration of inspiration/expiration CT scans