Research Papers

Comparison Among Different High Porosity Stent Configurations: Hemodynamic Effects of Treatment in a Large Cerebral Aneurysm

[+] Author and Article Information
Breigh N. Roszelle

Daniel Felix Ritchie School of Engineering
and Computer Science,
Department of Mechanical
and Materials Engineering,
University of Denver,
Clarence M. Knudson Hall,
2390 South York Street #200,
Denver, CO 80208
e-mail: breigh.roszelle@du.edu

Priya Nair, M. Haithem Babiker, Justin Ryan

School of Biological
and Health Systems Engineering,
Arizona State University,
Tempe, AZ 85287

L. Fernando Gonzalez

Department of Neurological Surgery,
Jefferson Medical College,
Philadelphia, PA 19107

David Frakes

School of Biological
and Health Systems Engineering,
Arizona State University,
Tempe, AZ 85287;
School of Electrical,
Computer, and Energy Engineering,
Arizona State University,
Tempe, AZ 85287

Please see pyformex.berlios.de.

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the Journal of Biomechanical Engineering. Manuscript received September 2, 2013; final manuscript received December 11, 2013; accepted manuscript posted December 16, 2013; published online February 5, 2014. Editor: Victor H. Barocas.

J Biomech Eng 136(2), 021013 (Feb 05, 2014) (9 pages) Paper No: BIO-13-1403; doi: 10.1115/1.4026257 History: Received September 02, 2013; Revised December 11, 2013; Accepted December 16, 2013

Whether treated surgically or with endovascular techniques, large and giant cerebral aneurysms are particularly difficult to treat. Nevertheless, high porosity stents can be used to accomplish stent-assisted coiling and even standalone stent-based treatments that have been shown to improve the occlusion of such aneurysms. Further, stent assisted coiling can reduce the incidence of complications that sometimes result from embolic coiling (e.g., neck remnants and thromboembolism). However, in treating cerebral aneurysms at bifurcation termini, it remains unclear which configuration of high porosity stents will result in the most advantageous hemodynamic environment. The goal of this study was to compare how three different stent configurations affected fluid dynamics in a large patient-specific aneurysm model. Three common stent configurations were deployed into the model: a half-Y, a full-Y, and a crossbar configuration. Particle image velocimetry was used to examine post-treatment flow patterns and quantify root-mean-squared velocity magnitude (VRMS) within the aneurysmal sac. While each configuration did reduce VRMS within the aneurysm, the full-Y configuration resulted in the greatest reduction across all flow conditions (an average of 56% with respect to the untreated case). The experimental results agreed well with clinical follow up after treatment with the full-Y configuration; there was evidence of thrombosis within the sac from the stents alone before coil embolization was performed. A computational simulation of the full-Y configuration aligned well with the experimental and in vivo findings, indicating potential for clinically useful prediction of post-treatment hemodynamics. This study found that applying different stent configurations resulted in considerably different fluid dynamics in an anatomically accurate aneurysm model and that the full-Y configuration performed best. The study indicates that knowledge of how stent configurations will affect post-treatment hemodynamics could be important in interventional planning and demonstrates the capability for such planning based on novel computational tools.

Copyright © 2014 by ASME
Your Session has timed out. Please sign back in to continue.


Lawton, M. T., and Spetzler, R. F., 1995, “Surgical Management of Giant Intracranial Aneurysms: Experience With 171 Patients,” Clin. Neurosurg., 42, pp. 245–266. [PubMed]
Whittle, I. R., Dorsch, N. W., and Besser, M., 1982, “Spontaneous Thrombosis in Giant Intracranial Aneurysms,” J. Neurol., Neurosurg. Psychiatry, 45, pp. 1040–1047. [CrossRef]
Johnston, S. C., Higashida, R. T., Barrow, D. L., Caplan, L. R., Dion, J. E., Hademenos, G., Hopkins, L. N., Molyneux, A., Rosenwasser, R. H., Vinuela, F., and Wilson, C. B., 2002, “Recommendations for the Endovascular Treatment of Intracranial Aneurysms: A Statement for Healthcare Professionals From the Committee on Cardiovascular Imaging of the American Heart Association Council on Cardiovascular Radiology,” Stroke, 33, pp. 2536–2544. [CrossRef] [PubMed]
Sluzewski, M., Menovsky, T., Jan van Rooij, W., and Wijnalda, D., 2003, “Coiling of Very Large or Giant Cerebral Aneurysms: Long-Term Clinical and Serial Angiographic Results,” AJNR Am. J. Neuroradiol., 24, pp. 257–262. [PubMed]
Raaymakers, T. W. M., Rinkel, G. J. E., Linburg, M., and Algra, A., 1998, “Mortality and Morbidity of Surgery for Unruptured Intracranial Aneurysms: A Meta-Analysis,” Stroke, 29, pp. 1531–1538. [CrossRef] [PubMed]
Arat, A., Islak, C., Saatci, I., Kocer, N., and Cekirge, S., 2002, “Endovascular Parent Artery Occlusion in Large-Giant or Fusiform Distal Posterior Cerebral Artery Aneurysms,” Neuroradiology, 44, pp. 700–705. [CrossRef] [PubMed]
International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group, 2002, “International Subarachnoid Aneurysm Trial (ISAT) of Neurosurgical Clipping Versus Endovascular Coiling in 2143 Patients With Ruptured Intracranial Aneurysms: A Randomized Trial,” Lancet, 360, pp. 1267–1274. [CrossRef] [PubMed]
Vinuela, F., Duckwiler, G., and Mawad, M., 1997, “Guglielmi Detachable Coil Embolization of Acute Intracranial Aneurysm: Perioperative Anatomical and Clinical Outcome in 403 Patients,” J. Neurosurg., 86, pp. 475–482. [CrossRef] [PubMed]
Murayama, Y., Nien, Y., Duckwiler, G., Gobin, Y. P., Jahan, R., Frazee, J., Martin, N., and Viñuela, F., 1998, “Guglielmi Detachable Coil Emolization of Cerebral Aneurysms: 11 Years' Experience,” J. Neurosurg., 98, pp. 959–966. [CrossRef]
Pumar, J. M., Lete, I., Pardo, M. I., Vazquez-Herrero, F., and Blanco, M., 2008, “LEO Stent Monotherapy for the Endovascular Reconstruction of Fusiform Aneurysms of the Middle Cerebral Artery,” AJNR Am. J. Neuroradiol., 29, pp. 1775–1776. [CrossRef] [PubMed]
Lylyk, P., Cohen, J. E., Ceratto, R., Ferrario, A., and Miranda, C., 2002, “Endovascular Reconstruction of Intracranial Arteries by Stent Placement and Combined Techniques,” J. Neurosurg., 97, pp. 1306–1313. [CrossRef] [PubMed]
Akpek, S., Arat, A., Morsi, H., Klucznick, R. P., Strother, C. M., and Mawad, M. E., 2005, “Self-Expandable Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms: A Single-Cent Experience,” AJNR Am. J. Neuroradiol., 26, pp. 1223–1231. [PubMed]
Wanke, I., and Forsting, M., 2008, “Stents for Intracranial Wide-Necked Aneurysms: More Than Mechanical Protection,” Neuroradiology, 50, pp. 991–998. [CrossRef] [PubMed]
Cross, D. T., Moran, C. J., Derdeyn, C. P., Mazumdar, A., Rivet, D., and Chicoine, M. M., 2005, “Neuroform Stent Deployment for Treatment of a Basilar Tip Aneurysm via a Posterior Communicating Artery Route,” AJNR Am. J. Neuroradiol., 26, pp. 2578–2581. [PubMed]
Babiker, M. H., Gonzalez, L. F., Ryan, J., Albuquerque, F., Collins, D., Elvikis, A., and Frakes, D. H., 2011, “Influence of Stent Configuration on Cerebral Aneurysm Fluid Dynamics,” J. Biomech., 45, pp. 440–447. [CrossRef]
Frakes, D., Pekkan, K., Dasi, L., Kitajima, H. D., de Zelicourt, D., Leo, H. L., Carberry, J., Sundareswaran, K., Simon, H., and Yoganathan, A. P., 2008, “Modified Control Grid Interpolation for the Volumetric Reconstruction of Fluid Flows,” Exp. Fluids, 45, pp. 987–997. [CrossRef] [PubMed]
Frakes, D. H., Conrad, C. P., Healy, T. M., Monaco, J. W., Fogel, M., Sharma, S., Smith, M. J., and Yoganathan, A. P., 2003, “Application of an Adaptive Control Grid Interpolation Technique to Morphological Vascular Reconstruction,” IEEE Trans. Biomed. Eng., 50(2), pp. 197–206. [CrossRef] [PubMed]
Ford, M. D., Alperin, N., Lee, S. H., Holdsworth, D. W., and Steinman, D. A., 2005, “Characterization of Volumetric Flow Rate Waveforms in the Normal Internal Carotid and Vertebral Arteries,” Physiol. Meas., 26, pp. 477–488. [CrossRef] [PubMed]
Hall, G., and Kasper, E., 2006, “Comparison of Element Technologies for Modeling Stent Expansion,” ASME J. Biomech. Eng., 128(5), pp. 751–756. [CrossRef]
Gong, X. Y., and Pelton, A., 2004, “Finite Element Analysis on Nitinol Medical Applications,” Proceedings of the International Conference on Shape Memory and Superelastic Technologies, ASM International, Pacific Grove, CA, pp. 443–451.
Auricchio, F., Taylor, R. L., and Lubliner, J., 1997, “Shape-Memory Alloys: Macromodelling and Numerical Simulations of the Superelastic Behavior,” Comput. Methods Appl. Mech. Eng., 146, pp. 281–312. [CrossRef]
Babiker, M. H., Chong, B. W., Gonzalez, L. F., and Frakes, D. H., 2013, “Simulating the Effects of Embolic Coils on Cerebral Aneurysm Fluid Dynamics Using Finite Element Modeling,” Proceedings of the American Society of Mechanical Engineering (ASME) Summer Bioengineering Conference, Sunriver, OR.
Ma, D., Dargush, G., Natarajan, S., Levy, E. I., Siddiqui, A. H., and Meng, H., 2012, “Computer Modeling of Deployment and Mechanical Expansion of Neurovascular Flow Diverter in Patient-Specific Intracranial Aneurysms,” J. Biomech., 45(13), pp. 2256–2263. [CrossRef] [PubMed]
Dunn, A., Zaveri, T., Keselowsky, B., and Sawyer, W. G., 2007, “Macroscopic Friction Coefficient Measurements on Living Endothelial Cells,” Tribol. Lett., 27(2), pp. 233–238. [CrossRef]
Vad, S., Eskinazi, A., Corbett, T., McGloughlin, T., and Vande Geest, J. P., 2010, “Determination of Coefficient of Friction for Self-Expanding Stent-Grafts,” ASME J. Biomed Eng, 132(12), p. 121007. [CrossRef]
Takashima, K., Shimomura, R., Kitou, T., Terada, H., Yoshinaka, K., and Ikeuchi, K., 2007, “Contact and Friction Between Catheter and Blood Vessel,” Tribol. Int., 40(2), pp. 319–328. [CrossRef]
Roszelle, B. N., Gonzalez, L. F., Babiker, M. H., Ryan, J., Albuquerque, F. C., and Frakes, D. H., 2013, “Flow Diverter Effect on Cerebral Aneurysm Hemodynamics: An in vitro Comparison of Telescoping Stents and the Pipeline,” Neuroradiology, 55, pp. 751–758. [CrossRef] [PubMed]
Biondi, A., Janardhan, V., Katz, J. M., Salvaggio, K., Riina, H. A., and Gobin, Y. P., 2007, “Neuroform Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: Strategies in Stent Deployment and Midterm Follow-Up,” Neurosurgery, 61, pp. 460–469. [CrossRef] [PubMed]
Appanaboyina, S., Mut, F., Lohner, R., Putman, C., and Cebral, J., 2009, “Simulation of Intracranial Aneurysm Stenting: Techniques and Challenges,” Comput. Methods Appl. Mech. Eng., 198, pp. 3567–3582. [CrossRef]
Kim, M., Taulbee, D. B., Tremmel, M., and Meng, H., 2008, “Comparison of Two Stents in Modifying Cerebral Aneurysm Hemodynamics,” Ann. Biomed. Eng., 36(5), pp. 726–741. [CrossRef] [PubMed]
Rayz, V. L., Boussel, L., Lawton, M. T., Acevedo-Bolton, G., Ge, L., Young, W. L., Higashida, R. T., and Saloner, D., 2008, “Numerical Modeling of the Flow in Intracranial Aneurysms: Prediction of Regions Prone to Thrombus Formation,” Ann. Biomed. Eng., 36(11), pp. 1793–1804. [CrossRef] [PubMed]
Cebral, J. R., Mut, F., Weir, J., and Putman, C., 2011, “Association of Hemodynamic Characteristics and Cerebral Aneurysm Rupture,” AJNR Am. J. Neuroradiol., 32, pp. 264–270. [CrossRef] [PubMed]


Grahic Jump Location
Fig. 1

Illustrations of three different stent configurations: (a) half-Y, (b) crossbar, and (c) full-Y

Grahic Jump Location
Fig. 2

Computational model of the patient-specific aneurysm

Grahic Jump Location
Fig. 3

Image sequence showing the simulated deployment of two Neuroform stents in a full-Y configuration. The final FE simulation result (pane 8) was used in a fluid dynamic simulation.

Grahic Jump Location
Fig. 4

Reductions in VRMS for all flow conditions explored. The percentages shown in each column are the reductions in VRMS with respect to the untreated case.

Grahic Jump Location
Fig. 5

Velocity vector flow patterns within the aneurysm for each stent deployment configuration at 4 ml/s steady flow

Grahic Jump Location
Fig. 6

Velocity vector flow patterns within the aneurysm for each stent deployment configuration at 4 ml/s pulsatile flow

Grahic Jump Location
Fig. 7

Fluid dynamic simulation results showing 3D streamtraces for the untreated case (a) and the full-Y configuration (b) at 4 ml/s steady flow

Grahic Jump Location
Fig. 8

Simulated WSS contour plots for the untreated case (a) and the full-Y configuration (b). Contour plots are shown for the posterior view of the aneurysm (view 1—(a) and (b)) and the anterior view (view 2—(c) and (d)).

Grahic Jump Location
Fig. 9

Simulated contour plot of the WSSG gradient for the untreated case (a) and the full-Y configuration (b). Contour plots are shown for the posterior view of the aneurysm (view 1—(a) and (b)) and anterior view (view 2—(c) and (d)).

Grahic Jump Location
Fig. 10

Digital subtraction angiography images of the large aneurysm at different stages of treatment: (a) immediately after stent treatment, (b) one month after stent treatment, before coiling (note the partial occlusion of the sac), and (c) one year after stent assisted coiling

Grahic Jump Location
Fig. 11

Comparison of VRMS reductions associated with all three stent configurations in both the patient-specific anatomical model and a previously examined idealized model



Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In