High-frequency wall vibrations in a cerebral patient-specific aneurysm model.

The presence of high-frequency velocity fluctuations in aneurysms have been confirmed by in-vivo measurements and by several numerical simulation studies. Only a few studies have located and recorded wall vibrations in in-vitro experiments using physiological patient models. In this study, we investigated the wall fluctuations produced by a flowing perfusion fluid in a true-to-scale elastic model of a cerebral fusiform aneurysm using a laser Doppler vibrometer (LDV). The model was obtained from patient data. The experimental setup reproduced physiologically relevant conditions using a compliant perfusion system, physiological flow parameters, unsteady flow and a non-Newtonian fluid. Three geometrically identical models with different wall elasticities were used for measurements. The influence of five different flow rates was considered. Wall vibrations were predominantly found at frequencies in the range 40-60 Hz and 255-265 Hz. Their amplitude increased with increasing elasticity of the model, but the spectral peaks remained at about the same frequency. Varying the flow rate produced almost no changes in the frequency domain of the models. The frequency of the spectral peaks varied slightly between points at the lateral wall and at the bottom of the aneurysm. Indeed, embedding the model in a fluid during measurements produced higher and smoother amplitude fluctuations.

Phase-contrast MRI versus numerical simulation to quantify hemodynamical changes in cerebral aneurysms after flow diverter treatment.

Cerebral aneurysms are a major risk factor for intracranial bleeding with devastating consequences for the patient. One recently established treatment is the implantation of flow-diverters (FD). Methods to predict their treatment success before or directly after implantation are not well investigated yet. The aim of this work was to quantitatively study hemodynamic parameters in patient-specific models of treated cerebral aneurysms and its correlation with the clinical outcome. Hemodynamics were evaluated using both computational fluid dynamics (CFD) and phase contrast (PC) MRI. CFD simulations and in vitro MRI measurements were done under similar flow conditions and results of both methods were comparatively analyzed. For preoperative and postoperative distribution of hemodynamic parameters, CFD simulations and PC-MRI velocity measurements showed similar results. In both cases where no occlusion of the aneurysm was observed after six months, a flow reduction of about 30-50% was found, while in the clinically successful case with complete occlusion of the aneurysm after 6 months, the flow reduction was about 80%. No vortex was observed in any of the three models after treatment. The results are in agreement with recent studies suggesting that CFD simulations can predict post-treatment aneurysm flow alteration already before implantation of a FD and PC-MRI could validate the predicted hemodynamic changes right after implantation of a FD.

Opened end-to-side technique for end-to-side anastomosis and analyses by an elastic true-to-scale silicone rubber model.

The end-to-side anastomosis is frequently used in microvascular free flap transfer, but detailed rheological analyses are not available. The purpose of this study was to introduce a new modified end-to-side (Opened End-to-Side, OES-) technique and compare the resulting flow pattern to a conventional technique. The new technique was based on a bi-triangulated preparation of the branching-vessel end, resulting in a "fish-mouthed" opening. We performed two different types of end-to-side anastomoses in forty pig coronary arteries and produced one elastic, true-to-scale silicone rubber model of each anastomosis. Then we installed the transparent models in a circulatory experimental setup that simulated the physiological human blood flow. Flow velocity was measured with the one-component Laser-Doppler-Anemometer system, recording flow axial and perpendicular to the model at four defined cross-sections for seven heart cycles in each model. Maximal and minimal axial velocities ranged in the conventional model between 0.269 and -0.122 m/s and in the experimental model between 0.313 and -0.153 m/s. A less disturbed flow velocity distribution was seen in the experimental model distal to the anastomosis. The OES-technique showed superior flow profiles distal to the anastomosis with minor tendencies of flow separation and represents a new alternative for end-to-side anastomosis.

Evaluation of intra-aneurysmal hemodynamics after flow diverter placement in a patient-specific aneurysm model.

BACKGROUND: The growth and rupture of cerebral aneurysms is intrinsically related to the hemodynamics prevailing in the diseased area. Therefore, a better understanding of intra-aneurysmal hemodynamics is essential for developing effective treatment methods. OBJECTIVE: The intention of this study was to evaluate the intra-aneurysmal flow and flow reduction induced by flow diverters in a true-to-scale elastic aneurysm model, obtained from real patient data. METHODS: Based on the computed tomography angiography (CTA) data of a fusiform aneurysm of a 34 year old patient, an elastic silicon rubber model of the aneurysm was produced. A physiologic pulsatile flow was created with a circulatory experimental set-up, and a non-Newtonian perfusion fluid was used as a substitute for human blood. Hemodynamics were measured by LDA before and after flow diverter implantation. RESULTS: Implantation of a flow diverter device resulted in a reduction of intra-aneurysmal maximum flow velocities of 97.8% at the inflow zone, 89.1% in the dome and 89.3% at the outflow zone, when compared to the native model. A significant reduction of 94% in the mean intra-aneurysmal velocity was found. CONCLUSIONS: This promising methodology can optimize patient treatment and will correlate with computational simulations to evaluate their reliability.

The effect of stents on intra-aneurysmal hemodynamics: in vitro evaluation of a pulsatile sidewall aneurysm using laser Doppler anemometry.

INTRODUCTION: Hemodynamic modification by means of flow diversion is increasingly used for treatment of intracranial aneurysms. Despite of promising results, there is still a paucity of methods to reliably predict long-term success of this technique. Laser Doppler anemometry (LDA) can be used to quantify the influence of stents on intra-aneurysmal flow in vitro. METHODS: All experiments were performed with a pulsatile model of a sidewall aneurysm. A physiologic flow was created with a circulatory experimental setup, and a transparent non-Newtonian glycerol-water solution was used to substitute human blood. Flow velocity was measured with a one-component LDA system, recording flow components parallel and perpendicular to the parent vessel. Three different stents (Solitaire, Silk, Phenox flow diverter) were deployed over the aneurysm neck, respectively. RESULTS: Flow reduction was 67.59% (inflow zone), 9.65% (dome) and 37.94% (outflow zone) by the Solitaire stent. The Silk stent reduced the flow by 58.15% (inflow zone), 89.06% (dome) and 90.06% (outflow zone). The Phenox flow diverter reduced the flow by 96.76% (inflow zone), 90% (dome) and 90.91% (outflow zone) when positioned with narrow stent struts but increased the velocity of up to seven times compared to the unstented model when placed with loose strut packing in the proximal part of the aneurysm. CONCLUSION: LDA is a feasible method to quantify intra-aneurysmal flow and flow reduction efficacy of stents in vitro. Flow reduction was negligible with a standard self-expanding stent. For dedicated flow diverters, it depended both on stent design and on appropriate positioning.