Numerical Assessment of the Risk of Abnormal Endothelialization for Diverter Devices: Clinical Data Driven Numerical Study

Numerical modeling is an effective tool for preoperative planning. The present work is devoted to a retrospective analysis of neurosurgical treatments for the occlusion of cerebral aneurysms using flow-diverters and hemodynamic factors affecting stent endothelization. Several different geometric approaches have been considered for virtual flow-diverters deployment. A comparative analysis of hemodynamic parameters as a result of computational modeling has been carried out basing on the four clinical cases: one successful treatment, one with no occlusion and two with in stent stenosis. For the first time, a quantitative assessment of both: the limiting magnitude of shear stresses that are necessary for the occurrence of in stent stenosis (MaxWSS > 1.23) and for conditions in which endothelialization is insufficiently active and occlusion of the cervical part of the aneurysm does not occur (MaxWSS < 1.68)-has been statistacally proven (p < 0.01).

Automated summary

This study retrospectively analyzed neurosurgical treatments for occlusion of cerebral aneurysms using flow-diverters and investigated the hemodynamic factors affecting stent endothelization. Various geometric approaches were considered for virtual deployment of flow-diverters. A comparative analysis of hemodynamic parameters was conducted on four clinical cases, which revealed statistically proven shear stress thresholds for in stent stenosis and insufficient endothelialization leading to non-occlusion of the aneurysm.