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Original research
Role of distal cerebral vasculature in vessel constriction after aneurysm treatment with flow diverter stents
  1. Ana Paula Narata1,
  2. Fernando Moura2,
  3. Ignacio Larrabide3,
  4. René Chapot4,
  5. Christophe Cognard5,
  6. Anne-Christine Januel6,
  7. Stéphane Velasco7,
  8. Ayache Bouakaz1,
  9. Frederic Patat1,
  10. Alberto Marzo8
  1. 1 Department of Neuroradiology, University Hospital of Tours, Tours, France
  2. 2 Federal University of the ABC Engineering Modeling and Applied Social Sciences Center Sao Bernardo do Campo, Sao Bernardo do Campo, Brazil
  3. 3 PLADEMA-CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
  4. 4 Department of Neurointerventional Therapy, Krupp Krankenhaus, Germany, Essen, Germany
  5. 5 Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
  6. 6 Department of Neuroradiology, University Hospital of Purpan, Toulouse, France
  7. 7 Department of Radiology, CHU de Poitiers, Poitiers, Vienne, France
  8. 8 Department of Mechanical Engineering, Insigneo Institute for in silico medicine, The University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Alberto Marzo, Department of Mechanical Engineering, Insigneo Institute for in silico medicine, The University of Sheffield, Sheffield S1 3JD, UK; a.marzo{at}


Background Treatment of intracranial aneurysms with flow diverter stent (FDS) procedures can lead to caliber changes of jailed vessels. The reason some branches remain unchanged and others are affected by narrowing remains unknown.

Objective To investigate the influence of resistance to flow from distal vasculature on stent-induced hemodynamic modifications affecting bifurcating vessels.

Materials and methods Radiological images and demographic data were acquired for 142 aneurysms treated with a FDS. Vascular resistance was estimated from patient-specific anatomic data. Correlation analysis was used to identify correspondence between anatomic data and clinical outcome. Computational Fluid Dynamics was performed on a typical patient-specific model to evaluate the influence of FDS on flow. Relevant hemodynamic variables along the bifurcating vessels were quantitatively analyzed and validated with in vitro data obtained using power Doppler ultrasound.

Results Statistical analysis showed a correlation between clinical outcome and FDS resistance to flow considering overall jailed vessel vascular resistance (r=0.5, P<0.001). Computational predictions of blood flow showed that hemodynamics is minimally affected by FDS treatment in the ophthalmic artery.

Conclusions Jailed vessels are affected by narrowing when resistance to flow from the FDS constitutes a larger proportion of the overall vessel resistance to flow. This knowledge may contribute to better understanding of intracranial hemodynamics after a FDS procedure and reinforce indications for flow diversion in the treatment of intracranial aneurysms.

  • aneurysm
  • blood flow
  • flow diverter
  • ultrasound

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  • Contributors Conception and design: all authors; acquisition of data: APN, FM, IL, RC; analysis and interpretation of data: all authors; drafting of the article—AM; critically revising the article: all authors; reviewing the final version of the manuscript and approving it for submission: all authors; study supervision: APN, AM.

  • Funding This work was partially supported by the Newton Fund of the Royal Academy of Engineering grant number NRCP1415/2/20.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data will be made available through FigShare ORDA from the University of Sheffield upon publication of the study.