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Original research
Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm
  1. Chien-Wei Chen1,
  2. Ho-Fai Wong2,
  3. Yu-Ling Ye1,
  4. Yao-Liang Chen3,
  5. Wei-Liang Chen4,
  6. Chang-Hsien Ou5,
  7. Yuan-Hsiung Tsai1
  1. 1 Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang Gun University College of Medicine, Puzi, Taiwan
  2. 2 Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
  3. 3 Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
  4. 4 Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
  5. 5 Departments of Neuroradiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
  1. Correspondence to Dr Yuan-Hsiung Tsai, Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University, Puzi, Taiwan; russell.tsai{at}


Objectives To evaluate the differences in arterial flow after flow diverter placement using quantitative flow measurements based on digital subtraction angiography (DSA).

Methods Between November 2013 and November 2015, all patients who had flow diverters placed for distal internal carotid artery (ICA) aneurysms were reviewed. Patients in whom the stent was placed across the ostia of the ophthalmic artery (OphA) and anterior choroidal artery (AChA) were enrolled. Five regions of interest were selected: the proximal ICA (as a reference), terminal ICA, middle cerebral artery (MCA), anterior cerebral artery (ACA), OphA, and AChA. The values of the peak, time-to-peak (TTP), and area under the curve (AUC) were analyzed using a quantitative DSA technique.

Results The study enrolled 13 patients. The quantitative flow analysis showed improved flow in the terminal ICA (peak and AUC, p=0.036 and p=0.04, respectively), MCA (AUC, p=0.023), and ACA (AUC, p=0.006), and decreased flow in the OphA (peak and AUC, p=0.013 and p=0.005, respectively) and AChA (peak and subtracted TTP, p=0.023 and p=0.050, respectively) after flow diverter placement. Larger aneurysm volume was significantly correlated with decreased OphA flow after the procedure (peak and AUC, p=0.049 and p=0.037, respectively). Larger aneurysm volume also had a marginal correlation with increased distal ICA flow after the procedure, but this did not reach significance (peak and AUC, p=0.195 and p=0.060, respectively).

Conclusions Without using extra contrast medium or radiation dosages, color-coded DSA enables quantitative monitoring of the cerebral circulation after flow-diverting treatment.

  • Aneurysm
  • Flow Diverter
  • Stent
  • Intervention
  • Blood Flow

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  • Chien-Wei Chen and Ho-Fai Wong contributed equally to this work.

  • Contributors C-WC: conducted literature search, post-processing of image and data analysis; drafted the initial manuscript and revised it critically. H-FW: conducted initial data collection, provided the initial idea for the study, assisted in selecting appropriate images and data collection. Y-LY: assisted in selecting appropriate images, post-processing of image, and data collection. Y-LC, W-LC, and C-HO: assisted in selecting appropriate images and data collection. Y-HT: provided the initial idea of the study, conducted literature searches, and monitored overall data collection, analysis and revision of the drafts. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by grants CMRPG6E0391 and CORPG6D0123 from the Chang Gung Medical Research Council.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the Institutional Review Board of Chang Gung Medical Foundation.

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

  • Data sharing statement All available data can be obtained by contacting the corresponding author.