The Physics of Endoluminal Stenting in the Treatment of Cerebrovascular Aneurysms

Endovascular stenting of aneurysms offers potential advantages over surgical clipping. Stenting is minimally invasive, and with the implementation of rapidly developing micro and nano technologies, it will in the future be possible to deploy stents in more remote locations of the cerebrovasculature. The key advantage of stenting is that in addition to impeding flow into the aneurysm, it provides the parent artery with a scaffold over which the artery can remodel. However, for a stent to be effective in this goal, it must be tailored to the local hemodynamics at the aneurysm site. This paper is a review of the qualitative and quantitative in vitro and in vivo experimentation as well as computer simulations that have been performed to elucidate the effects of various stent design parameters and the prevailing parent vessel hemodynamics on intra-aneurysmal flow patterns. Our results in numerous studies have shown that stenting substantially alters intra-aneurysmal flow. Furthermore, it is demonstrated that techniques have been developed in order to assess the efficacy of the stent in promoting intra-aneurysmal flow stagnation, thus creating the potential to optimize the device design for the treatment of intracranial aneurysms.