Application of Virtual Deployment and Hemodynamic Simulation in Treatment of a Basal Arterial Dissecting Aneurysm Using Flow Diverter: A Case Report and Literature Review

Overview

Journal Heliyon

Specialty Social Sciences

Date 2025 Mar 3

PMID 40028598

Authors

Shijie Zhu

Rong Zou

Zhiwen Lu

Yazhou Yan

Yina Wu

Jianping Xiang

Qinghai Huang

Affiliations

Soon will be listed here.

Abstract

The application of flow diverters (FDs) to treat basilar artery (BA) aneurysms has been proven to be one of the most effective ways. The hemodynamic changes caused by FD have been proven to be a principal factor affecting the healing of aneurysms. Virtual deployment based on simulation technology can intuitively reflect the hemodynamic changes caused by FD, providing more information for the surgeon. A 6-year-old child presented with a week of persistent, severe headaches due to a large dissecting aneurysm in the upper-middle BA. To select the appropriate size of the stent and observe the changes in blood flow, the virtual deployment of the FD was completed in AneuPlan. The simulated results were in good agreement with postoperative digital subtraction angiography (DSA). Moreover, hemodynamic analysis indicated the overall thrombosis and healing of the aneurysm and the incomplete occlusion risk close to the left superior cerebellar artery, which was confirmed by the subsequent assessment following the FD deployment. Encouragingly, the DSA images at 28 weeks showed that the residual sac of the basilar artery aneurysm had been basically healed. This case report initially reflects the guiding role of AneuPlan in the endovascular treatment protocol for complex cerebrovascular diseases.

References

Ospel J, Gascou G, Costalat V, Piergallini L, Blackham K, Zumofen D . Comparison of Pipeline Embolization Device Sizing Based on Conventional 2D Measurements and Virtual Simulation Using the Sim&Size Software: An Agreement Study. AJNR Am J Neuroradiol. 2019; 40(3):524-530. PMC: 7028658. DOI: 10.3174/ajnr.A5973. View

Heiferman D, Billingsley J, Kasliwal M, Johnson A, Keigher K, Frudit M . Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms. J Neurointerv Surg. 2015; 8(7):692-5. DOI: 10.1136/neurintsurg-2015-011672. View

Fink M, Slavova N, Grunt S, Perret E, Regenyi M, Steinlin M . Posterior Arterial Ischemic Stroke in Childhood. Stroke. 2019; 50(9):2329-2335. DOI: 10.1161/STROKEAHA.119.025154. View

Nash M, Rafay M . Craniocervical Arterial Dissection in Children: Pathophysiology and Management. Pediatr Neurol. 2019; 95:9-18. DOI: 10.1016/j.pediatrneurol.2019.01.020. View

Tong X, Shan Y, Leng X, Chen J, Fiehler J, Siddiqui A . Predicting flow diverter sizing using the AneuGuide software: a validation study. J Neurointerv Surg. 2022; 15(1):57-62. PMC: 9763218. DOI: 10.1136/neurintsurg-2021-018353. View

Leng X, Wang Y, Xu J, Jiang Y, Zhang X, Xiang J . Numerical simulation of patient-specific endovascular stenting and coiling for intracranial aneurysm surgical planning. J Transl Med. 2018; 16(1):208. PMC: 6054731. DOI: 10.1186/s12967-018-1573-9. View

Patankar T, Madigan J, Downer J, Sonwalkar H, Cowley P, Iori F . How precise is PreSize Neurovascular? Accuracy evaluation of flow diverter deployed-length prediction. J Neurosurg. 2022; 137(4):1072-1080. DOI: 10.3171/2021.12.JNS211687. View

Debette S, Compter A, Labeyrie M, Uyttenboogaart M, Metso T, Majersik J . Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol. 2015; 14(6):640-54. DOI: 10.1016/S1474-4422(15)00009-5. View

Tsai Y, Wong H, Hsu S . Endovascular management of spontaneous delayed migration of the flow-diverter stent. J Neuroradiol. 2018; 47(1):38-45. DOI: 10.1016/j.neurad.2018.11.004. View

10.

Wang M, Shi S, Xiang J, Wan S . Establishing surgical plan of endovascular intervention for intracranial aneurysm using AneuPlan™ - An exploratory study. Asian J Surg. 2024; 47(12):5191-5193. DOI: 10.1016/j.asjsur.2024.05.273. View

11.

Dandapat S, Mendez-Ruiz A, Martinez-Galdamez M, Macho J, Derakhshani S, Foa Torres G . Review of current intracranial aneurysm flow diversion technology and clinical use. J Neurointerv Surg. 2020; 13(1):54-62. DOI: 10.1136/neurintsurg-2020-015877. View

12.

Chen L, Leng X, Zheng C, Shan Y, Wang M, Bao X . Computational fluid dynamics (CFD) analysis in a ruptured vertebral artery dissecting aneurysm implanted by Pipeline when recurrent after LVIS-assisted coiling treatment: Case report and review of the literatures. Interv Neuroradiol. 2022; 29(4):442-449. PMC: 10399494. DOI: 10.1177/15910199221097766. View

13.

Zhang M, Tian Z, Zhang Y, Zhang Y, Wang K, Leng X . How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint. J Neurointerv Surg. 2022; 15(2):157-162. DOI: 10.1136/neurintsurg-2021-018361. View

14.

Lv B, Sun M, Shan Y, Cao X, Du Z, Liu X . AneuGuide™ software-assisted vs. manual measurements in sizing for pipeline embolization device: An agreement study. Comput Biol Med. 2023; 168:107715. DOI: 10.1016/j.compbiomed.2023.107715. View

15.

Kashiwazaki D, Ushikoshi S, Asano T, Kuroda S, Houkin K . Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection. Neuroradiology. 2012; 55(2):201-6. DOI: 10.1007/s00234-012-1114-9. View

16.

Roach E, Golomb M, Adams R, Biller J, Daniels S, deVeber G . Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008; 39(9):2644-91. DOI: 10.1161/STROKEAHA.108.189696. View

17.

Rai A, Boo S, Downer J, DuPlessis J, Rautio R, Sinisalo M . High variability in physician estimations of flow-diverting stent deployment versus PreSize Neurovascular software simulation: a comparison study. J Neurointerv Surg. 2023; 16(6):559-566. PMC: 11187387. DOI: 10.1136/jnis-2023-020527. View

18.

Cherian J, Srinivasan V, Froehler M, Grossberg J, Cawley C, Hanel R . Flow Diversion for Treatment of Intracranial Aneurysms in Pediatric Patients: Multicenter Case Series. Neurosurgery. 2019; 87(1):53-62. DOI: 10.1093/neuros/nyz380. View

19.

Jeon P, Kim B, Kim D, Shin Y, Kim K, Park S . Emergent self-expanding stent placement for acute intracranial or extracranial internal carotid artery dissection with significant hemodynamic insufficiency. AJNR Am J Neuroradiol. 2010; 31(8):1529-32. PMC: 7966117. DOI: 10.3174/ajnr.A2115. View

20.

Huang Q, Xu J, Cheng J, Wang S, Wang K, Liu J . Hemodynamic changes by flow diverters in rabbit aneurysm models: a computational fluid dynamic study based on micro-computed tomography reconstruction. Stroke. 2013; 44(7):1936-41. DOI: 10.1161/STROKEAHA.113.001202. View