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Platelet Dynamics and Hemodynamics of Cerebral Aneurysms Treated with Flow-Diverting Stents

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Abstract

Flow-diverting stents (FDS) are used to treat cerebral aneurysms. They promote the formation of a stable thrombus within the aneurysmal sac and, if successful, isolate the aneurysmal dome from mechanical stresses to prevent rupture. Platelet activation, a mechanism necessary for thrombus formation, is known to respond to biomechanical stimuli, particularly to the platelets’ residence time and shear stress exposure. Currently, there is no reliable method for predicting FDS treatment outcomes, either a priori or after the procedure. Eulerian computational fluid dynamic (CFD) studies of aneurysmal flow have searched for predictors of endovascular treatment outcome; however, the hemodynamics of thrombus formation cannot be fully understood without considering the platelets’ trajectories and their mechanics-triggered activation. Lagrangian analysis of the fluid mechanics in the aneurysmal vasculature provides novel metrics by tracking the platelets’ residence time (RT) and shear history (SH). Eulerian and Lagrangian parameters are compared for 19 patient-specific cases, both pre- and post-treatment, to assess the degree of change caused by the FDS and subsequent treatment efficacy.

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Acknowledgments

This work was supported by the National Institutes of Health/National Institute of Neurological Disorders and Stroke Grants R01NS088072 and R01NS105692, American Heart Association Grant 18CDA34110295 and unrestricted educational equipment grants to our academic institution from Volcano Philips and Medtronic, which had no role in the experimental design, data analysis, or scholarship of this work.

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Authors and Affiliations

  1. Mechanical Engineering, University of Washington, 4000 15th Ave NE, Box 352600, Seattle, WA, 98195, USA

    Laurel M. M. Marsh, Michael C. Barbour, Venkat Keshav Chivukula, Fanette Chassagne, Michael R. Levitt & Alberto Aliseda

  2. Neurological Surgery, University of Washington, Seattle, WA, USA

    Cory M. Kelly, Samuel H. Levy, Louis J. Kim, Michael R. Levitt & Alberto Aliseda

  3. Stroke & Applied NeuroScience Center, University of Washington, Seattle, WA, USA

    Cory M. Kelly, Samuel H. Levy, Louis J. Kim, Michael R. Levitt & Alberto Aliseda

  4. Radiology, University of Washington, Seattle, WA, USA

    Louis J. Kim & Michael R. Levitt

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  1. Laurel M. M. Marsh
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Correspondence to Alberto Aliseda.

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Associate Editor Ender A. Finol oversaw the review of this article.

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Marsh, L.M.M., Barbour, M.C., Chivukula, V.K. et al. Platelet Dynamics and Hemodynamics of Cerebral Aneurysms Treated with Flow-Diverting Stents. Ann Biomed Eng 48, 490–501 (2020). https://doi.org/10.1007/s10439-019-02368-0

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