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European Radiology

, Volume 25, Issue 2, pp 428–435 | Cite as

Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results

  • Philipp GölitzEmail author
  • Tobias Struffert
  • Julie Rösch
  • Oliver Ganslandt
  • Frauke Knossalla
  • Arnd Doerfler
Vascular-Interventional

Abstract

Objectives

After deployment of flow-diverting stents (FDS), complete aneurysm occlusion is not predictable. This study investigated whether parametric colour coding (PCC) could allow in vivo visualization of flow alterations induced by FDS and identify favourable or adverse flow modulations.

Methods

Thirty-six patients treated by FDS were analyzed. Preinterventional and postinterventional DSA-series were postprocessed by PCC and time-density curves (TDCs) were calculated. The parameters aneurysmal inflow, outflow, and relative time-to-peak (rTTP) were calculated. Preinterventional and postinterventional values were compared and related to occlusion rate.

Results

Postinterventional inflow showed a mean reduction of 37 %, outflow of 51 %, and rTTP a prolongation of 82 %. Saccular aneurysm occlusion occurred if a reduction of at least 15 % was achieved for inflow and 35 % for outflow (sensitivity: 89 %, specificity: 82 %). Unchanged outflow and a slightly prolonged rTTP were associated with growth in one fusiform aneurysm.

Conclusions

PCC allows visualization of flow alterations after FDS treatment, illustrating “flow diverting effects” by the TDC shape and indicating mainly aneurysmal outflow and lesser inflow changes. Quantifiable parameters (inflow, outflow, rTTP) can be obtained, thresholds for predicting aneurysm occlusion determined, and adverse flow modulations assumed. As a rapid intraprocedural tool, PCC might support the decision to implant more than one FDS.

Key Points

After deployment of a flow-diverting stent, complete aneurysm occlusion is unpredictable.

Parametric colour coding offers new options for visualizing in vivo flow alterations non-invasively.

Quantifiable parameters, i.e., aneurysmal inflow/outflow can be obtained allowing prognostic stratification.

Rapid, intraprocedural application allows treatment monitoring, potentially contributing to patient safety.

Keywords

Flow-diverting stent Time-density curve Digital subtraction angiography Image postprocessing Aneurysms 

Abbreviations

DSA

Digital subtraction angiography

FDS

Flow-diverting stent

ICA

Internal carotid artery

PCC

Parametric colour coding

rTTP

Relative time-to-peak

sec

Seconds

TDC

Time-density curve

Notes

Acknowledgments

The scientific guarantor of this publication is Philipp Gölitz, MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has received funding of the Medical Valley national leading edge cluster, Erlangen, Germany, diagnostic imaging network, sub-project BD 16, research grant nr. 13EX1212G and sub-project BD 20, research grant nr. 13G 0031A. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Philipp Gölitz
    • 1
    Email author
  • Tobias Struffert
    • 1
  • Julie Rösch
    • 1
  • Oliver Ganslandt
    • 2
  • Frauke Knossalla
    • 3
  • Arnd Doerfler
    • 1
  1. 1.Department of NeuroradiologyUniversity of Erlangen- NurembergErlangenGermany
  2. 2.Department of NeurosurgeryUniversity of Erlangen-NurembergErlangenGermany
  3. 3.Department of NeurologyUniversity of Erlangen- NurembergErlangenGermany

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