Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results
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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.
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.
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.
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.
• 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.
KeywordsFlow-diverting stent Time-density curve Digital subtraction angiography Image postprocessing Aneurysms
Digital subtraction angiography
Internal carotid artery
Parametric colour coding
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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