Abstract TP86: Predicting Aneurysm Occlusion After Flow Diversion
Introduction: Predicting the course of aneurysms after treatment with flow diverters is important to prognosticate long term outcomes and optimize interventions.
Hypothesis: Aneurysm occlusion after flow diversion can be predicted using post-treatment flow information.
Methods: Flows in experimental aneurysms in rabbits (n=15) and clinical cases (n=23) were evaluated with computational fluid dynamics. Subject-specific models were created from 3D angiographies. Flow conditions were measured with ultrasound in the rabbits, and derived from measurements in normal subjects in the clinical cases. Models of the devices were virtually deployed into the anatomical models. Experimental aneurysms were assigned to either a “complete” occlusion group if completely occluded at 4 weeks follow up, or to an “incomplete” occlusion group if still open at 8 weeks. Similarly, clinical cases were classified as “complete” occlusions if completely occluded at 3 months, or as “incomplete” occlusions if still patent at 6 months. Flow variables were then statistically compared between these groups for both the experimental and clinical series, and the predictive power of different variables to discriminate between aneurysms in each group was assessed by calculating the area under the receiving operating characteristics curves.
Results: In the clinical (experimental) series, the aneurysm inflow rate was 4.02 (3.29) times larger in the incomplete occlusion group than in the completely occluded group, p=0.0210 (0.0239). Similarly, the mean aneurysm velocity was 2.75 (2.29) times larger, p=0.0044 (0.0582), and the shear rate was 1.57 (1.78) times larger, p=0.0210 (0.0722). Inflow rate could discriminate complete and incomplete occlusions with a 77% (90%) accuracy in the clinical (experimental) series. Similarly, mean velocity had a predictive power of 84% (83%) and shear rate of 76% (76%) in the clinical and experimental series.
Conclusions: Flow conditions created immediately after treatment, in particular aneurysm inflow rate and mean aneurysm velocity, can prognosticate the future occlusion of aneurysms treated with flow diverters.
Author Disclosures: J. Cebral: None. F. Mut: None. B. Chung: None. R. Kadirvel: None. D. Kallmes: None. C. Bleise: None. E. Scrivano: None. P. Lylyk: None.
- © 2016 by American Heart Association, Inc.