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<meta name="DC.Title" content="Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5062" />
<meta name="DC.Date" content="2017-01-05" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 American Society of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares with overlapping 2 flow diverters for aneurysmal flow reduction.

MATERIALS AND METHODS: Using a high-fidelity virtual stent placement method, we simulated 3 flow-diverter strategies (single noncompacted, 2 overlapped, and single compacted) in 3 aneurysms (fusiform, large saccular, and medium saccular). Computational fluid dynamics analysis provided posttreatment hemodynamic parameters, including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area.

RESULTS: Flow-diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other 2 strategies, as indicated by all 5 hemodynamic parameters. In the 2 saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the noncompacted flow diverter.

CONCLUSIONS: Compacting a single flow diverter can outperform overlapping 2 flow diverters in aneurysmal flow reduction, provided that the compaction produces a mesh denser than 2 overlapped flow diverters and this denser mesh covers a sufficient portion of the aneurysm orifice area, for which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.

### Abbreviations

CC
:   compaction coverage
CFD
:   computational fluid dynamics
DPPT
:   dynamic push-pull technique
FD
:   flow diverter
HiFiVS
:   high-fidelity virtual stent placement
IA
:   intracranial aneurysm" />
<meta name="DC.Contributor" content="R.J. Damiano" />
<meta name="DC.Contributor" content="V.M. Tutino" />
<meta name="DC.Contributor" content="N. Paliwal" />
<meta name="DC.Contributor" content="D. Ma" />
<meta name="DC.Contributor" content="J.M. Davies" />
<meta name="DC.Contributor" content="A.H. Siddiqui" />
<meta name="DC.Contributor" content="H. Meng" />
<meta name="article:published_time" content="2017-01-05" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares with overlapping 2 flow diverters for aneurysmal flow reduction.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Using a high-fidelity virtual stent placement method, we simulated 3 flow-diverter strategies (single noncompacted, 2 overlapped, and single compacted) in 3 aneurysms (fusiform, large saccular, and medium saccular). Computational fluid dynamics analysis provided posttreatment hemodynamic parameters, including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Flow-diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other 2 strategies, as indicated by all 5 hemodynamic parameters. In the 2 saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the noncompacted flow diverter.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Compacting a single flow diverter can outperform overlapping 2 flow diverters in aneurysmal flow reduction, provided that the compaction produces a mesh denser than 2 overlapped flow diverters and this denser mesh covers a sufficient portion of the aneurysm orifice area, for which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_section" content="INTERVENTIONAL" />
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<meta name="citation_author" content="R.J. Damiano" />
<meta name="citation_author_institution" content="From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York." />
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<meta name="citation_author" content="V.M. Tutino" />
<meta name="citation_author_institution" content="From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-1331-2551" />
<meta name="citation_author" content="N. Paliwal" />
<meta name="citation_author_institution" content="From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York." />
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<meta name="citation_author" content="D. Ma" />
<meta name="citation_author_institution" content="From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York." />
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<meta name="citation_author" content="J.M. Davies" />
<meta name="citation_author_institution" content="From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York." />
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<meta name="citation_author" content="A.H. Siddiqui" />
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<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-9519-0059" />
<meta name="citation_author" content="H. Meng" />
<meta name="citation_author_institution" content="From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York." />
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<meta name="twitter:title" content="Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares with overlapping 2 flow diverters for aneurysmal flow reduction.

MATERIALS AND METHODS: Using a high-fidelity virtual stent placement method, we simulated 3 flow-diverter strategies (single noncompacted, 2 overlapped, and single compacted) in 3 aneurysms (fusiform, large saccular, and medium saccular). Computational fluid dynamics analysis provided posttreatment hemodynamic parameters, including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area.

RESULTS: Flow-diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other 2 strategies, as indicated by all 5 hemodynamic parameters. In the 2 saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the noncompacted flow diverter.

CONCLUSIONS: Compacting a single flow diverter can outperform overlapping 2 flow diverters in aneurysmal flow reduction, provided that the compaction produces a mesh denser than 2 overlapped flow diverters and this denser mesh covers a sufficient portion of the aneurysm orifice area, for which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.

### Abbreviations

CC
:   compaction coverage
CFD
:   computational fluid dynamics
DPPT
:   dynamic push-pull technique
FD
:   flow diverter
HiFiVS
:   high-fidelity virtual stent placement
IA
:   intracranial aneurysm" />
<meta name="og-title" property="og:title" content="Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2017/01/05/ajnr.A5062" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares with overlapping 2 flow diverters for aneurysmal flow reduction.

MATERIALS AND METHODS: Using a high-fidelity virtual stent placement method, we simulated 3 flow-diverter strategies (single noncompacted, 2 overlapped, and single compacted) in 3 aneurysms (fusiform, large saccular, and medium saccular). Computational fluid dynamics analysis provided posttreatment hemodynamic parameters, including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area.

RESULTS: Flow-diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other 2 strategies, as indicated by all 5 hemodynamic parameters. In the 2 saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the noncompacted flow diverter.

CONCLUSIONS: Compacting a single flow diverter can outperform overlapping 2 flow diverters in aneurysmal flow reduction, provided that the compaction produces a mesh denser than 2 overlapped flow diverters and this denser mesh covers a sufficient portion of the aneurysm orifice area, for which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.

### Abbreviations

CC
:   compaction coverage
CFD
:   computational fluid dynamics
DPPT
:   dynamic push-pull technique
FD
:   flow diverter
HiFiVS
:   high-fidelity virtual stent placement
IA
:   intracranial aneurysm" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node806--5" data-node-nid="806" id="top-node-806--686120794" data-pisa="ajnr;ajnr.A5062v1" data-pisa-master="ajnr;ajnr.A5062" data-apath="/ajnr/early/2017/01/05/ajnr.A5062.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">R.J. Damiano</span>, <span class="highwire-citation-author" data-delta="1">V.M. Tutino</span>, <span class="highwire-citation-author" data-delta="2">N. Paliwal</span>, <span class="highwire-citation-author" data-delta="3">D. Ma</span>, <span class="highwire-citation-author" data-delta="4">J.M. Davies</span>, <span class="highwire-citation-author" data-delta="5">A.H. Siddiqui</span> and <span class="highwire-citation-author" data-delta="6">H. Meng</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2017,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5062 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-806--686120794" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">R.J. Damiano </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.J.%2BDamiano%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Damiano%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.J.%2BDamiano%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2256-2154" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.J. Damiano</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">V.M. Tutino </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.M.%2BTutino%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tutino%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.M.%2BTutino%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1331-2551" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V.M. Tutino</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">N. Paliwal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BPaliwal%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Paliwal%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BPaliwal%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0396-4409" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Paliwal</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D. Ma </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BMa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ma%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2BMa%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1121-7876" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Ma</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J.M. Davies </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.M.%2BDavies%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Davies%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.M.%2BDavies%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-5225-3072" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. 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Siddiqui </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Mechanical and Aerospace Engineering (R.J.D., N.P., D.M., H.M.), Toshiba Stroke and Vascular Research Center (R.J.D., V.M.T., N.P., D.M., J.M.D., A.H.S., H.M.), Department of Biomedical Engineering (V.M.T., H.M.), and Department of Neurosurgery (J.M.D., A.H.S., H.M.), University at Buffalo, State University of New York, Buffalo, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.H.%2BSiddiqui%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Siddiqui%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.H.%2BSiddiqui%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9519-0059" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.H. 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