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Anderson Chun On Tsang,Simon Sui Man Lai,Wai Choi Chung,Abraham Yik Sau Tang,Gilberto Ka Kit Leung,Alexander Kai Kei Poon,Alfred Cheuk Hang Yu,Kwok Wing Chow 대한초음파의학회 2015 ULTRASONOGRAPHY Vol.34 No.2
Purpose: The aim of this study was to validate a computational fluid dynamics (CFD) simulationof flow-diverter treatment through Doppler ultrasonography measurements in patient-specificmodels of intracranial bifurcation and side-wall aneurysms. Methods: Computational and physical models of patient-specific bifurcation and sidewallaneurysms were constructed from computed tomography angiography with use ofstereolithography, a three-dimensional printing technology. Flow dynamics parametersbefore and after flow-diverter treatment were measured with pulse-wave and color Dopplerultrasonography, and then compared with CFD simulations. Results: CFD simulations showed drastic flow reduction after flow-diverter treatment in bothaneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysmand the side-wall aneurysm, respectively. Velocity contour plots from computer simulationsbefore and after flow diversion closely resembled the patterns obtained by color Dopplerultrasonography. Conclusion: The CFD estimation of flow reduction in aneurysms treated with a flow-divertingstent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcationand side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasibleand reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.
Wan Yue,Yang I-Hsiao,Orru Emanuele,Krings Timo,Tsang Anderson Chun On 대한신경중재치료의학회 2019 Neurointervention Vol.14 No.2
Distal intracranial occlusions can sometimes cause significant neurological deficits. Endovascular thrombectomy in these vessels may improve outcome but carry a higher risk of haemorrhagic complications due to the small calibre and tortuosity of the target vessel. We report two cases of isolated M2/3 artery occlusion causing dense hemiplegia that was successfully treated with stent retrieval thrombectomy. A “semi-deployment technique” of a 3 mm stentriever was employed at the M2/3 bifurcation of the middle cerebral artery. Partial stent unsheathing allowed adequate clot engagement while avoiding excessive tension by the stent metal struts along the tortuous course of a distal vessel. Complete revascularization was achieved after first-pass of the stent retriever without complication, resulting in good clinical outcome in both cases. The described semi-deployment technique reduces the radial and tractional force exerted by the stentreiver on small branches, and may reduce the risk of vessel laceration or dissection in distal vessel thrombectomy.