Comparison of Flow Diverter Deployment Strategies for Cerebral Aneurysm Treatment: Evaluation of Hemodynamic Modifications

Flow diversion with the Pipeline Embolization Device (PED, Covidien, Irvine, CA) represents the most recent advancement in endovascular treatment of cerebral aneurysms. Despite great success at treating previously untreatable aneurysms, complications such as delayed rupture after PED treatment raise concerns that clinical outcome is not always predictable. This is due to the lack of knowledge about the flow modifications by different configurations of PED placement in patient-specific geometry and how these affect thrombosis. To shed light on mechanisms behind these issues, this study investigated the hemodynamic modifications induced by different treatment scenarios, including (1) a single PED vs. 2 overlapping PEDs and (2) uniform vs. dense packing of a single PED. Besides flow reduction and wall shear stress (WSS) modification, we also conducted a preliminary investigation of the potential for platelet activation from high blood shear induced by PED struts.