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Research ArticleNeurointervention
Open Access

Evaluation of Outcome Prediction of Flow Diversion for Intracranial Aneurysms

S. Hadad, F. Mut, R. Kadirvel, Y.-H. Ding, D. Kallmes and J.R. Cebral
American Journal of Neuroradiology August 2021, DOI: https://doi.org/10.3174/ajnr.A7263
S. Hadad
aFrom the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
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F. Mut
aFrom the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
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R. Kadirvel
bDepartment of Interventional Neuroradiology (R.K., Y.-H.D., D.K.), Mayo Clinic, Rochester, Minnesota
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Y.-H. Ding
bDepartment of Interventional Neuroradiology (R.K., Y.-H.D., D.K.), Mayo Clinic, Rochester, Minnesota
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D. Kallmes
bDepartment of Interventional Neuroradiology (R.K., Y.-H.D., D.K.), Mayo Clinic, Rochester, Minnesota
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J.R. Cebral
aFrom the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
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  • FIG 1.
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    FIG 1.

    Subject-specific, multimodal image–based CFD modeling methodology. A subject-specific vascular model constructed from a 3D rotational angiography (3DRA) image, flow conditions derived from Doppler ultrasound images, and an FD model constructed from device-design data and virtually deployed into vascular model guided by 2D-DSA. Pre- and posttreatment hemodynamics characterized by corresponding CFD simulations and inflow jets visualized with velocity isosurfaces. Tx indicates Treatment; Pre-Tx, Pretreatment; Post-Tx, Posttreatment.

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    FIG 2.

    Examples of a completely occluded (left, subject 11) and an incompletely occluded (right, subject 7) aneurysm after treatment with FD devices. In both cases, prospective CFD predictions coincided with the angiographic outcomes at 8 weeks. Visualizations show the inflow jet (isovelocity surfaces) and flow pattern (streamlines) before and after treatment. Substantial reduction of the inflow and flow velocities is observed in the completely occluded aneurysm, but persistent posttreatment inflow and flow velocity can be seen in the incompletely occluded aneurysm. The circled white line show neck area of the aneurysm. Tx indicates Treatment; Fup,follow up; Fup DSA, Follow up DSA.

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    Table 1:

    Posttreatment hemodynamic variables, predictions, outcomes, and agreement

    SubjectQ (mL/s)VEL (cm/s)PredictionOutcomeAgreement
    10.0550.391IIA
    20.0130.127CID
    30.0480.532IIA
    40.0130.112CID
    50.0180.179IIA
    60.0530.362IIA
    70.0310.344IIA
    80.0940.664IIA
    90.0110.108CCA
    100.0070.156CCA
    110.0210.102CCA
    120.1000.831ICD
    130.0250.156CCA
    • Note:—I indicates incomplete occlusion; C, complete occlusion; A, agreement; D, disagreement.

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    Table 2:

    Summary of agreement between predictions and outcomes

    PredictionsOutcomes
    CompleteIncompleteTotal
    Complete426
    Incomplete167
    Total5813
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Cite this article
S. Hadad, F. Mut, R. Kadirvel, Y.-H. Ding, D. Kallmes, J.R. Cebral
Evaluation of Outcome Prediction of Flow Diversion for Intracranial Aneurysms
American Journal of Neuroradiology Aug 2021, DOI: 10.3174/ajnr.A7263

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Evaluation of Outcome Prediction of Flow Diversion for Intracranial Aneurysms
S. Hadad, F. Mut, R. Kadirvel, Y.-H. Ding, D. Kallmes, J.R. Cebral
American Journal of Neuroradiology Aug 2021, DOI: 10.3174/ajnr.A7263
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