When Treating Brain Aneurysms, Two Isn’t Always Better Than One

Just in case you need factual data to question your doctor about your aneurysm. It joins the other options for handling aneurysms, coiling, surgery, mesh, and glue   being the others.
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The old adage about two being better than one doesn’t necessarily apply to brain surgery, according to a study published in the American Journal of Neuroradiology.
To reduce blood flow into aneurysms, surgeons often insert a flow diverter across the opening of an aneurysm. If the neck of an aneurysm is large, surgeons will sometimes overlap 2 diverters, to increase the density of the mesh over the opening. Another technique is to compress the diverter to increase the mesh density and block more blood flow. But which technique is better?
The current study points to the single, compressed diverter provided that it produces a mesh denser than the 2 overlapped diverters, and that it covers at least half of the aneurysm opening.
The research, which is ongoing, could eventually help doctors determine the best way to treat patients suffering from aneurysms.
“When doctors see the simulated blood flow in our models, they’re able to visualise it,” said Hui Meng, University at Buffalo, Buffalo, New York. “They see that they need to put more of the dense mesh here or there to diffuse the jets [of blood], because the jets are dangerous.”
The researchers used virtual models of 3 types of aneurysms -- fusiform, and medium and large saccular -- and applied engineering principles to model the pressure and speed of blood flowing through the vessels.
The engineers modelled 3 different diverter treatment methods -- single non-compacted, two overlapped, and single compacted -- and ran tests to determine how they would affect blood flow in and out of the aneurysm using computational fluid dynamics.
The models showed that compressing a diverter produced a dense mesh that covered 57% of a fusiform-shaped aneurysm. That proved more effective than overlapping 2 diverters.
The compacted diverter was less effective in saccular aneurysms. As diverters are compressed, they become wider and bump into the sides of the vessel, so they could not be compressed enough to cover a small opening of an aneurysm. Compression was more effective in a large necked saccular aneurysm, producing a dense mesh that covered 47% of the opening.
Complete coverage of an aneurysm using a solid diverter is not favourable because a porous scaffold is needed to allow cell and tissue growth around the neck of the aneurysm. In addition, the danger of blocking off smaller arteries prevents the use of solid diverters.
Next, the team wants to look back over hundreds of previous cases, to determine how blood flow was affected by the use of diverters. The idea is to build a database so that more definitive conclusions can be drawn.
SOURCE: University at Buffalo