De Novo Aneurysm Formation After Wingspan Stenting of Intracranial Carotid Stenosis: Computational Hemodynamic Analysis.

Abstract

The pathophysiology of de novo aneurysm after stenting is poorly understood. Hemodynamic effects may play an important role. We report and discuss the hemodynamic analysis of de novo aneurysm after intracranial stenting. A 51-year-old female underwent angioplasty and coiling for stenosis associated with an aneurysm of the left intracranial carotid artery. Six years later, the follow-up digital subtraction angiography demonstrated a de novo aneurysm at the proximal tine of the Wingspan stent. Computational fluid dynamics simulations showed that stenting for intracranial stenosis resulted in higher oscillatory shear index and lower time-averaged wall shear stress in the neck region of de novo aneurysm. The hemodynamic change after stenting may lead to formation of a de novo aneurysm. After an initial injury that might result from the tine on the endothelial cells, stenting could produce high oscillatory shear index and low time-averaged wall shear stress near the tine, thus potentially inducing de novo aneurysm formation.