Assessing Endovascular Treatment Approaches for Rare Blood Blister Aneurysms: Insights from a Computational Study Using CTA Data from real Patients

Introduction: A blood blister aneurysm (BBA), a rare and high-risk type of intracranial aneurysm, presents unique challenges due to its thin-walled, broad-based structure with no identifiable neck. Endovascular treatment has become the preferred choice for BBAs, offering better outcomes and fewer complications compared to microsurgery. The pipeline embolization device (PED) represents a significant advancement in endovascular techniques. However, questions persist regarding the most effective approach, whether it involves Livis stents or PED. This study aims to simulate BBA models and to determine the optimal strategy for managing blood blister aneurysms based on hemodynamic performance.

Methods: This study builds upon our previous research, focusing on hemodynamic analysis in endovascular BBA treatment. We utilized Computed Tomography Angiography (CTA) data from 12 BBA patients, investigating three treatment approaches: One Livis Stent, Two Livis Stents, and PED. Hemodynamic parameters, including Wall Shear Stress (WSS), blood flow velocity distribution, and intra-aneurysmal blood flow, were analyzed using Ansys® software.
Between February 2019 and February 2021, our study encompassed 12 patients who underwent endovascular treatment for ruptured BBAs. CTA data from these patients were collected and analyzed to construct patient-specific vascular models.

Results: Using Ansys® software, numerical simulations evaluated key parameters for different stent treatment strategies. The results showed a 36.38% reduction in aneurysm inflow with two Lvis stents compared to one, and a 12.33% reduction with PED compared to one Lvis stent. The proportions of low wall shear stress within the aneurysm were as follows: One Lvis stent - 75.26%, Two Lvis stents - 69.38%, and PED - 75.74%. These findings provide insights into the mechanical performance of each strategy regarding aneurysmal wall shear stress.

Conclusion : In our simulations, two Lvis stents exhibited the best hemodynamic performance, followed by PED, while One Lvis stent was less effective. Nonetheless, real-world challenges in achieving perfect stent overlap make PED the most promising option for optimal treatment outcomes in managing ruptured blood blister aneurysms. This research offers valuable insights for selecting treatment strategies for BBAs, emphasizing the practical advantages of PED.