Intracranial aneurysms are a serious cerebrovascular condition with a risk of subarachnoid hemorrhage due to rupture, leading to high mortality and morbidity. Flow Diverter Stents (FDSs) have become an important endovascular treatment option for unruptured large or wide-neck aneurysms. Hemodynamic factors significantly influence treatment outcomes in aneurysms treated with FDSs, and Computational Fluid Dynamics (CFD) has been widely used to evaluate post-deployment flow characteristics. However, conventional wire-resolved CFD methods require extremely fine meshes to reconstruct individual FDS wires, resulting in prohibitively high computational costs. This severely limits their feasibility for use in clinical treatment planning, where fast and robust simulations are essential. To address this limitation, we developed a computationally efficient CFD method that incorporates a porous media model accounting for local variations in wire density after FDS deployment. Based on Virtual Stent Simulation, the FDS region was defined as a hollow cylindrical domain with spatially varying resistance derived from cell-specific wire density. We validated the proposed method using 15 clinical cases, demonstrating close agreement with conventional wire-resolved CFD results. Relative errors in key hemodynamic parameters, including velocity, shear rate, inflow rate, and turnover time, were within 5%, with correlation coefficients exceeding 0.98. The number of grid elements, the data size, and total analysis time were reduced by over 90%. The method also allowed comparison between Total-Filling (OKM Grade A) and Occlusion (Grade D) cases, and evaluation of different FDS sizing, positioning, and coil-assisted strategies. The proposed method enables practical and efficient CFD analysis following FDS treatment and supports hemodynamics-based treatment planning of aneurysms.
Fujimura et al. (Tue,) studied this question.