{
  "abstract": "Background Despite the expanding use of flow-diverting stents (flow diverters—FDs) for middle cerebral artery (MCA) bifurcation aneurysms, their efficacy remains contentious in this complex anatomy. Current studies report conflicting complete occlusion rates (55–92%) and significant branch stenosis/occlusion risks (8–43%), highlighting unmet needs in stent placement strategy.Methods In this retrospective cohort study combining clinical data with computational fluid dynamics (CFD), 20 MCA bifurcation aneurysms (19 patients) treated with FDs were analyzed. Patient-specific models derived from three-dimensional digital subtraction angiography underwent CFD simulations to quantify pre/post-stent hemodynamic changes. Key parameters (inflow rate, wall shear stress, residual flow volume) were compared between aneurysms with complete versus incomplete healing, and the impact of stent placement in branches of varying diameters was analyzed.Results At a median follow-up of 9 months, complete occlusion was achieved in 55% (11/20) and partial occlusion in 25% (5/20). Though not statistically significant, hemodynamic analysis revealed the daughter artery diameter ratio (DR)-stratified efficacy. Stents with a DR between 0.65 and 0.80 placed in smaller-diameter branches more effectively reduced inflow rate, relative inflow rate, and aneurysm wall shear stress. Conversely, stents with a DR between 0.80 and 0.95 were more effective in larger-diameter branches.Conclusion This study indicates that vessel DR could guide intraoperative decisions for FD placement in MCA bifurcations. Prioritizing smaller branches in certain anatomical profiles may enhance flow remodeling without increasing procedural risks. These findings suggest a hemodynamic basis for moving beyond traditional size-based approaches and could inform more precise stent selection in complex bifurcation interventions. Further validation through controlled trials is needed.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Xin Feng"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Jiwan Huang"
    },
    {
      "affiliations": [
        "The Department of Neurosurgery, Dongguan Kanghua Hospital, Dongguan, Guangdong, China"
      ],
      "name": "Shiyan Weng"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Chi Huang"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Mengshi Huang"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Zhuohua Wen"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Runze Ge"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Can Li"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Jiancheng Lin"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Hao Yuan"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Lele Dai"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Wenxin Chen"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Ruizhe Yi"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Anqi Xu"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "HongYu Shi"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Yuheng Jin"
    },
    {
      "affiliations": [
        "The Second Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Xueyan Deng"
    },
    {
      "affiliations": [
        "The Second Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Zehui Xie"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Shuyin Liang"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Yiming Bi"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Shixing Su"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Xin Zhang"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Xifeng Li"
    },
    {
      "affiliations": [
        "Guangdong Provincial People’s Hospital, Guangzhou, Guangdong, China"
      ],
      "name": "Chubin Ou"
    },
    {
      "affiliations": [
        "ArteryFlow Technology Co Ltd, Hangzhou, Zhejiang, China"
      ],
      "name": "Jianping Xiang"
    },
    {
      "affiliations": [
        "Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital，Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Chuan-Zhi Duan"
    }
  ],
  "title": "Hemodynamic analysis of optimal branch selection for flow-diverting stents in middle cerebral artery bifurcation aneurysms: a pilot study",
  "uid": "f813aaaf-a4c1-5669-b610-4f19df9454f8"
}