Hemodynamic numerical simulation of aortic arch modular inner branched stent-graft in eight early patients from the first-in-human case series

BACKGROUND: The modular inner branched stent-graft (MIBSG) (WeFlow-Arch™) is an emerging device for challenging aortic arch pathologies. Hemodynamic numerical simulation is conducive to predicting long-term outcomes as well as optimizing the stent-graft design. OBJECTIVE: This study aims to analyze the hemodynamic characteristics of the MIBSG devices based on numerical simulation analyses. METHODS: From June 2019 to June 2021, MIBSGs were utilized in eight cases. Numerical simulation analyses of branch perfusion and indicators including the time-averaged wall shear stress, oscillatory shear index, and relative residence time were performed. RESULTS: Lesions involved Zone 1 (n = 2), Zone 2 (n = 4), and Zone 3 (n = 2). Branched stent-grafts were deployed in the innominate artery and left common carotid artery (n = 5) or in the innominate artery and left subclavian artery (n = 3). The hemodynamic change in common was increased perfusion in the descending aorta and left common carotid artery. Half of the patients had increased cerebral perfusion of 8.7% at most, and the other half of the patients showed a reduction of 5.3% or less. Case 3 was considered to have acquired the greatest improvement in hemodynamic features. CONCLUSION: The MIBSG showed improved hemodynamic features in most cases. The design of the MIBSG could be partly modified to acquire better hemodynamic performance.