Braided endovascular implants for intracranial aneurysms: mechanics, hemodynamics, and clinical translation

Abstract

Endovascular implants prevent intracranial aneurysm rupture by altering the mechanical and hemodynamic environment at the aneurysm neck. Yet many in silico workflows prescribe or reconstruct the post-deployment geometry before computing flow, leaving unresolved the mechanics that create the clinically relevant interface. Here we review braided intraluminal flow diverters, intrasaccular devices, and emerging flow-disruption concepts across deployment mechanics, inter-wire and wire-wall contact, superelasticity, wall apposition, pore geometry, computational fluid dynamics, and fluid-structure interaction. We connect these modeling choices to neck coverage, malapposition, migration, deformation, and durability, and distinguish established evidence from mechanistic inference and prospective hypotheses. We argue that model fidelity should match the clinical question: prescribed or fast placement may support screening, whereas questions of coverage, apposition, compaction, and migration benefit from mechanically plausible deployment states. An interface-resolved mechanics-to-flow framework, supported by measurable validation targets and standardized reporting, could improve device design and enable more reliable patient-specific treatment planning.