Can the Windkessel Hypothesis Explain Delayed Intraparenchymal Haemorrhage After Flow Diversion? A Case Report and Model-Based Analysis of Possible Mechanisms

Abstract

Background: Delayed ipsilateral intraparenchymal haemorrhage is a recently recognised complication after endovascular flow diversion for intracranial aneurysms. Although the mechanism of this phenomenon is not understood, one proposed explanation (the windkessel hypothesis) is that removal of aneurysmal compliance increases distal pulse pressure. Methods: We present a case of delayed haemorrhage after placement of a Pipeline stent, discuss the proposed mechanisms, and describe a novel electrical analogue model that was used to evaluate the likely haemodynamic effect of stent placement. Results: Model-based analysis suggests that stenting is not likely to produce a significant change in dista..