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Jeken-Rico P, Chau Y, Goetz A, Lannelongue V, Sédat J, Hachem E. Virtual flow diverter deployment and embedding for hemodynamic simulations. Comput Biol Med 2024; 180:109023. [PMID: 39163828 DOI: 10.1016/j.compbiomed.2024.109023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 08/03/2024] [Accepted: 08/11/2024] [Indexed: 08/22/2024]
Abstract
Flow-diverter stents offer clinicians an effective solution for treating intracranial aneurysms, especially in cases where other devices may be unsuitable. However, strongly deviating success rates among different centres, manufacturers, and aneurysm phenotypes highlight the need for better in-situ studies of these devices. To support research in this area, virtual stenting algorithms have been proposed that, combined with computational fluid dynamics, provide insights into the hemodynamic alterations induced by the device. Yet, many existing algorithms rely on uncertain parameters, such as the forces applied during operation, fail to predict the length of the device after deployment, or lack robust validation steps, raising concerns about their reliability. Therefore, we developed a robust deployment technique that builds upon the geometrical features of the vessel and includes advancements from previous works. The algorithm is detailed and validated against literature examples, in-vitro experiments, and patient data, achieving a mean angular error below 5° in the latter. Furthermore, we describe and demonstrate how the deployed device can be embedded in a computational mesh using open-source tools and anisotropic meshing routines.
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Affiliation(s)
- Pablo Jeken-Rico
- Mines Paris, Université PSL, CEMEF, UMR7635 CNRS, Sophia Antipolis, 06904, France.
| | - Yves Chau
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, 06000, France
| | - Aurèle Goetz
- Mines Paris, Université PSL, CEMEF, UMR7635 CNRS, Sophia Antipolis, 06904, France
| | - Vincent Lannelongue
- Mines Paris, Université PSL, CEMEF, UMR7635 CNRS, Sophia Antipolis, 06904, France
| | - Jacques Sédat
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, 06000, France
| | - Elie Hachem
- Mines Paris, Université PSL, CEMEF, UMR7635 CNRS, Sophia Antipolis, 06904, France
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Dazeo N, Orlando JI, García C, Muñoz R, Obrado L, Fernandez H, Blasco J, Román LS, Macho JM, Ding A, Utz R, Larrabide I. Computer Aided Intracranial Aneurysm Treatment Based on 2D/3D Mapping, Virtual Deployment and Online Distal Marker Detection. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00745-y. [PMID: 39160330 DOI: 10.1007/s13239-024-00745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To introduce a computational tool for peri-interventional intracranial aneurysm treatment guidance that maps preoperative planning information from simulation onto real-time X-Ray imaging. METHODS Preoperatively, multiple flow diverter (FD) devices are simulated based on the 3D mesh of the vessel to treat, to choose the optimal size and location. In the peri-operative stage, this 3D information is aligned and mapped to the continuous 2D-X-Ray scan feed from the operating room. The current flow diverter position in the 3D model is estimated by automatically detecting the distal FD marker locations and mapping them to the treated vessel. This allows to visually assess the possible outcome of releasing the device at the current position, and compare it with the one chosen pre-operatively. RESULTS The full pipeline was validated using retrospectively collected biplane images from four different patients (5 3D-DSA datasets in total). The distal FD marker detector obtained an average F1-score of 0.67 ( ± 0.224 ) in 412 2D-X-Ray scans. After aligning 3D-DSA + 2D-X-Ray datasets, the average difference between simulated and deployed positions was 0.832 mm ( ± 0.521 mm). Finally, we qualitatively show that the proposed approach is able to display the current location of the FD compared to their pre-operatively planned position. CONCLUSIONS The proposed method allows to support the FD deployment procedure by merging and presenting preoperative simulation information to the interventionists, aiding them to make more accurate and less risky decisions.
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Affiliation(s)
- Nicolas Dazeo
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina.
| | - José Ignacio Orlando
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
| | - Camila García
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
| | - Romina Muñoz
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
| | | | | | - Jordi Blasco
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
| | - Luis San Román
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
| | - Juan M Macho
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
| | | | | | - Ignacio Larrabide
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
- Mentice S. L., Barcelona, Spain
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Vukasinovic I, Nedeljkovic Z, Nedeljkovic A, Petrovic M, Jovanovic Macvanski M, Bascarevic V, Micovic M, Milic M, Mircic U, Ilic R, Grujicic D. "Stent-within-a-Stent" technique for the endovascular treatment of giant aneurysm of basilar artery bifurcation: A case report. Radiol Case Rep 2024; 19:2402-2407. [PMID: 38585399 PMCID: PMC10997870 DOI: 10.1016/j.radcr.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Stents have become very important devices in the treatment of intracranial aneurysms. Flow diverters as high metal coverage stents are developed for hemodynamic treatment of challenging intracranial aneurysms. High level of metal coverage can also be achieved by implementing regular stents telescopically one in another. We present the case of a patient successfully treated for giant aneurysm of basilar artery bifurcation by a "Stent-within-a-Stent" technique. After stent implantation, coil embolization was performed using multiple-sized platinum helical coils. Control angiography performed at the end of the procedure revealed aneurysm occlusion. After 3 years, the patient is fully neurologically recovered, without pyramidal deficit, independently active and able to work.
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Affiliation(s)
- Ivan Vukasinovic
- Center for Radiology and MRI, University Clinical Center of Serbia, Pasterova 2, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
| | - Zarko Nedeljkovic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
| | - Aleksandra Nedeljkovic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
| | - Masa Petrovic
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
- Institute for Cardiovascular Diseases “Dedinje”, Heroja Milana Tepica 1, Belgrade, Serbia
| | - Marija Jovanovic Macvanski
- Center for Radiology and MRI, University Clinical Center of Serbia, Pasterova 2, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
| | - Vladimir Bascarevic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
| | - Mirko Micovic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
| | - Marina Milic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
| | - Uros Mircic
- Center for Radiology and MRI, University Clinical Center of Serbia, Pasterova 2, Serbia
| | - Rosanda Ilic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
| | - Danica Grujicic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Koste Todorovica 4, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica Starijeg 8, Serbia
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Zhang X, Wang D, Zhang X, Liang S, Wu Z, Wen Z, Ventikos Y, Xiong J, Chen D. A CT-based predictive model for stent-induced vessel damage: application to type B aortic dissection. Eur Radiol 2023; 33:8682-8692. [PMID: 37368110 DOI: 10.1007/s00330-023-09773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The distal stent-induced new entry (distal SINE) is a life-threatening device-related complication after thoracic endovascular aortic repair (TEVAR). However, risk factors for distal SINE are not fully determined, and prediction models are lacking. This study aimed to establish a predictive model for distal SINE based on the preoperative dataset. METHODS Two hundred and six patients with Stanford type B aortic dissection (TBAD) that experienced TEVAR were involved in this study. Among them, thirty patients developed distal SINE. Pre-TEVAR morphological parameters were measured based on the CT-reconstructed configurations. Virtual post-TEVAR morphological and mechanical parameters were computed via the virtual stenting algorithm (VSA). Two predictive models (PM-1 and PM-2) were developed and presented as nomograms to help risk evaluation of distal SINE. The performance of the proposed predictive models was evaluated and internal validation was conducted. RESULTS Machine-selected variables for PM-1 included key pre-TEVAR parameters, and those for PM-2 included key virtual post-TEVAR parameters. Both models showed good calibration in both development and validation subsamples, while PM-2 outperformed PM-1. The discrimination of PM-2 was better than PM-1 in the development subsample, with an optimism-corrected area under the curve (AUC) of 0.95 and 0.77, respectively. Application of PM-2 in the validation subsample presented good discrimination with an AUC of 0.9727. The decision curve demonstrated that PM-2 was clinically useful. CONCLUSION This study proposed a predictive model for distal SINE incorporating the CT-based VSA. This predictive model could efficiently predict the risk of distal SINE and thus might contribute to personalized intervention planning. CLINICAL RELEVANCE STATEMENT This study established a predictive model to evaluate the risk of distal SINE based on the pre-stenting CT dataset and planned device information. With an accurate VSA tool, the predictive model could help to improve the safety of the endovascular repair procedure. KEY POINTS • Clinically useful prediction models for distal stent-induced new entry are still lacking, and the safety of the stent implantation is hard to guarantee. • Our proposed predictive tool based on a virtual stenting algorithm supports different stenting planning rehearsals and real-time risk evaluation, guiding clinicians to optimize the presurgical plan when necessary. • The established prediction model provides accurate risk evaluation for vessel damage, improving the safety of the intervention procedure.
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Affiliation(s)
- Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Dianpeng Wang
- School of Mathematics, Beijing Institute of Technology, Beijing, China
| | - Xuyang Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ziheng Wu
- Department of Vascular Surgery, First Affiliated Hospital of Medical College, Zhejiang University, Zhejiang, China
| | - Zipeng Wen
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Yiannis Ventikos
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Department of Mechanical Engineering, University College London, London, UK
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China.
- Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
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Lu Y, Ding C, Tan S, Zhou X, Wang Y. Predisposing factors for the deformation of parent artery of anterior circulation saccular aneurysm after stent-assisted embolization: A retrospective cohort study. Interv Neuroradiol 2023; 29:243-250. [PMID: 35238673 PMCID: PMC10369118 DOI: 10.1177/15910199221084797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It has been previously reported in several studies that deformation of parent artery (DPA) occurs after stent-assisted coil embolization (SACE) for intracranial aneurysms (IAs). OBJECTIVE To investigate the predisposing factors of stent-induced DPA, as well as its effect on the follow-up of aneurysm embolization. METHODS Clinical and imaging data were collected from 198 patients (201 aneurysms). Angles of the stent-covered parental artery were measured before treatment and during follow-up. Cases in which the angle had changed more than 5 degrees, were defined as DPA. The related factors of DPA were analyzed. The relation between DPA and follow-up results was also studied. RESULTS Univariate analysis revealed that sex (p = 0.014), age (p = 0.017), aneurysm location (p < 0.001), stent type (p < 0.001), aneurysm size (p = 0.019), and pretreatment angle (p = 0.002) correlated with DPA. On the other hand, multivariate analysis revealed that aneurysms located in the anterior communicating artery (ACOA) (OR = 4.559, p = 0.013) and middle cerebral artery (MCA) (OR = 9.474, p < 0.001) were independent predisposing factors for DPA after stent implantation, whereas a braided stent (OR = 0.221, p = 0.030), flow diverter (FD) device (OR = 0.100, p = 0.028) were negative factors to develop DPA. The complete occlusion rate in the DPA group was higher (p = 0.035) than in the non-DPA group. CONCLUSIONS Aneurysms located in ACOA and MCA are more prone to DPA after SACE than aneurysms at other locations in the anterior circulation, braided stents and FD devices do not predispose to induce vascular deformation. DPA may be beneficial for the long-term cure of IAs after SACE.
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Affiliation(s)
- Yuzhao Lu
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Cong Ding
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Song Tan
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Xiaobing Zhou
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Bisighini B, Aguirre M, Biancolini ME, Trovalusci F, Perrin D, Avril S, Pierrat B. Machine learning and reduced order modelling for the simulation of braided stent deployment. Front Physiol 2023; 14:1148540. [PMID: 37064913 PMCID: PMC10090671 DOI: 10.3389/fphys.2023.1148540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Endoluminal reconstruction using flow diverters represents a novel paradigm for the minimally invasive treatment of intracranial aneurysms. The configuration assumed by these very dense braided stents once deployed within the parent vessel is not easily predictable and medical volumetric images alone may be insufficient to plan the treatment satisfactorily. Therefore, here we propose a fast and accurate machine learning and reduced order modelling framework, based on finite element simulations, to assist practitioners in the planning and interventional stages. It consists of a first classification step to determine a priori whether a simulation will be successful (good conformity between stent and vessel) or not from a clinical perspective, followed by a regression step that provides an approximated solution of the deployed stent configuration. The latter is achieved using a non-intrusive reduced order modelling scheme that combines the proper orthogonal decomposition algorithm and Gaussian process regression. The workflow was validated on an idealized intracranial artery with a saccular aneurysm and the effect of six geometrical and surgical parameters on the outcome of stent deployment was studied. We trained six machine learning models on a dataset of varying size and obtained classifiers with up to 95% accuracy in predicting the deployment outcome. The support vector machine model outperformed the others when considering a small dataset of 50 training cases, with an accuracy of 93% and a specificity of 97%. On the other hand, real-time predictions of the stent deployed configuration were achieved with an average validation error between predicted and high-fidelity results never greater than the spatial resolution of 3D rotational angiography, the imaging technique with the best spatial resolution (0.15 mm). Such accurate predictions can be reached even with a small database of 47 simulations: by increasing the training simulations to 147, the average prediction error is reduced to 0.07 mm. These results are promising as they demonstrate the ability of these techniques to achieve simulations within a few milliseconds while retaining the mechanical realism and predictability of the stent deployed configuration.
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Affiliation(s)
- Beatrice Bisighini
- Mines Saint-Étienne, University Lyon, University Jean Monnet, INSERM, Saint-Étienne, France
- Predisurge, Grande Usine Creative 2, Saint-Etienne, France
- Department of Enterprise Engineering, University Tor Vergata, Rome, Italy
| | - Miquel Aguirre
- Mines Saint-Étienne, University Lyon, University Jean Monnet, INSERM, Saint-Étienne, France
- Laboratori de Càlcul Numèric, Universitat Politècnica de Catalunya, Barcelona, Spain
- International Centre for Numerical Methods in Engineering (CIMNE), Gran Capità, Barcelona, Spain
| | | | | | - David Perrin
- Predisurge, Grande Usine Creative 2, Saint-Etienne, France
| | - Stéphane Avril
- Mines Saint-Étienne, University Lyon, University Jean Monnet, INSERM, Saint-Étienne, France
| | - Baptiste Pierrat
- Mines Saint-Étienne, University Lyon, University Jean Monnet, INSERM, Saint-Étienne, France
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7
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Tong X, Shan Y, Leng X, Chen J, Fiehler J, Siddiqui AH, Hu X, Liu A, Xiang J. Predicting flow diverter sizing using the AneuGuide TM software: a validation study. J Neurointerv Surg 2023; 15:57-62. [PMID: 35039401 DOI: 10.1136/neurintsurg-2021-018353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Stent sizing remains a challenging task for flow diverter implantation because of stent foreshortening. In this study, we aimed to quantify the change in length after implantation and assess the error in length prediction using AneuGuideTM software. METHODS In a retrospective cohort of 101 patients with 102 aneurysms undergoing treatment with a pipeline embolization device (PED; Covidien, Irvine, California, USA), we used AneuGuideTM software to obtain measured lengths (ML) and calculated lengths (CL) after stent implantation. Stent elongation was defined as the ratio of ML-LL to the labeled length (LL). Simulation error was defined as the ratio of the absolute value of CL-ML to ML. The correlation and consistency between ML and LL and between ML and CL were analyzed using Pearson's correlation test and the Bland-Altman plot. Statistical significance was set at p<0.05. RESULTS The mean elongation of ML was 32.6% (range 26.3-109.2%). Moderate consistency was observed between LL and ML (ρ=0.74, p<0.001). With the AneuGuideTM software, the mean simulation error was 6.6% (range 0.32-21.2%). Pearson's correlation test and the Bland-Altman plot showed a high correlation and consistency between ML and CL (ρ=0.96, p<0.001). CONCLUSION Labeled length provides only a low reference value for predicting the actual length of the flow diverter after implantation. The high consistency between ML and CL obtained from AneuGuideTM software shows its great potential for the optimization of the flow diverter sizing process.
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Affiliation(s)
- Xin Tong
- Neurointervention Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Yejie Shan
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | | | - Jigang Chen
- Neurointervention Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aihua Liu
- Neurointervention Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
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Kishore K, Bodani V, Olatunji RB, Spears J, Marotta TR, Pereira VM. PREDICT: Precise deployment of Silk Vista Baby in confined territory: A technical note. Interv Neuroradiol 2022:15910199221142640. [PMID: 36457289 DOI: 10.1177/15910199221142640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Flow diverters (FD) have become increasingly useful in treating complex intracranial aneurysms, particularly wide-necked and recurrent aneurysms. Their use has progressively expanded to smaller vessels beyond the circle of Willis (CoW), and Silk Vista Baby (SVB) is one such low-profile FD which stands out because of deliverability through a 0.017″ microcatheter and smoother navigability. Precise deployment of SVB, specifically, the proximal end, can be challenging in certain anatomical locations when the proximal landing zone is very short, limited by vessel bifurcation or important branches arising from the artery or its geometry. We present our series to describe our technique and rule to 'PREDICT' the final deployment of SVB in real time, and discuss the nuances, exceptions and bail-out strategies. Using this technique, we were able to precisely deploy SVB in distal intracranial vessels with a mean proximal landing zone as short as 2.6 mm in 80% instances, requiring bail-out strategies in only 20% cases. This rule can be reliably followed in treating complex intracranial aneurysms with SVB FD within a confined territory, until validated software-based real-time planning tools are developed.
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Affiliation(s)
- Kislay Kishore
- Division of Neurosurgery, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
- Division of Interventional Neuroradiology, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Vivek Bodani
- Division of Neurosurgery, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
- Division of Interventional Neuroradiology, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Richard B Olatunji
- Division of Interventional Neuroradiology, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Julian Spears
- Division of Neurosurgery, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Thomas R Marotta
- Division of Interventional Neuroradiology, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Vitor Mendes Pereira
- Division of Neurosurgery, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
- Division of Interventional Neuroradiology, 10071St. Michael's Hospital, University of Toronto, Toronto, Canada
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9
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Patankar T, Madigan J, Downer J, Sonwalkar H, Cowley P, Iori F. How precise is PreSize Neurovascular? Accuracy evaluation of flow diverter deployed-length prediction. J Neurosurg 2022; 137:1072-1080. [PMID: 35120310 DOI: 10.3171/2021.12.jns211687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of flow-diverting stents has been increasingly important in intracranial aneurysm treatment. However, accurate sizing and landing zone prediction remain challenging. Inaccurate sizing can lead to suboptimal deployment, device waste, and complications. This study presents stent deployment length predictions offered in medical software (PreSize Neurovascular) that provides physicians with real-time planning support, allowing them to preoperatively "test" different devices in the patient's anatomy in a safe virtual environment. This study reports the software evaluation methodology and accuracy results when applied to real-world data from a wide range of cases and sources as a necessary step in demonstrating its reliability, prior to impact assessment in prospective clinical practice. METHODS Imaging data from 138 consecutive stent cases using the Pipeline embolization device were collected from 5 interventional radiology centers in the United Kingdom and retrospectively analyzed. Prediction accuracy was calculated as the degree of agreement between stent deployed length measured intraoperatively and simulated in the software. RESULTS The software predicted the deployed stent length with a mean accuracy of 95.61% (95% confidence interval [CI] 94.87%-96.35%), the highest reported accuracy in clinical stent simulations to date. By discounting 4 outlier cases, in which events such as interactions with coils and severe push/pull maneuvers impacted deployed length to an extent the software was not able to simulate or predict, the mean accuracy further increases to 96.13% (95% CI 95.58%-96.69%). A wide discrepancy was observed between labeled and measured deployed stent length, in some cases by more than double, with no demonstrable correlation between device dimensions and deployment elongation. These findings illustrate the complexity of stent behavior and need for simulation-assisted sizing for optimal surgical planning. CONCLUSIONS The software predicts the deployed stent length with excellent accuracy and could provide physicians with real-time accurate device selection support.
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Affiliation(s)
- Tufail Patankar
- 1Department of Neuroradiology, Leeds Teaching Hospital, Leeds
| | - Jeremy Madigan
- 2Atkinson Morley Neurosciences Centre, St. George's University Hospital, London
| | - Jonathan Downer
- 3Royal Infirmary of Edinburgh, Department of Clinical Neurosciences, Edinburgh
| | - Hemant Sonwalkar
- 4Department of Neuroradiology, Lancashire Teaching Hospitals, Preston
| | - Peter Cowley
- 5Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London; and
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10
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Coorey G, Figtree GA, Fletcher DF, Snelson VJ, Vernon ST, Winlaw D, Grieve SM, McEwan A, Yang JYH, Qian P, O'Brien K, Orchard J, Kim J, Patel S, Redfern J. The health digital twin to tackle cardiovascular disease-a review of an emerging interdisciplinary field. NPJ Digit Med 2022; 5:126. [PMID: 36028526 PMCID: PMC9418270 DOI: 10.1038/s41746-022-00640-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Potential benefits of precision medicine in cardiovascular disease (CVD) include more accurate phenotyping of individual patients with the same condition or presentation, using multiple clinical, imaging, molecular and other variables to guide diagnosis and treatment. An approach to realising this potential is the digital twin concept, whereby a virtual representation of a patient is constructed and receives real-time updates of a range of data variables in order to predict disease and optimise treatment selection for the real-life patient. We explored the term digital twin, its defining concepts, the challenges as an emerging field, and potentially important applications in CVD. A mapping review was undertaken using a systematic search of peer-reviewed literature. Industry-based participants and patent applications were identified through web-based sources. Searches of Compendex, EMBASE, Medline, ProQuest and Scopus databases yielded 88 papers related to cardiovascular conditions (28%, n = 25), non-cardiovascular conditions (41%, n = 36), and general aspects of the health digital twin (31%, n = 27). Fifteen companies with a commercial interest in health digital twin or simulation modelling had products focused on CVD. The patent search identified 18 applications from 11 applicants, of which 73% were companies and 27% were universities. Three applicants had cardiac-related inventions. For CVD, digital twin research within industry and academia is recent, interdisciplinary, and established globally. Overall, the applications were numerical simulation models, although precursor models exist for the real-time cyber-physical system characteristic of a true digital twin. Implementation challenges include ethical constraints and clinical barriers to the adoption of decision tools derived from artificial intelligence systems.
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Affiliation(s)
- Genevieve Coorey
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia. .,The George Institute for Global Health, Sydney, NSW, Australia.
| | - Gemma A Figtree
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.,Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David F Fletcher
- University of Sydney, School of Chemical and Biomolecular Engineering, Sydney, NSW, Australia
| | - Victoria J Snelson
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.,University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - Stephen Thomas Vernon
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David Winlaw
- Cincinnati Children's Hospital Medical Cente, Cincinnati, OH, USA
| | - Stuart M Grieve
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.,University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - Alistair McEwan
- The University of Sydney, School of Biomedical Engineering, Sydney, NSW, Australia
| | - Jean Yee Hwa Yang
- University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - Pierre Qian
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.,Westmead Applied Research Centre, Westmead Hospital, Sydney, NSW, Australia
| | - Kieran O'Brien
- Siemens Healthcare Pty Ltd; and Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - Jessica Orchard
- University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - Jinman Kim
- University of Sydney, School of Computer Science, Sydney, NSW, Australia
| | - Sanjay Patel
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Heart Research Institute, Sydney, NSW, Australia
| | - Julie Redfern
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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11
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Simulation of intra-saccular devices for pre-operative device size selection: Method and validation for sizing and porosity simulation. Comput Biol Med 2022; 147:105744. [PMID: 35763930 DOI: 10.1016/j.compbiomed.2022.105744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022]
Abstract
Intra-saccular devices (ID) are novel braided devices used for complex intracranial aneurysms treatment. Treatment success is associated with correct device size selection. A technique that predicts the ID size within the aneurysm before intervention will provide a powerful computational tool to aid the interventionist during device selection. We present a method to calculate the device's final height, radial expansion and porosity within the patient's anatomy, which allows assessing different device sizes before treatment takes place. The proposed sizing technique was tested in-vitro and in real patient's geometries obtained from 3DRA angiographic images of 8 unruptured aneurysms previously treated with IDs. The obtained simulated height was compared to the real height, with a mean error of less than 0.28 mm (±0.44). The porosity calculation method was tested in-vitro with an error of 0.02 (±0.022). The results of both sizing and porosity experiments resemble well measures from real patients. This methodology could be used before treatment to provide the interventionist with additional information that allows selecting the device that best fits the patient's aneurysm to be treated.
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12
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Xu J, Karmonik C, Yu Y, Lv N, Shi Z, Liu JM, Huang Q. Modeling Flow Diverters using a Porous Medium Approach: A Fast Alternative to Virtual Flow Diverter Deployment. World Neurosurg 2022; 164:e501-e508. [PMID: 35552028 DOI: 10.1016/j.wneu.2022.04.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and eliminating the aneurysm. Numerical simulations based on virtual FD deployment allow the assessment of the complex nature of aneurismal flow changes before the actual intervention but are demanding on computational resources. Here, we evaluate an alternative strategy of modeling FD effects for the Tubridge system using a porous medium. The goal of this study is to reduce demands on time and complexity of the simulation procedure for applications in clinical research. METHODS Ten patient-specific aneurysm models were reconstructed from retrospectively collected diagnostic 3D-DSA images. Virtual FDs were deployed (SolidWorks, Meshmixer) and corresponding porous medium patches were constructed at the ostium with a research CFD prototype (Siemens Healthineers, Forchheim, Germany). Hemodynamic conditions were simulated in two approaches. RESULTS Hemodynamics inside the aneurysm based on these two approaches were compared. Both approaches yielded similar results. Mean wall shear stress (WSS) and mean pressure of the aneurysmal wall correlated significantly (r=0.8, r=1.0, p-value<0.05) as did mean velocity, mean pressure at a region inside the aneurysm, at the ostium and at a cross section containing the main vertex (for velocities r=0.9; for pressures r=1.0, p-value<0.05). The use of porous medium patches reduced the preparation and simulation time together by approximately 50%. CONCLUSION Using a porous medium approach yields comparable mean values for hemodynamic alterations compared to direct virtual FD simulations. Additionally, the porous medium approach greatly reduced the modeling complexity and computation time.
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Affiliation(s)
- Jinyu Xu
- From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Christof Karmonik
- Translational Imaging Center, MRI core, Houston Methodist Research Institute, Houston TX, USA
| | - Ying Yu
- From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Nan Lv
- From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhaoyue Shi
- Translational Imaging Center, MRI core, Houston Methodist Research Institute, Houston TX, USA
| | - Jian-Min Liu
- From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Qinghai Huang
- From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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13
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Pionteck A, Pierrat B, Gorges S, Albertini JN, Avril S. Evaluation and Verification of Fast Computational Simulations of Stent-Graft Deployment in Endovascular Aneurysmal Repair. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:704806. [PMID: 35047943 PMCID: PMC8757824 DOI: 10.3389/fmedt.2021.704806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
Fenestrated Endovascular Aortic Repair, also known as FEVAR, is a minimally invasive procedure that allows surgeons to repair the aorta while still preserving blood flow to kidneys and other critical organs. Given the high complexity of FEVAR, there is a pressing need to develop numerical tools that can assist practitioners at the preoperative planning stage and during the intervention. The aim of the present study is to introduce and to assess an assistance solution named Fast Method for Virtual Stent-graft Deployment for computer assisted FEVAR. This solution, which relies on virtual reality, is based on a single intraoperative X-ray image. It is a hybrid method that includes the use of intraoperative images and a simplified mechanical model based on corotational beam elements. The method was verified on a phantom and validated on three clinical cases, including a case with fenestrations. More specifically, we quantified the errors induced by the different simplifications of the mechanical model, related to fabric simulation and aortic wall mechanical properties. Overall, all errors for both stent and fenestration positioning were less than 5 mm, making this method compatible with clinical expectations. More specifically, the errors related to fenestration positioning were less than 3 mm. Although requiring further validation with a higher number of test cases, our method could achieve an accuracy compatible with clinical specifications within limited calculation time, which is promising for future implementation in a clinical context.
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Affiliation(s)
- Aymeric Pionteck
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France.,THALES, Microwave & Imaging Sub-Systems, Moirans, France
| | - Baptiste Pierrat
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | | | - Jean-Noël Albertini
- INSERM, U1059 Sainbiose and University Hospital of Saint-Etienne, Univ Jean Monnet, Saint-Etienne, France
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
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14
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Berti F, Antonini L, Poletti G, Fiuza C, Vaughan TJ, Migliavacca F, Petrini L, Pennati G. How to Validate in silico Deployment of Coronary Stents: Strategies and Limitations in the Choice of Comparator. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:702656. [PMID: 35047942 PMCID: PMC8757815 DOI: 10.3389/fmedt.2021.702656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
This study aims at proposing and discussing useful indications to all those who need to validate a numerical model of coronary stent deployment. The proof of the reliability of a numerical model is becoming of paramount importance in the era of in silico trials. Recently, the ASME V&V Standard Committee for medical devices prepared the V&V 40 standard document that provides a framework that guides users in establishing and assessing the relevance and adequacy of verification and validation activities performed for proving the credibility of models. To the knowledge of the authors, only a few examples of the application of the V&V 40 framework to medical devices are available in the literature, but none about stents. Specifically, in this study, the authors wish to emphasize the choice of a relevant set of experimental activities to provide data for the validation of computational models aiming to predict coronary stent deployment. Attention is focused on the use of ad hoc 3D-printed mock vessels in the validation plan, which could allow evaluating aspects of clinical relevance in a representative but controlled environment.
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Affiliation(s)
- Francesca Berti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Luca Antonini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Gianluca Poletti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Constantino Fiuza
- Biomechanics Research Center (BioMEC), Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Galway, Ireland
| | - Ted J Vaughan
- Biomechanics Research Center (BioMEC), Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Galway, Ireland
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milan, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
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15
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Cerebral aneurysm flow diverter modeled as a thin inhomogeneous porous medium in hemodynamic simulations. Comput Biol Med 2021; 139:104988. [PMID: 34717230 DOI: 10.1016/j.compbiomed.2021.104988] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022]
Abstract
Rapid and accurate simulation of cerebral aneurysm flow modifications by flow diverters (FDs) can help improving patient-specific intervention and predicting treatment outcome. However, when FD devices are explicitly represented in computational fluid dynamics (CFD) simulations, flow around the stent wires must be resolved, leading to high computational cost. Classic porous medium (PM) methods can reduce computational expense but cannot capture the inhomogeneous FD wire distribution once implanted on a cerebral artery and thus cannot accurately model the post-stenting aneurysmal flow. We report a novel approach that models the FD flow modification as a thin inhomogeneous porous medium (iPM). It improves over the classic PM approaches in two ways. First, the FD is more appropriately treated as a thin screen, which is more accurate than the classic 3D-PM-based Darcy-Forchheimer relation. Second, pressure drop is calculated cell-by-cell using the local FD geometric parameters across an inhomogeneous PM. We applied the iPM technique to simulating the post-stenting hemodynamics of three patient-specific aneurysms. To test its accuracy and speed, we compared the results from the iPM technique against CFD simulations with explicit FD devices. The iPM CFD ran 500% faster than the explicit CFD while achieving 94%-99% accuracy; thus, iPM is a promising clinical bedside modeling tool to assist endovascular interventions with FD and stents.
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16
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Djukic T, Saveljic I, Pelosi G, Parodi O, Filipovic N. A study on the accuracy and efficiency of the improved numerical model for stent implantation using clinical data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106196. [PMID: 34091419 DOI: 10.1016/j.cmpb.2021.106196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Stent implantation procedure should be carefully planned and adapted to the particular patient in order to minimize possible complications. Numerical simulations can provide useful quantitative data about the state of the artery after the implantation, as well as information about the benefits of the intervention from the hemodynamical point of view. METHODS In this paper, a numerical model for stent implantation is presented. This numerical model simulates the stent expansion, the interaction of the stent with arterial wall and the deformation of the arterial wall under the influence of the stent. FE method was used to perform CFD simulations and the effects of stenting were analyzed by comparing the hemodynamic parameters before and after stent implantation. RESULTS Clinical data for overall 34 patients was used for the simulations, and for 9 of them data from follow up examinations was used to validate the results of simulations of stent implantation. CONCLUSIONS The good agreement of results (less than 4.1% of SD error for all the 9 validation cases) demonstrated the accuracy of the presented numerical model. The developed approach can be a valuable tool for the improvement of pre-operative planning and patient-specific treatment optimization.
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Affiliation(s)
- Tijana Djukic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Institute for Information Technologies, University of Kragujevac, Jovana Cvijica bb, 34000 Kragujevac, Serbia.
| | - Igor Saveljic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Institute for Information Technologies, University of Kragujevac, Jovana Cvijica bb, 34000 Kragujevac, Serbia.
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
| | - Oberdan Parodi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
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17
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Dazeo N, Muñoz R, Narata AP, Fernandez H, Larrabide I. Intra-saccular device modeling for treatment planning of intracranial aneurysms: from morphology to hemodynamics. Int J Comput Assist Radiol Surg 2021; 16:1663-1673. [PMID: 34195929 DOI: 10.1007/s11548-021-02427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
MOTIVATION Intra-saccular devices (ID), developed for the treatment of bifurcation aneurysms, offer new alternatives for treating complex terminal and bifurcation aneurysms. In this work, a complete workflow going from medical images to post-treatment CFD analysis is described and used in the assessment of a concrete clinical problem. MATERIALS AND METHODS Two different intra-saccular device sizes were virtually implanted in 3D models of the patient vasculature using the ID-Fit method. After deployment, the local porosity at the closed end of the device in contact with the blood flow was computed. This porosity was then used to produce a CFD porous medium model of the device. Velocities and wall shear stress were assessed for each model. RESULTS Six patients treated with intra-saccular devices were included in this work. For each case, 2 different device sizes were virtually implanted and 3 CFD simulations were performed: after deployment simulation with each size and before deployment simulation (untreated). A visible reduction in velocities was observed after device implantation. Velocity and WSS reduction was statistically significant (K-S statistics, [Formula: see text]). CONCLUSIONS Placement of different device size can lead to a partial filling of the aneurysm, either at the dome or at the neck, depending on the particular positioning by the interventionist. The methodology used in this work can have a strong clinical impact, since it provides additional information in the process of device selection using preoperative data.
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Affiliation(s)
- Nicolás Dazeo
- Instituto Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.
| | - Romina Muñoz
- Instituto Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Ana Paula Narata
- Neuroradiology Department, University Hospital of Southampton, Southampton, UK
| | | | - Ignacio Larrabide
- Instituto Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.,Galgo Medical S.L., Barcelona, Spain
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18
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In-silico trial of intracranial flow diverters replicates and expands insights from conventional clinical trials. Nat Commun 2021; 12:3861. [PMID: 34162852 PMCID: PMC8222326 DOI: 10.1038/s41467-021-23998-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/25/2021] [Indexed: 01/18/2023] Open
Abstract
The cost of clinical trials is ever-increasing. In-silico trials rely on virtual populations and interventions simulated using patient-specific models and may offer a solution to lower these costs. We present the flow diverter performance assessment (FD-PASS) in-silico trial, which models the treatment of intracranial aneurysms in 164 virtual patients with 82 distinct anatomies with a flow-diverting stent, using computational fluid dynamics to quantify post-treatment flow reduction. The predicted FD-PASS flow-diversion success rates replicate the values previously reported in three clinical trials. The in-silico approach allows broader investigation of factors associated with insufficient flow reduction than feasible in a conventional trial. Our findings demonstrate that in-silico trials of endovascular medical devices can: (i) replicate findings of conventional clinical trials, and (ii) perform virtual experiments and sub-group analyses that are difficult or impossible in conventional trials to discover new insights on treatment failure, e.g. in the presence of side-branches or hypertension. In-silico trials rely on virtual populations and interventions simulated using patient-specific models and may offer a solution to lower costs. Here, the authors present the flow diverter performance assessment in-silico trial, which models the treatment of intracranial aneurysms with a flow-diverting stent.
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19
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Fast virtual coiling algorithm for intracranial aneurysms using pre-shape path planning. Comput Biol Med 2021; 134:104496. [PMID: 34077817 DOI: 10.1016/j.compbiomed.2021.104496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 09/30/2022]
Abstract
To aid in predicting and improving treatment outcome of endovascular coiling of intracranial aneurysms, simulation of patient-specific coil deployment should be both accurate and fast. We developed a fast virtual coiling algorithm called Pre-shape Path Planning (P3). It captures the mechanical propensity of a released coil to restore its pre-shape for bending energy minimization, producing coils without unrealistic kinks and bends. A coil is discretized into finite-length segments and extruded from the delivery catheter segment-by-segment following a generic coil pre-shape. With the release of each segment, coil-wall and coil-coil collisions are detected and resolved. Modeling of each case took seconds to minutes. To test the algorithm, we evaluated its output against the literature, experiments, and patient angiograms. The periphery-to-core ratio of coils deployed by P3 decreased with increasing coil packing density, consistent with observations in the literature. Coils deployed by P3 compared well with in vitro experiments, free from unphysical kinks and loops that arose from previous virtual coiling algorithms. Simulations of coiling in four patient-specific aneurysms agreed well with the patient angiograms. To test the influence of coil pre-shape on P3, we performed hemodynamic simulations in aneurysms with coils deployed by P3 using the generic pre-shape, P3 using a coil-specific pre-shape, and full finite-element-method simulation. We found that the generic pre-shape was sufficient to produce results comparable to virtual coiling by finite element modeling. Based on these findings, P3 can rapidly simulate coiling in patient-specific aneurysms with good accuracy and is thus a potential candidate for clinical treatment planning.
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20
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Dazeo N, Dottori J, Boroni G, Narata AP, Larrabide I. Stenting as porous media in anatomically accurate geometries. A comparison of models and spatial heterogeneity. J Biomech 2020; 110:109945. [PMID: 32827768 DOI: 10.1016/j.jbiomech.2020.109945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Modelling intracranial aneurysm blood flow after flow diverter treatment has proven to be of great scientific and clinical interest. One of the reasons for not having CFD as an everyday clinical tool yet is the time required to set-up such simulations plus the required computational time. The speed-up of these simulations can have a considerable impact during treatment planning and device selection. Modelling flow diverters as a porous medium (PM) can considerably improve the computational time. Many models have been presented in literature, but quantitative comparisons between models are scarce. In this study, the untreated case, the explicit definition of the flow diverter wires as no-slip boundary condition and five different porous medium models were chosen for comparison, and evaluated on intracranial aneurysm of 14 patients with different shapes, sizes, and locations. CFD simulations were made using finite volume method on steady flow conditions. Velocities, kinetic energy, wall shear stress, and computational time were assessed for each model. Then, all models are compared against the no-slip boundary condition using non parametric Kolmogorov-Smirnov test. The model with least performance showed a mean K-S statistic of 0.31 and deviance of 0.2, while the model with best values always gave K-S statistics below 0.2. Kinetic energy between PM models varied between an over estimation of 218.3% and an under estimation of 73.06%. Also, speedups were between 4.75x and 5.3x (stdev: 0.38x and 0.15x) when using PM models. Flow diverters can be simulated with PM with a good agreement to standard CFD simulations were FD wires are represented with no-slip boundary condition in less than a quarter of the time. Best results were obtained on PM models based on geometrical properties, in particular, when using a heterogeneous medium based on equations for flat rhomboidal wire frames.
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Affiliation(s)
- Nicolás Dazeo
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina.
| | - Javier Dottori
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Boroni
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Ana Paula Narata
- University Hospital of Tours, UMR Imagerie et Cerveau, Inserm U930, Université François-Rabelais, Tours, France
| | - Ignacio Larrabide
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
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21
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Závodszky G, Csippa B, Paál G, Szikora I. A novel virtual flow diverter implantation method with realistic deployment mechanics and validated force response. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3340. [PMID: 32279440 PMCID: PMC7317397 DOI: 10.1002/cnm.3340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Virtual flow diverter deployment techniques underwent significant development during the last couple of years. Each existing technique displays advantageous features, as well as significant limitations. One common drawback is the lack of quantitative validation of the mechanics of the device. In the following work, we present a new spring-mass-based method with validated mechanical responses that combines many of the useful capabilities of previous techniques. The structure of the virtual braids naturally incorporates the axial length changes as a function of the local expansion diameter. The force response of the model was calibrated using the measured response of real FDs. The mechanics of the model allows to replicate the expansion process during deployment, including additional effects such as the push-pull technique that is required for the deployment of braided FDs to achieve full opening and proper wall apposition. Furthermore, it is a computationally highly efficient solution that requires little pre-processing and has a run-time of a few seconds on a general laptop and thus allows for exploratory analyses. The model was applied in a patient-specific geometry, where corresponding accurate control measurements in a 3D-printed model were also available. The analysis shows the effects of FD oversizing and push-pull application on the radial expansion, surface density, and on the wall contact pressure.
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Affiliation(s)
- Gábor Závodszky
- Computational Science Lab, Faculty of Science, Institute for InformaticsUniversity of AmsterdamAmsterdamNetherlands
- Department of Hydrodynamic SystemsBudapest University of Technology and EconomicsBudapestHungary
| | - Benjámin Csippa
- Department of Hydrodynamic SystemsBudapest University of Technology and EconomicsBudapestHungary
| | - György Paál
- Department of Hydrodynamic SystemsBudapest University of Technology and EconomicsBudapestHungary
| | - István Szikora
- Department of NeurointerventionsNational Institute of Clinical NeurosciencesBudapestHungary
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22
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Cai Y, Meng Z, Jiang Y, Zhang X, Yang X, Wang S. Finite element modeling and simulation of the implantation of braided stent to treat cerebral aneurysm. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2020. [DOI: 10.1016/j.medntd.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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Narata AP, Moura F, Larrabide I, Chapot R, Cognard C, Januel AC, Velasco S, Bouakaz A, Patat F, Marzo A. Role of distal cerebral vasculature in vessel constriction after aneurysm treatment with flow diverter stents. J Neurointerv Surg 2020; 12:818-826. [PMID: 31900352 DOI: 10.1136/neurintsurg-2019-015447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Treatment of intracranial aneurysms with flow diverter stent (FDS) procedures can lead to caliber changes of jailed vessels. The reason some branches remain unchanged and others are affected by narrowing remains unknown. OBJECTIVE To investigate the influence of resistance to flow from distal vasculature on stent-induced hemodynamic modifications affecting bifurcating vessels. MATERIALS AND METHODS Radiological images and demographic data were acquired for 142 aneurysms treated with a FDS. Vascular resistance was estimated from patient-specific anatomic data. Correlation analysis was used to identify correspondence between anatomic data and clinical outcome. Computational Fluid Dynamics was performed on a typical patient-specific model to evaluate the influence of FDS on flow. Relevant hemodynamic variables along the bifurcating vessels were quantitatively analyzed and validated with in vitro data obtained using power Doppler ultrasound. RESULTS Statistical analysis showed a correlation between clinical outcome and FDS resistance to flow considering overall jailed vessel vascular resistance (r=0.5, P<0.001). Computational predictions of blood flow showed that hemodynamics is minimally affected by FDS treatment in the ophthalmic artery. CONCLUSIONS Jailed vessels are affected by narrowing when resistance to flow from the FDS constitutes a larger proportion of the overall vessel resistance to flow. This knowledge may contribute to better understanding of intracranial hemodynamics after a FDS procedure and reinforce indications for flow diversion in the treatment of intracranial aneurysms.
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Affiliation(s)
- Ana Paula Narata
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Fernando Moura
- Federal University of the ABC Engineering Modeling and Applied Social Sciences Center Sao Bernardo do Campo, Sao Bernardo do Campo, Brazil
| | - Ignacio Larrabide
- PLADEMA-CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - René Chapot
- Department of Neurointerventional Therapy, Krupp Krankenhaus, Germany, Essen, Germany
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | | | - Stéphane Velasco
- Department of Radiology, CHU de Poitiers, Poitiers, Vienne, France
| | - Ayache Bouakaz
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Frederic Patat
- Department of Neuroradiology, University Hospital of Tours, Tours, France
| | - Alberto Marzo
- Department of Mechanical Engineering, Insigneo Institute for in silico medicine, The University of Sheffield, Sheffield, UK
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Joshi KC, Larrabide I, Saied A, Elsaid N, Fernandez H, Lopes DK. Software-based simulation for preprocedural assessment of braided stent sizing: a validation study. J Neurosurg 2019; 131:1423-1429. [PMID: 30497172 DOI: 10.3171/2018.5.jns18976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to validate the use of a software-based simulation for preassessment of braided self-expanding stents in the treatment of wide-necked intracranial aneurysms. METHODS This was a retrospective, observational, single-center study of 13 unruptured and ruptured intracranial aneurysms treated with braided self-expanding stents. Pre- and postprocedural angiographic studies were analyzed. ANKYRAS software was used to compare the following 3 variables: the manufacturer-given nominal length (NL), software-calculated simulated length (SL), and the actual measured length (ML) of the stent. Appropriate statistical methods were used to draw correlations among the 3 lengths. RESULTS In this study, data obtained in 13 patients treated with braided self-expanding stents were analyzed. Data for the 3 lengths were collected for all patients. Error discrepancy was calculated by mean squared error (NL to ML -22.2; SL to ML -6.14, p < 0.05), mean absolute error (NL to ML 3.88; SL to ML -1.84, p < 0.05), and mean error (NL to ML -3.81; SL to ML -1.22, p < 0.05). CONCLUSIONS The ML was usually less than the NL given by the manufacturer, indicating significant change in length in most cases. Computational software-based simulation for preassessment of the braided self-expanding stents is a safe and effective way for accurately calculating the change in length to aid in choosing the right-sized stent for optimal placement in complex intracranial vasculature.
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Affiliation(s)
| | | | - Ahmed Saied
- 3Department of Neurology, Mansoura University, Mansoura, Egypt; and
| | - Nada Elsaid
- 1Department of Neurosurgery, Rush Medical Center, Chicago, Illinois
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Kellermann R, Serowy S, Beuing O, Skalej M. Deployment of flow diverter devices: prediction of foreshortening and validation of the simulation in 18 clinical cases. Neuroradiology 2019; 61:1319-1326. [PMID: 31473786 DOI: 10.1007/s00234-019-02287-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Flow diverter (FD) devices show severe shortening during deployment in dependency of the vessel geometry. Valid information regarding the geometry of the targeted vessel is therefore mandatory for correct device selection, and to avoid complications. But the geometry of diseased tortuous intracranial vessels cannot be measured accurately with standard methods. The goal of this study is to prove the accuracy of a novel virtual stenting method in prediction of the behavior of a FD in an individual vessel geometry. METHODS We applied a virtual stenting method on angiographic 3D imaging data of the specific vasculature of patients, who underwent FD treatment. The planning tool analyzes the local vessel morphology and deploys the FD virtually. We measured in 18 cases the difference between simulated FD length and real FD length after treatment in a landmark-based registration of pre-/post-interventional 3D angiographic datasets. RESULTS The mean value of length deviation of the virtual FD was 2.2 mm (SD ± 1.9 mm) equaling 9.5% (SD ± 8.2%). Underestimated cases present lower deviations compared with overestimated FDs. Flow diverter cases with a nominal device length of 20 mm had the highest prediction accuracy. CONCLUSION The results suggest that the virtual stenting method used in this study is capable of predicting FD length with a clinically sufficient accuracy in advance and could therefore be a helpful tool in intervention planning. Imaging data of high quality are mandatory, while processing and manipulation of the FD during the intervention may impact the accuracy.
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Affiliation(s)
- Robert Kellermann
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany
| | - Steffen Serowy
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany.
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany
| | - Martin Skalej
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany
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Djukic T, Saveljic I, Pelosi G, Parodi O, Filipovic N. Numerical simulation of stent deployment within patient-specific artery and its validation against clinical data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 175:121-127. [PMID: 31104701 DOI: 10.1016/j.cmpb.2019.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND OBJECTIVE One of the most widely adopted endovascular treatment procedures is the stent implantation. The effectiveness of the treatment depends on the appropriate stent expansion. However, it is difficult to accurately predict the outcome of such an endovascular intervention. Numerical simulations represent a useful tool to study the complex behavior of the stent during deployment. This study presents a numerical model capable of simulating this process. METHODS The numerical model consists of three parts: modeling of stent expansion, modeling the interaction of the stent with the arterial wall and the deformation of the arterial wall. The model is able to predict the shapes of both stent and arterial wall during the entire deployment process. Simulations are performed using patient-specific clinical data that ensures more realistic results. RESULTS The numerical simulations of stent deployment are performed using the extracted geometry of the coronary arteries of two patients. The obtained results are validated against clinical data from the follow up examination and both quantitative and qualitative analysis of the results is presented. The areas of several slices of the arterial wall are calculated for all the three states (before, after and follow up) and the standard error of the area when comparing simulation and follow up examination is 5.27% for patient #1 and 4.5% for patient #2. CONCLUSIONS The final goal of numerical simulations in stent deployment should be to provide a clinical tool that is capable of reliably predicting the treatment outcome. This study showed through the good agreement of results of the numerical simulations and clinical data that the presented numerical model represents a step towards this final goal. These simulations can also provide valuable information about distribution of forces and stress in the arterial wall that can improve pre-operative planning and treatment optimization.
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Affiliation(s)
- Tijana Djukic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia.
| | - Igor Saveljic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, 34000 Kragujevac, Serbia.
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
| | - Oberdan Parodi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
| | - Nenad Filipovic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, 34000 Kragujevac, Serbia
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Evaluating the Effectiveness of 2 Different Flow Diverter Stents Based on the Stagnation Region Formation in an Aneurysm Sac Using Lagrangian Coherent Structure. World Neurosurg 2019; 127:e727-e737. [DOI: 10.1016/j.wneu.2019.03.255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
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28
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Nishimura K, Otani K, Mohamed A, Dahmani C, Ishibashi T, Yuki I, Kaku S, Takao H, Murayama Y. Accuracy of Length of Virtual Stents in Treatment of Intracranial Wide-Necked Aneurysms. Cardiovasc Intervent Radiol 2019; 42:1168-1174. [PMID: 31076839 PMCID: PMC6597734 DOI: 10.1007/s00270-019-02230-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022]
Abstract
Background and Purpose Precise stent deployment is important for successful treatment of intracranial aneurysms by stent-assisted coiling (SAC). We evaluated the accuracy of virtual stents generated using commercial stent planning software by comparing the length of virtual and actually deployed intracranial laser cut stents on three-dimensional digital subtraction angiography (3D-DSA) images. Methods We retrospectively analyzed the data of 75 consecutive cases of intracranial wide-necked aneurysms treated with the SAC technique using laser cut stents. Based on 3D-DSA images acquired by C-arm CT, stent sizing and placement were intraoperatively simulated by a commercial software application. The difference in length of the stents was estimated by measuring proximal discrepancies between the end points of the virtual and actually deployed stents on fused pre-procedural and post-procedural 3D-DSA images. Discrepancies between distal stent end points were manually minimized. The Kruskal–Wallis test was applied to test whether stent location, type, and length had an effect on difference in length between virtual and real stent. Results The median difference in length between virtual and real stents was 1.58 mm with interquartile range 1.12–2.12 mm. There was no evidence for an effect of stent location (p = 0.23), stent type (p = 0.33), or stent length (p = 0.53) on difference in length between virtual and real stents. Conclusions Stent planning software allows 3D simulation of laser cut stents overlain on 3D-DSA images of vessels and may thus be useful for stent selection and deployment of laser cut stents during stent-assisted coiling of intracranial aneurysms.
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Affiliation(s)
- Kengo Nishimura
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Katharina Otani
- Siemens Healthcare K.K., Gate City Osaki West Tower, 1-11-1 Osaki, Shinagawa-ku, Tokyo, 141-8644 Japan
| | - Ashraf Mohamed
- Siemens Healthcare K.K., Gate City Osaki West Tower, 1-11-1 Osaki, Shinagawa-ku, Tokyo, 141-8644 Japan
| | - Chihebeddine Dahmani
- Siemens Healthcare Pte Ltd, Surgery Business Line, 60 MacPherson Road, Singapore, 348615 Singapore
| | - Toshihiro Ishibashi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Ichiro Yuki
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Shogo Kaku
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Hiroyuki Takao
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Yuichi Murayama
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
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Paliwal N, Tutino VM, Shallwani H, Beecher JS, Damiano RJ, Shakir HJ, Atwal GS, Fennell VS, Natarajan SK, Levy EI, Siddiqui AH, Davies JM, Meng H. Ostium Ratio and Neck Ratio Could Predict the Outcome of Sidewall Intracranial Aneurysms Treated with Flow Diverters. AJNR Am J Neuroradiol 2019; 40:288-294. [PMID: 30679216 DOI: 10.3174/ajnr.a5953] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Incompletely occluded flow diverter treated aneurysms remain at risk of rupture and thromboembolic complications. Our aim was to identify the potential for incomplete occlusion of intracranial aneurysms treated by flow diverters. We investigated whether aneurysm ostium size in relation to parent artery size affects angiographic outcomes of flow diverter-treated sidewall aneurysms. MATERIALS AND METHODS Flow diverter-treated sidewall aneurysms were divided into "occluded" and "residual" (incomplete occlusion) groups based on 6-month angiographic follow-up. We calculated the ostium ratio, a new parameter defined as the aneurysm ostium surface area versus the circumferential surface area of the parent artery. We also calculated the neck ratio, defined as clinical aneurysm neck diameter versus parent artery diameter from pretreatment 2D DSA, as a 2D surrogate. We compared the performance of these ratios with existing aneurysm morphometrics (size, neck diameter, volume, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, bottleneck factor, aneurysm angle, and parent vessel angle) and flow diverter-related parameters (metal coverage rate and pore density). Statistical tests and receiver operating characteristic analyses were performed to identify significantly different parameters between the 2 groups and test their predictive performances. RESULTS We included 63 flow diverter-treated aneurysms, 46 occluded and 17 residual. The ostium ratio and neck ratio were significantly higher in the residual group than in the occluded group (P < .001 and P = .02, respectively), whereas all other parameters showed no statistical difference. As discriminating parameters for occlusion, ostium ratio and neck ratio achieved areas under the curve of 0.912 (95% CI, 0.838-0.985) and 0.707 (95% CI, 0.558-0.856), respectively. CONCLUSIONS High ostium ratios and neck ratios could predict incomplete occlusion of flow diverter-treated sidewall aneurysms. Neck ratio can be easily calculated by interventionists to predict flow-diverter treatment outcomes.
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Affiliation(s)
- N Paliwal
- From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.).,Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.)
| | - V M Tutino
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Department of Biomedical Engineering (V.M.T., H.M.), University at Buffalo, Buffalo, New York.,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.)
| | - H Shallwani
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - J S Beecher
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - R J Damiano
- From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.).,Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.)
| | - H J Shakir
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - G S Atwal
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - V S Fennell
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - S K Natarajan
- Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - E I Levy
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Radiology (E.I.L., A.H.S.)
| | - A H Siddiqui
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Radiology (E.I.L., A.H.S.).,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute (A.H.S., J.M.D.), Buffalo, New York
| | - J M Davies
- Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.).,Biomedical Informatics (J.M.D.), Jacobs School of Medicine, University at Buffalo, Buffalo, New York.,Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute (A.H.S., J.M.D.), Buffalo, New York
| | - H Meng
- From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.) .,Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.).,Department of Biomedical Engineering (V.M.T., H.M.), University at Buffalo, Buffalo, New York.,Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.)
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Dazeo N, Dottori J, Boroni G, Larrabide I. A comparative study of porous medium CFD models for flow diverter stents: Advantages and shortcomings. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3145. [PMID: 30152120 DOI: 10.1002/cnm.3145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
In computational fluid dynamics, there is a high interest in modeling flow diverter stents as porous media due to its reduced computational loads. One of the main difficulties of such models is proper parameter setup. Most authors assume flow diverter's wire screen as an isotropic and homogeneous medium, while others proposes anisotropic configurations, yet very little is discussed about the effect of these assumptions on model's accuracy. In this paper, we compare the effect of different models on hemodynamics in relation to their parameters. The fidelity and efficiency of the different models to capture wire screen effect on fluid flow are quantitatively analyzed and compared.
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Affiliation(s)
- Nicolás Dazeo
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Javier Dottori
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Boroni
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Larrabide
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
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Chen D, Wei J, Deng Y, Xu H, Li Z, Meng H, Han X, Wang Y, Wan J, Yan T, Xiong J, Tang X. Virtual stenting with simplex mesh and mechanical contact analysis for real-time planning of thoracic endovascular aortic repair. Theranostics 2018; 8:5758-5771. [PMID: 30555579 PMCID: PMC6276306 DOI: 10.7150/thno.28944] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/06/2018] [Indexed: 11/29/2022] Open
Abstract
In aortic endovascular repair, the prediction of stented vessel remodeling informs treatment plans and risk evaluation; however, there are no highly accurate and efficient methods to quantitatively simulate stented vessels. This study developed a fast virtual stenting algorithm to simulate stent-induced aortic remodeling to assist in real-time thoracic endovascular aortic repair planning. Methods: The virtual stenting algorithm was established based on simplex deformable mesh and mechanical contact analysis. The key parameters of the mechanical contact analysis were derived from mechanical tests on aortic tissue (n=40) and commonly used stent-grafts (n=6). Genetic algorithm was applied to select weighting parameters. Testing and validation of the algorithm were performed using pre- and post-treatment computed tomography angiography datasets of type-B aortic dissection cases (n=66). Results: The algorithm was efficient in simulating stent-induced aortic deformation (mean computing time on a single processor: 13.78±2.80s) and accurate at the morphological (curvature difference: 1.57±0.57%; cross-sectional area difference: 4.11±0.85%) and hemodynamic (similarity of wall shear stress-derived parameters: 90.16-90.94%) levels. Stent-induced wall deformation was higher (p<0.05) in distal stent-induced new entry cases than in successfully treated cases, and this deformation did not differ significantly among the different stent groups. Additionally, the high stent-induced wall deformation regions and the new-entry sites overlapped, indicating the usefulness of wall deformation to evaluate the risks of device-induced complications. Conclusion: The novel algorithm provided fast real-time and accurate predictions of stent-graft deployment with luminal deformation tracking, thereby potentially informing individualized stenting planning and improving endovascular aortic repair outcomes. Large, multicenter studies are warranted to extend the algorithm validation and determine stress-induced wall deformation cutoff values for the risk stratification of particular complications.
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32
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Narata AP, Blasco J, Roman LS, Macho JM, Fernandez H, Moyano RK, Winzenrieth R, Larrabide I. Early Results in Flow Diverter Sizing by Computational Simulation: Quantification of Size Change and Simulation Error Assessment. Oper Neurosurg (Hagerstown) 2018; 15:557-566. [PMID: 29351652 DOI: 10.1093/ons/opx288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/20/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sizing of flow diverters (FDs) stent in the treatment of intracranial aneurysms is a challenging task due to the change of stent length after implantation. OBJECTIVE To quantify the size change and assess the error in length prediction in 82 simulated FD deployments. METHODS Eighty-two consecutive patients treated with FDs were retrospectively analyzed. Implanted FD length was measured from angiographic images and compared to the nominal sizes of the implanted device. Length change was obtained by subtracting the nominal length from the real length and dividing by the nominal length. Implanted devices were simulated on 3-dimensional models of each patient. Simulation error was obtained by subtracting real length from simulated length and dividing by the real length of the FD. Subanalysis was done using ANOVA. Statistical significance was set to P < .05, and bootstrap resampling was used. RESULTS When assessing the length change of the FD after implantation, changes of 30% in average and up to 80% with reference to the nominal length of the device were observed. The simulation results showed a lower error of 3.52% in average with a maximum of 30%. Paired t-test showed nonsignificant differences between measured and real length (P = .07, with the mean of differences at 0.45 mm, 95% confidence interval [-0.950 0.038]). CONCLUSION Nominal length is not an accurate sizing metric when choosing the size of an FD irrespective of the brand and manufacturer. Good estimation of the final length of the stent after deployment as expressed by an error of 3.5% in average.
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Affiliation(s)
- Ana Paula Narata
- CHRU Hospitaux de Tours, UMR "Imagerie et Cervau," Inserm U930, Université Francois-Rabelais, Tours, France
| | - Jordi Blasco
- Hospital Clinic Provincial de Barcelona, Barcelona, Spain
| | - Luis San Roman
- Hospital Clinic Provincial de Barcelona, Barcelona, Spain
| | | | | | | | | | - Ignacio Larrabide
- Galgo Medical SL, Barcelona, Spain.,Pladema, CONICET, UNICEN, Tandil, Argentina
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Leng X, Wang Y, Xu J, Jiang Y, Zhang X, Xiang J. Numerical simulation of patient-specific endovascular stenting and coiling for intracranial aneurysm surgical planning. J Transl Med 2018; 16:208. [PMID: 30031395 PMCID: PMC6054731 DOI: 10.1186/s12967-018-1573-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background In this study, we develop reliable and practical virtual coiling and stenting methods for intracranial aneurysm surgical planning. Since the purpose of deploying coils and stents is to provide device geometries for subsequent accurate post-treatment computational fluid dynamics analysis, we do not need to accurately capture all the details such as the stress and force distribution for the devices and vessel walls. Our philosophy for developing these methods is to balance accuracy and practicality. Methods We consider the mechanical properties of the devices and recapitulate the clinical practice using a finite element method (FEM) approach. At the same time, we apply some simplifications for FEM modeling to make our methods efficient. For the virtual coiling, the coils are modeled as 3D Euler–Bernoulli beam elements, which is computationally efficient and provides good geometry representation. During the stent deployment process, the stent–catheter system is transformed according to the centerline of the parent vessel since the final configuration of the stent is not dependent of the deployment history. The aneurysm and vessel walls are assumed to be rigid and are fully constrained during the simulation. All stent–catheter system and coil–catheter system are prepared and packaged as a library which contains all types of stents, coils and catheters, which improves the efficiency of surgical planning process. Results The stent was delivered to the suitable position during the clinical treatment, achieving good expansion and apposition of the stent to the arterial wall. The coil was deployed into the aneurysm sac and deformed to different shapes because of the stored strain energy during coil package process and the direction of the microcatheter. Conclusions The method which we develop here could become surgical planning for intracranial aneurysm treatment in the clinical workflow.
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Affiliation(s)
- Xiaochang Leng
- ArteryFlow Technology Co., Ltd, 459 Qianmo Road, Suite C1-501, Binjiang District, Hangzhou, 310000, Zhejiang Province, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Jing Xu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Yeqing Jiang
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Jianping Xiang
- ArteryFlow Technology Co., Ltd, 459 Qianmo Road, Suite C1-501, Binjiang District, Hangzhou, 310000, Zhejiang Province, China.
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Zhang Q, Liu J, Zhang Y, Zhang Y, Tian Z, Li W, Chen J, Mo X, Cai Y, Paliwal N, Meng H, Wang Y, Wang S, Yang X. Efficient simulation of a low-profile visualized intraluminal support device: a novel fast virtual stenting technique. Chin Neurosurg J 2018; 4:6. [PMID: 32922867 PMCID: PMC7398371 DOI: 10.1186/s41016-018-0112-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/28/2018] [Indexed: 11/17/2022] Open
Abstract
Background The low-profile visualized intraluminal support (LVIS) stent has become a promising endovascular option for treating intracranial aneurysms. To achieve better treatment of aneurysms using LVIS, we developed a fast virtual stenting technique for use with LVIS (F-LVIS) to evaluate hemodynamic changes in the aneurysm and validate its reliability. Methods A patient-specific aneurysm was selected for making comparisons between the real LVIS (R-LVIS) and the F-LVIS. To perform R-LVIS stenting, a hollow phantom based on a patient-specific aneurysm was fabricated using a three-dimensional printer. An R-LVIS was released in the phantom according to standard procedure. F-LVIS was then applied successfully in this aneurysm model. The computational fluid dynamics (CFD) values were calculated for both the F-LVIS and R-LVIS models. Qualitative and quantitative comparisons of the two models focused on hemodynamic parameters. Results The hemodynamic characteristics for R-LVIS and F-LVIS were well matched. Representative contours of velocities and wall shear stress (WSS) were consistently similar in both distribution and magnitude. The velocity vectors also showed high similarity, although the R-LVIS model showed faster and more fluid streams entering the aneurysm. Variation tendencies of the velocity in the aneurysm and the WSS on the aneurysm wall were also similar in the two models, with no statistically significant differences in either velocity or WSS. Conclusions The results of the computational hemodynamics indicate that F-LVIS is suitable for evaluating hemodynamic factors. This novel F-LVIS is considered efficient, practical, and effective.
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Affiliation(s)
- Qianqian Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Junfan Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao Mo
- Capital Medical University School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Beijing, China
| | - Yunhan Cai
- Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Nikhil Paliwal
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York USA.,Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York USA
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Shengzhang Wang
- Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Narata AP, de Moura FS, Larrabide I, Perrault CM, Patat F, Bibi R, Velasco S, Januel AC, Cognard C, Chapot R, Bouakaz A, Sennoga CA, Marzo A. The Role of Hemodynamics in Intracranial Bifurcation Arteries after Aneurysm Treatment with Flow-Diverter Stents. AJNR Am J Neuroradiol 2018; 39:323-330. [PMID: 29170270 DOI: 10.3174/ajnr.a5471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Treatment of intracranial bifurcation aneurysms with flow-diverter stents can lead to caliber changes of the distal vessels in a subacute phase. This study aims to evaluate whether local anatomy and flow disruption induced by flow-diverter stents are associated with vessel caliber changes in intracranial bifurcations. MATERIALS AND METHODS Radiologic images and demographic data were acquired for 25 patients with bifurcation aneurysms treated with flow-diverter stents. Whisker plots and Mann-Whitney rank sum tests were used to evaluate if anatomic data and caliber changes could be linked. Symmetry/asymmetry were defined as diameter ratio 1 = symmetric and diameter ratio <1 = asymmetric. Computational fluid dynamics was performed on idealized and patient-specific anatomies to evaluate flow changes induced by flow-diverter stents in the jailed vessel. RESULTS Statistical analysis identified a marked correspondence between asymmetric bifurcation and caliber change. Symmetry ratios were lower for cases showing narrowing or subacute occlusion (medium daughter vessel diameter ratio = 0.59) compared with cases with posttreatment caliber conservation (medium daughter vessel diameter ratio = 0.95). Computational fluid dynamics analysis in idealized and patient-specific anatomies showed that wall shear stress in the jailed vessel was more affected when flow-diverter stents were deployed in asymmetric bifurcations (diameter ratio <0.65) and less affected when deployed in symmetric anatomies (diameter ratio ∼1.00). CONCLUSIONS Anatomic data analysis showed statistically significant correspondence between caliber changes and bifurcation asymmetry characterized by diameter ratio <0.7 (P < .001). Similarly, computational fluid dynamics results showed the highest impact on hemodynamics when flow-diverter stents are deployed in asymmetric bifurcations (diameter ratio <0.65) with noticeable changes on wall sheer stress fields. Further research and clinical validation are necessary to identify all elements involved in vessel caliber changes after flow-diverter stent procedures.
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Affiliation(s)
- A P Narata
- From the University Hospital of Tours (A.P.N., R.B.), Tours, France
| | - F S de Moura
- Engineering, Modeling, and Applied Social Sciences Center (F.S.d.M.), Federal University of ABC, Santo André, Brazil
| | - I Larrabide
- PLADEMA-CONICET (I.L.), Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - C M Perrault
- Mechanical Engineering Department, INSIGNEO Institute for in Silico Medicine (C.M.P., A.M.), University of Sheffield, Sheffield, United Kingdom
| | - F Patat
- UMR "Imagerie et Cerveau," Inserm U930 (F.P., A.B., C.A.S.), Université Francois Rabelais, Tours, France
| | - R Bibi
- From the University Hospital of Tours (A.P.N., R.B.), Tours, France
| | - S Velasco
- University Hospital of Poitiers (S.V.), Poitiers, France
| | - A-C Januel
- University Hospital of Toulouse (A.-C.J., C.C.), Toulouse, France
| | - C Cognard
- University Hospital of Toulouse (A.-C.J., C.C.), Toulouse, France
| | - R Chapot
- Alfried Krupp Krankenhaus (R.C.), Essen, Germany
| | - A Bouakaz
- UMR "Imagerie et Cerveau," Inserm U930 (F.P., A.B., C.A.S.), Université Francois Rabelais, Tours, France
| | - C A Sennoga
- UMR "Imagerie et Cerveau," Inserm U930 (F.P., A.B., C.A.S.), Université Francois Rabelais, Tours, France
| | - A Marzo
- Mechanical Engineering Department, INSIGNEO Institute for in Silico Medicine (C.M.P., A.M.), University of Sheffield, Sheffield, United Kingdom
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Acosta Santamaría VA, Daniel G, Perrin D, Albertini JN, Rosset E, Avril S. Model reduction methodology for computational simulations of endovascular repair. Comput Methods Biomech Biomed Engin 2018; 21:139-148. [DOI: 10.1080/10255842.2018.1427740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V. A. Acosta Santamaría
- SaInBioSE, INSERM, U1059, Saint Etienne, France
- SaInBioSE, Mines Saint-Etienne, Saint Etienne, France
- SaInBioSE, Université de Lyon, Saint Etienne, France
| | - G. Daniel
- SaInBioSE, INSERM, U1059, Saint Etienne, France
- SaInBioSE, Mines Saint-Etienne, Saint Etienne, France
- SaInBioSE, Université de Lyon, Saint Etienne, France
- Service de Chirurgie Vasculaire, Centre Hospitalier Régional Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - D. Perrin
- SaInBioSE, INSERM, U1059, Saint Etienne, France
- SaInBioSE, Mines Saint-Etienne, Saint Etienne, France
- SaInBioSE, Université de Lyon, Saint Etienne, France
| | - J. N. Albertini
- SaInBioSE, INSERM, U1059, Saint Etienne, France
- SaInBioSE, Université de Lyon, Saint Etienne, France
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Saint-Etienne, Saint Etienne, France
| | - E. Rosset
- SaInBioSE, INSERM, U1059, Saint Etienne, France
- Service de Chirurgie Vasculaire, Centre Hospitalier Régional Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - S. Avril
- SaInBioSE, INSERM, U1059, Saint Etienne, France
- SaInBioSE, Mines Saint-Etienne, Saint Etienne, France
- SaInBioSE, Université de Lyon, Saint Etienne, France
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Interaction between Flow Diverter and Parent Artery of Intracranial Aneurysm: A Computational Study. Appl Bionics Biomech 2017; 2017:3751202. [PMID: 29209136 PMCID: PMC5676342 DOI: 10.1155/2017/3751202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/16/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022] Open
Abstract
To evaluate the influence of deployment strategy on the mechanical interaction between braided stent and parent artery of intracranial aneurysm (the elasticity of the arterial wall is considered), finite-element analyses are carried out by referring to computational models of flow-diverter device and arterial wall. Two implantation strategies are used to virtually implant the braided stent into the ideal intracranial aneurysm model. One is the noncompacted implantation method, and the other is the implantation method of using push-pull technique. During the process of the implantation, the changes of the arterial shape around the aneurysm and the changes of the wall pressure at the contact area between the braided stent and the inner wall of the artery are analyzed. The results indicate that the average contact pressure in the area of low porosity is 57 mmHg using the push-pull technique, and the average contact pressure of the parent artery is 10.45 mmHg using the non-push-pull technique. The diameter of the parent artery at the aneurismal orifice increased about 0.2 mm when using the push-pull technique, so the elasticity of the vessel should be considered in the mechanical analysis of interaction between stent and vessel.
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Lv N, Cao W, Larrabide I, Karmonik C, Zhu D, Liu J, Huang Q, Fang Y. Hemodynamic Changes Caused by Multiple Stenting in Vertebral Artery Fusiform Aneurysms: A Patient-Specific Computational Fluid Dynamics Study. AJNR Am J Neuroradiol 2017; 39:118-122. [PMID: 29097416 DOI: 10.3174/ajnr.a5452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The multiple stent placement technique has largely improved the long-term outcomes of intracranial fusiform aneurysms, but the hemodynamic mechanisms remain unclear. In this study, we analyzed the hemodynamic changes caused by different stent-placement strategies in patient-specific models using the computational fluid dynamics technique, aiming to provide evidence for clinical decision-making. MATERIALS AND METHODS Ten vertebral artery fusiform aneurysms were included, and their patient-specific computational fluid dynamics models were reconstructed. A fast virtual stent placement technique was used to simulate sequential multiple stent placements (from a single stent to triple stents) in the vertebral artery fusiform aneurysm models. Hemodynamic parameters, including wall shear stress, pressure, oscillatory shear index, relative residence time, and flow pattern, were calculated and compared among groups with different numbers of stents. RESULTS Virtual stents were deployed in all 10 cases successfully, consistent with the real stent configuration. Wall shear stress decreased progressively by 7.2%, 20.6%, and 25.8% as the number of stents increased. Meanwhile, relative residence time and pressure increased on average by 11.3%, 15.4%, and 45.0% and by 15.7%, 21.5%, and 28.2%. The oscillatory shear index showed no stable variation trend. Flow patterns improved by weakening the intensity of the vortices and displacing the vortex center from the aneurysmal wall. CONCLUSIONS Stent placement modifies hemodynamic patterns in vertebral artery fusiform aneurysms, which might favor thrombosis formation in the aneurysmal sac. This effect is amplified with the number of stents deployed. However, a potential risk of rupture or recanalization exists and should be considered when planning to use the multiple stent placement technique in vertebral artery fusiform aneurysms.
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Affiliation(s)
- N Lv
- From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - W Cao
- From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - I Larrabide
- National Scientific and Technical Research Council of Argentina (I.L.), Buenos Aires, Argentina
| | - C Karmonik
- MRI Core (C.K.), Houston Methodist Research Institute, Houston, Texas
| | - D Zhu
- From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - J Liu
- From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Q Huang
- From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Y Fang
- From the Department of Neurosurgery (N.V., W.C., D.Z., Y.F., Q.H., J.L.), Changhai Hospital, Second Military Medical University, Shanghai, China
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Sarrami-Foroushani A, Lassila T, Frangi AF. Virtual endovascular treatment of intracranial aneurysms: models and uncertainty. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2017; 9. [PMID: 28488754 DOI: 10.1002/wsbm.1385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/09/2017] [Accepted: 02/07/2017] [Indexed: 01/11/2023]
Abstract
Virtual endovascular treatment models (VETMs) have been developed with the view to aid interventional neuroradiologists and neurosurgeons to pre-operatively analyze the comparative efficacy and safety of endovascular treatments for intracranial aneurysms. Based on the current state of VETMs in aneurysm rupture risk stratification and in patient-specific prediction of treatment outcomes, we argue there is a need to go beyond personalized biomechanical flow modeling assuming deterministic parameters and error-free measurements. The mechanobiological effects associated with blood clot formation are important factors in therapeutic decision making and models of post-treatment intra-aneurysmal biology and biochemistry should be linked to the purely hemodynamic models to improve the predictive power of current VETMs. The influence of model and parameter uncertainties associated to each component of a VETM is, where feasible, quantified via a random-effects meta-analysis of the literature. This allows estimating the pooled effect size of these uncertainties on aneurysmal wall shear stress. From such meta-analyses, two main sources of uncertainty emerge where research efforts have so far been limited: (1) vascular wall distensibility, and (2) intra/intersubject systemic flow variations. In the future, we suggest that current deterministic computational simulations need to be extended with strategies for uncertainty mitigation, uncertainty exploration, and sensitivity reduction techniques. WIREs Syst Biol Med 2017, 9:e1385. doi: 10.1002/wsbm.1385 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Ali Sarrami-Foroushani
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), The University of Sheffield, Sheffield, UK
| | - Toni Lassila
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), The University of Sheffield, Sheffield, UK
| | - Alejandro F Frangi
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), The University of Sheffield, Sheffield, UK
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Zhang Q, Meng Z, Zhang Y, Yao K, Liu J, Zhang Y, Jing L, Yang X, Paliwal N, Meng H, Wang S. Phantom-based experimental validation of fast virtual deployment of self-expandable stents for cerebral aneurysms. Biomed Eng Online 2016; 15:125. [PMID: 28155680 PMCID: PMC5260011 DOI: 10.1186/s12938-016-0250-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endovascular intervention using a stent is a mainstream treatment for cerebral aneurysms. To assess the effect of intervention strategies on aneurysm hemodynamics, we have developed a fast virtual stenting (FVS) technique to simulate stent deployment in patient-specific aneurysms. However, quantitative validation of the FVS against experimental data has not been fully addressed. In this study, we performed in vitro analysis of a patient-specific model to illustrate the realism and usability of this novel FVS technique. METHODS We selected a patient-specific aneurysm and reproduced it in a manufactured realistic aneurismal phantom. Three numerical simulation models of the aneurysm with an Enterprise stent were constructed. Three models were constructed to obtain the stented aneurysms: a physical phantom scanned by micro-CT, fast virtual stenting technique and finite element method. The flow in the three models was simulated using a computational fluid dynamics software package, and the hemodynamics parameters for the three models were calculated and analyzed. RESULTS The computational hemodynamics in the patient-specific aneurysm of the three models resembled the very well. A qualitative comparison revealed high similarity in the wall shear stress, streamline, and velocity plane among the three different methods. Quantitative comparisons revealed that the difference ratios of the hemodynamic parameters were less than 10%, with the difference ratios for area average of wall shear stress in the aneurysm being very low. CONCLUSIONS In conclusion, the results of the computational hemodynamics indicate that FVS is suitable for evaluation of the hemodynamic factors that affect treatment outcomes.
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Affiliation(s)
- Qianqian Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhuangyuan Meng
- Department of Mechanics and Engineering Science, Fudan University, 220 Handan Rd., Yangpu District, Shanghai, 200433, China
| | - Ying Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Yao
- Department of Mechanics and Engineering Science, Fudan University, 220 Handan Rd., Yangpu District, Shanghai, 200433, China
| | - Jian Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linkai Jing
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Nikhil Paliwal
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Shengzhang Wang
- Department of Mechanics and Engineering Science, Fudan University, 220 Handan Rd., Yangpu District, Shanghai, 200433, China.
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Alherz AI, Tanweer O, Flamini V. A numerical framework for the mechanical analysis of dual-layer stents in intracranial aneurysm treatment. J Biomech 2016; 49:2420-7. [DOI: 10.1016/j.jbiomech.2016.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
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Wang C, Tian Z, Liu J, Jing L, Paliwal N, Wang S, Zhang Y, Xiang J, Siddiqui AH, Meng H, Yang X. Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device. J Transl Med 2016; 14:199. [PMID: 27370946 PMCID: PMC4930570 DOI: 10.1186/s12967-016-0959-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background The aim of this study was to quantify the effect of the new Low-profile Visualized Intraluminal Support (LVIS®D) device and the difference of fluid diverting effect compared with the Pipeline device and the Enterprise stent using computational fluid dynamics (CFD). Methods In this research, we simulated three aneurysms constructed from 3D digital subtraction angiography (DSA). The Enterprise, LVIS and the Pipeline device were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice. Computational fluid dynamics analysis was performed to compare the hemodynamic differences such as WSS, Velocity and Pressure among these stents. Results Control referred to the unstented model, the percentage of hemodynamic changes were all compared to Control. A single LVIS stent caused more wall shear stress reduction than double Enterprise stents (39.96 vs. 30.51 %) and velocity (23.13 vs. 18.64 %). Significant reduction in wall shear stress (63.88 %) and velocity (46.05 %) was observed in the double-LVIS stents. A single Pipeline showed less reduction in WSS (51.08 %) and velocity (37.87 %) compared with double-LVIS stent. The double-Pipeline stents resulted in the most reduction in WSS (72.37 %) and velocity (54.26 %). Moreover, the pressure increased with minuscule extent after stenting, compared with the unstented model. Conclusions This is the first study analyzing flow modifications associated with LVIS stents. We found that the LVIS stent has certain hemodynamic effects on cerebral aneurysms: a single LVIS stent caused more flow reductions than the double-Enterprise stent but less than a Pipeline device. Nevertheless, the double-LVIS stent resulted in a better flow diverting effect than a Pipeline device.
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Affiliation(s)
- Chao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, China.,Department of Neurosurgery, The Affiliated Hospital, Binzhou Medical University, Binzhou, Shandong, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, China
| | - Linkai Jing
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, China
| | - Nikhil Paliwal
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Shengzhang Wang
- Department of Mechanics and Engineering Science, Fudan University, Shanghai, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, China
| | - Jianping Xiang
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, China.
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Bouillot P, Brina O, Yilmaz H, Farhat M, Erceg G, Lovblad KO, Vargas MI, Kulcsar Z, Pereira VM. Virtual-versus-Real Implantation of Flow Diverters: Clinical Potential and Influence of Vascular Geometry. AJNR Am J Neuroradiol 2016; 37:2079-2086. [PMID: 27365325 DOI: 10.3174/ajnr.a4845] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/24/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial stents have become extremely important in the endovascular management of complex intracranial aneurysms. Sizing and landing zone predictions are still very challenging steps in the procedure. Virtual stent deployment may help therapeutic planning, device choice, and hemodynamic simulations. We aimed to assess the predictability of our recently developed virtual deployment model by comparing in vivo and virtual stents implanted in a consecutive series of patients presenting with intracranial aneurysms. MATERIALS AND METHODS Virtual stents were implanted in patient-specific geometries of intracranial aneurysms treated with the Pipeline Embolization Device. The length and cross-section of virtual and real stents measured with conebeam CT were compared. The influence of vessel geometry modifications occurring during the intervention was analyzed. RESULTS The virtual deployment based on pre- and poststent implantation 3D rotational angiography overestimated (underestimated) the device length by 13% ± 11% (-9% ± 5%). These differences were highly correlated (R2 = 0.67) with the virtual-versus-real stent radius differences of -6% ± 7% (5% ± 4%) for predictions based on pre- and poststent implantation 3D rotational angiography. These mismatches were due principally to implantation concerns and vessel-shape modifications. CONCLUSIONS The recently proposed geometric model was shown to predict accurately the deployment of Pipeline Embolization Devices when the stent radius was well-assessed. However, unpredictable delivery manipulations and variations of vessel geometry occurring during the intervention might impact the stent implantation.
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Affiliation(s)
- P Bouillot
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland.,Laboratory for Hydraulic Machines (P.B., M.F.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - O Brina
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland
| | - H Yilmaz
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland
| | - M Farhat
- Laboratory for Hydraulic Machines (P.B., M.F.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - G Erceg
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland
| | - K-O Lovblad
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland
| | - M I Vargas
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland
| | - Z Kulcsar
- From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland
| | - V M Pereira
- Division of Neuroradiology (V.M.P.), Department of Medical Imaging .,Division of Neurosurgery (V.M.P.), Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Frangi AF, Taylor ZA, Gooya A. Precision Imaging: more descriptive, predictive and integrative imaging. Med Image Anal 2016; 33:27-32. [PMID: 27373145 DOI: 10.1016/j.media.2016.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 12/22/2022]
Abstract
Medical image analysis has grown into a matured field challenged by progress made across all medical imaging technologies and more recent breakthroughs in biological imaging. The cross-fertilisation between medical image analysis, biomedical imaging physics and technology, and domain knowledge from medicine and biology has spurred a truly interdisciplinary effort that stretched outside the original boundaries of the disciplines that gave birth to this field and created stimulating and enriching synergies. Consideration on how the field has evolved and the experience of the work carried out over the last 15 years in our centre, has led us to envision a future emphasis of medical imaging in Precision Imaging. Precision Imaging is not a new discipline but rather a distinct emphasis in medical imaging borne at the cross-roads between, and unifying the efforts behind mechanistic and phenomenological model-based imaging. It captures three main directions in the effort to deal with the information deluge in imaging sciences, and thus achieve wisdom from data, information, and knowledge. Precision Imaging is finally characterised by being descriptive, predictive and integrative about the imaged object. This paper provides a brief and personal perspective on how the field has evolved, summarises and formalises our vision of Precision Imaging for Precision Medicine, and highlights some connections with past research and current trends in the field.
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Affiliation(s)
- Alejandro F Frangi
- CISTIB Centre for Computational Imaging & Simulation Technologies in Biomedicine, Electronic and Electrical Engineering Department, University of Sheffield, Sheffield, UK.
| | - Zeike A Taylor
- CISTIB Centre for Computational Imaging & Simulation Technologies in Biomedicine, Mechanical Engineering Department, University of Sheffield, Sheffield, UK.
| | - Ali Gooya
- CISTIB Centre for Computational Imaging & Simulation Technologies in Biomedicine, Electronic and Electrical Engineering Department, University of Sheffield, Sheffield, UK.
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Larrabide I, Geers AJ, Morales HG, Bijlenga P, Rüfenacht DA. Change in aneurysmal flow pulsatility after flow diverter treatment. Comput Med Imaging Graph 2016; 50:2-8. [DOI: 10.1016/j.compmedimag.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 12/16/2014] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
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Geometrical deployment for braided stent. Med Image Anal 2016; 30:85-94. [DOI: 10.1016/j.media.2016.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/20/2015] [Accepted: 01/20/2016] [Indexed: 11/21/2022]
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Hemodynamic alterations after stent implantation in 15 cases of intracranial aneurysm. Acta Neurochir (Wien) 2016; 158:811-819. [PMID: 26746828 DOI: 10.1007/s00701-015-2696-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In the current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and their association with the aneurysm location. METHODS We first retrospectively studied 15 aneurysm cases [8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms] treated with Enterprise stents and coils. Then, based on the patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. RESULTS Before and after the stent deployment, the average wall shear stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; the spatially averaged flow velocity in the perpendicular plane of the aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post stent implantation, the WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4 % (P = 0.012) and 16.6 % (P = 0.018), respectively, and the flow velocity also reduced by 10.3 % (P = 0.029) and 10.5 % (P = 0.013), respectively. Changes in the WSS, flow velocity, and pressure were not significantly different between ICA-OphA and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in either aneurysm type. CONCLUSION After the stent implantation, both the intra-aneurysmal flow velocity and WSS decreased independently of aneurysm type (ICA-OphA and PcoA). Little change was observed in peak systolic pressure.
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Reconstruction of coronary arteries from X-ray angiography: A review. Med Image Anal 2016; 32:46-68. [PMID: 27054277 DOI: 10.1016/j.media.2016.02.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/29/2016] [Accepted: 02/22/2016] [Indexed: 01/18/2023]
Abstract
Despite continuous progress in X-ray angiography systems, X-ray coronary angiography is fundamentally limited by its 2D representation of moving coronary arterial trees, which can negatively impact assessment of coronary artery disease and guidance of percutaneous coronary intervention. To provide clinicians with 3D/3D+time information of coronary arteries, methods computing reconstructions of coronary arteries from X-ray angiography are required. Because of several aspects (e.g. cardiac and respiratory motion, type of X-ray system), reconstruction from X-ray coronary angiography has led to vast amount of research and it still remains as a challenging and dynamic research area. In this paper, we review the state-of-the-art approaches on reconstruction of high-contrast coronary arteries from X-ray angiography. We mainly focus on the theoretical features in model-based (modelling) and tomographic reconstruction of coronary arteries, and discuss the evaluation strategies. We also discuss the potential role of reconstructions in clinical decision making and interventional guidance, and highlight areas for future research.
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Paliwal N, Yu H, Xu J, Xiang J, Siddiqui A, Yang X, Li H, Meng H. Virtual stenting workflow with vessel-specific initialization and adaptive expansion for neurovascular stents and flow diverters. Comput Methods Biomech Biomed Engin 2016; 19:1423-1431. [PMID: 26899135 DOI: 10.1080/10255842.2016.1149573] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endovascular intervention using traditional neurovascular stents and densely braided flow diverters (FDs) have become the preferred treatment strategies for traditionally challenging intracranial aneurysms. Modeling stent and FD deployment in patient-specific aneurysms and its flow modification results prior to the actual intervention can potentially predict the patient outcome and treatment optimization. We present a clinically focused, streamlined virtual stenting workflow that efficiently simulates stent and FD treatment in patient-specific aneurysms based on expanding a simplex mesh structure. The simplex mesh is generated using an innovative vessel-specific initialization technique, which uses the patient's parent artery diameter to identify the initial position of the simplex mesh inside the artery. A novel adaptive expansion algorithm enables the acceleration of deployment process by adjusting the expansion forces based on the distance of the simplex mesh from the parent vessel. The virtual stenting workflow was tested by modeling the treatment of two patient-specific aneurysms using the Enterprise stent and the Pipeline Embolization Device (commercial FD). Both devices were deployed in the aneurysm models in a few seconds. Computational fluid dynamics analyses of pre- and post-treatment aneurysmal hemodynamics show flow reduction in the aneurysmal sac in treated aneurysms, with the FD diverting more flow than the Enterprise stent. The test results show that this workflow can rapidly simulate clinical deployment of stents and FDs, hence paving the way for its future clinical implementation.
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Affiliation(s)
- Nikhil Paliwal
- Department of Mechanical & Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY
| | - Hongyu Yu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Jinhui Xu
- Department of Computer Science & Engineering, University at Buffalo, State University of New York, Buffalo, NY
| | - Jianping Xiang
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY
| | - Xinjian Yang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing, China
| | - Haiyun Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Hui Meng
- Department of Mechanical & Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY.,Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY.,Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY
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Ouared R, Larrabide I, Brina O, Bouillot P, Erceg G, Yilmaz H, Lovblad KO, Mendes Pereira V. Computational fluid dynamics analysis of flow reduction induced by flow-diverting stents in intracranial aneurysms: a patient-unspecific hemodynamics change perspective. J Neurointerv Surg 2016; 8:1288-1293. [DOI: 10.1136/neurintsurg-2015-012154] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 11/04/2022]
Abstract
Background and purposeFlow-diverter stents (FDSs) have been used effectively to treat large neck and complex saccular aneurysms on the anterior carotid circulation. Intra-aneurysmal flow reduction induces progressive aneurysm thrombosis in most patients. Understanding the degree of flow modification necessary to induce complete aneurysm occlusion among patients with considerable hemodynamics variability may be important for treatment planning.Materials and methodsPatients with incidental intracranial saccular aneurysms who underwent FDS endovascular procedures were included and studied for a 12 months’ follow-up period. We used computational fluid dynamics on patient-specific geometries from 3D rotational angiography without and with virtual stent placement and thus compared intra-aneurysmal hemodynamic problems. Receiver operating characteristic analysis was used to estimate the stent:no-stent minimum hemodynamic ratio thresholds that significantly (p≤0.05) determined the condition necessary for long-term (12 months) aneurysm occlusion.ResultsWe included 12 consecutive patients with sidewall aneurysms located in the internal carotid or vertebral artery. The measured porosity of the 12 deployed virtual FDSs was 83±3% (mean±SD). Nine aneurysms were occluded during the 12 months’ follow-up, whereas three were not. A significant (p=0.05) area under the curve (AUC) was found for spatiotemporal mean velocity reduction in the aneurysms: AUC=0.889±0.113 (mean±SD) corresponding to a minimum velocity reduction threshold of 0.353 for occlusion to occur. The 95% CI of the AUC was 0.66 to 1.00. The sensitivity and specificity of the method were ∼99% and ∼67%, respectively. For both wall shear stress and pressure reductions in aneurysms no thresholds could be determined: AUC=0.63±0.16 (p=0.518) and 0.67±0.165 (p=0.405), respectively.ConclusionsFor successful FDS treatment the post-stent average velocity in sidewall intracranial aneurysms must be reduced by at least one-third from the initial pre-stent conditions.
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