Intra-saccular device modeling for treatment planning of intracranial aneurysms: from morphology to hemodynamics

• Published in: International journal for computer assisted radiology and surgery 2021-10, Vol.16 (10), p.1663-1673
• Main Authors: Dazeo, Nicolás, Muñoz, Romina, Narata, Ana Paula, Fernandez, Hector, Larrabide, Ignacio
• Format: Article
• Language: English
• Subjects: Aneurysms; Bifurcations; Blood flow; Computer Imaging; Computer Science; Health Informatics; Health services; Hemodynamics; Imaging; Medical imaging; Medicine; Medicine & Public Health; Morphology; Original Article; Pattern Recognition and Graphics; Porosity; Porous media; Radiology; Simulation; Surgery; Three dimensional models; Vision; Wall shear stresses; Workflow
• ISSN: 1861-6410; 1861-6429
• DOI: 10.1007/s11548-021-02427-9

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, p < 0.001 ). 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.