A high-fidelity virtual stenting method for intracranial aneurysms
A flow diverter (FD) is a densely braided self-expandable stent mesh deployed across an intracranial aneurysmal region to reduce the inflow for aneurysmal occlusion. Intracranial aneurysm (IA) intervention by FD is emerging as a promising new endovascular therapy for treating previously untreatable IAs. Due to its high flexibility, the geometry of an implanted FD depends not only on the vessel but also on device manipulation during intervention. Thus, it is important to model the interaction of deployment devices and the resulting mechanical deformation of FD.
We have developed FEA-based high-fidelity virtual deployment technique. The following two videos are the FD deployment procedure in a fusiform and a sidewall IAs. After crimping (process not shown) the FD (blue) into the microcatheter (yellow) , the FD-microcatheter assembly is delivered along the lumen pathway to the intended location. Then the FD is released and let to expand through the synergistic manipulation of the microcatheter and delivery wire/pusher. This maneuver produces selectively maximized FD mesh density across the aneurysm orifice. This simulation framework for the first time recapitulates the FD implantation process to reliably predict the fully deformed FD geometry for accurate hemodynamic analysis.
FD virtual delopyment in a fursiform aneurysm.
FD virtual delopyment in a sidewall aneurysm.
For more informtion, please contact Rob Damiano at rjd150(at)gmail.com.
Further Reading:
Ma D, Dargush G, Natarajan SK, Siddiqui AH, Meng H, "Computer modeling of deployment and mechanical expansion of neurovascular flow diverters in patient-specific intracranial aneurysms". Journal of Biomechanics. 45:2256-63, 2012. PMID: 22818662
Ma D, Dumont T, Kosukegawa H, Ohta M, Yang X, Siddiqui AH, Meng H, "Deployment of flow diverter for treating aneurysm: In vitro and in silico". Ann Biomed Eng. 41(10):2143-56, 2013.PMID: 23604850
Ma D, Xiang J, Choi H, Natarajan S, Dumont TM, Siddiqui AH, Meng H, “ Enhanced Aneurysm Flow Diversion using Dynamic Push-Pull Technique: An Experimental and Modeling Study”, AJNR Am J Neuroradiol, 35(9):1779-85, 2014. PMID: 24763414
Xiang J, Ma D, Snyder K, Levy EI, Siddiqui AH, Meng, H, “ Increasing Flow Diversion for Cerebral Aneurysm Treatment Using a Single Flow Diverter”, Neurosurgery, 75(3):286-94, 2014. PMID: 24867201
Xiang J, Damiano R, Lin N, Snyder KV, Siddiqui AH, Levy EI, Meng H, “ High-fidelity virtual stenting: modeling of flow diverter deployment for hemodynamic characterization of complex intracranial aneurysms”, Journal of Neurosurgery, [Epub ahead of print], 2015 Jun 19:1-19. PMID: 26090829 (Xiang and Damiano contributed equally to this work)
Damiano R, Ma D, Xiang J, Snyder KV, Meng H, “ Finite Element Modeling of Endovascular Intervention Enables Hemodynamic Prediction of Complex Treatment Strategies of Coiling and Flow Diversion”, J Biomechanics, 2015 Jun 27.