Stenting as porous media in anatomically accurate geometries: A comparison of models and spatial heterogeneity

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.Fil: Dazeo, Nicolás Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Dottori, Javier Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Boroni, Gustavo Adolfo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Narata, Ana Paula. Universite de Tours; FranciaFil: Larrabide, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentin

ID-Fit: Intra-Saccular Device Adjustment for Personalized Cerebral Aneurysm Treatment

Intrasaccular devices, like Woven EndoBridge (WEB), are novel braided devices employed for the treatment of aneurysms with a complex shape and location, mostly terminal aneurysms. Such aneurysms are often challenging or impossible to treat with other endovascular techniques such as coils, stents, flow diverter stents. The selection of an appro- AQ1 priate endosaccular device size is crucial for a successful treatment and strongly depends of the final configuration that the device adopts when it adapts to the aneurysm sac morphology. This is frequently a problem during the intervention, leading to replacement of the device, reopening of the aneurysm or a need for re-treatment. A technique that allows predicting the released WEB configuration before intervention will provide a powerful computational tool to aid the interventionist during device selection. We propose a technique based on device design and aneurysm morphology that, by virtually deploying a WEB, will enable the assessment of different device sizes before the device implantation. This technique was tested on 6 MCA aneurysm cases and the simulation results were compared to the size of the deployed device on the patient, using post-treatment images.Fil: Muñoz, Romina Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Narata, Ana Paula. University Hospital of Southampton; Reino UnidoFil: Larrabide, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaMedical Image Computing and Computer Assisted InterventionLimaPerúMedical Image Computing and Computer Assisted Interventio

Acute stroke from paradoxical embolism of dense fibrous tissue following pacemaker lead extraction: salvation by mechanical thrombectomy

Systemic embolization is a dreaded complication of transvenous lead extraction (TLE), even without visible vegetations. Preoperative patent foramen ovale evaluation is important, justifying neurological surveillance or consideration of surgical extraction in selected cases. In case of stroke after TLE, mechanical thrombectomy is a successful therapy, and should be readily available

Use of stentrievers in acute stroke: tips, tricks, and current results

Stentrievers are stent-like devices used in the treatment of acute ischemic stroke. They have demonstrated efficacy in restoring the intracranial blood flow with low procedural times. This article is a synopsis of the available devices and different techniques. An extensive review of the literature summarizing all the data that have been published demonstrating their clinical impact and complications is also presented

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

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.Fil: Dazeo, Nicolás Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Muñoz, Romina Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Narata, Ana Paula. University Hospital of Southampton. Neuroradiology Department; Reino UnidoFil: Fernandez, Hector. Galgo Medical S.L; EspañaFil: Larrabide, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Galgo Medical S.L; Españ

Simulation of intra-saccular devices for pre-operative device size selection: Method and validation for sizing and porosity simulation

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.Fil: Muñoz, Romina Luciana. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Narata, Ana Paula. University Hospital Of Southampton; Reino UnidoFil: Obradó, Laura. Galgo Medical S.L; EspañaFil: Hernández, Héctor. Galgo Medical S.L; EspañaFil: Larrabide, Ignacio. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentin

Carotid artery stenting: rationale, technique, and current concepts

Carotid stenosis is a major risk factor for stroke. With the aging of the general population and the availability of non-invasive vascular imaging studies, the diagnosis of a carotid plaque is commonly made in medical practice. Asymptomatic and symptomatic carotid stenoses need to be considered separately because their natural history is different. Two large randomized controlled trials (RCTs) showed the effectiveness of carotid endarterectomy (CEA) in preventing ipsilateral ischemic events in patients with symptomatic severe stenosis. The benefit of surgery is much less for moderate stenosis and harmful in patients with stenosis less than 50%. Surgery has a marginal benefit in patients with asymptomatic stenosis. Improvements in medical treatment must be taken into consideration when interpreting the results of these previous trials which compared surgery against medical treatment available at the time the trials were conducted. Carotid artery stenting (CAS) might avoid the risks associated with surgery, including cranial nerve palsy, myocardial infarction, or pulmonary embolism. Therefore and additionally to well-established indications of CAS, this endovascular approach might be a valid alternative particularly in patients at high surgical risk. However, trials of endovascular treatment of carotid stenosis have failed to provide enough evidence to justify routine CAS as an alternative to CEA in patients suitable for surgery. More data from ongoing randomized trials of CEA versus CAS will be soon available. These results will help determining the role of CAS in the management of patients with carotid artery stenosis

Biology and hemodynamics of aneurismal vasculopathies

Aneurysm vasculopathies represents a group of vascular disorders that share a common morphological diagnosis: a vascular dilation, the aneurysm. They can have a same etiology and a different clinical presentation or morphology, or have different etiology and very similar anatomical geometry. The biology of the aneurysm formation is a complex process that will be a result of an endogenous predisposition and epigenetic factors later on including the intracranial hemodynamics. We describe the biology of saccular aneurysms, its growth and rupture, as well as, current concepts of hemodynamics derived from application of computational flow dynamics on patient specific vascular models. Furthermore, we describe different aneurysm phenotypes and its extremely variability on morphological and etiological presentation