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

MUÑOZ ROMINA; DAZEO NICOLÁS; NARATA ANA PAULA; FERNANDEZ HECTOR; LARRABIDE IGNACIO

International Journal of Computer Assisted Radiology and Surgery

Springer

Año: 2021 vol. 16 p. 1663 - 1673

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.