A Finite Element Method to Predict Adverse Events in Intracranial Stenting Using Microstents: In Vitro Verification and Patient Specific Case Study
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Clinical studies have demonstrated the efficacy of stent supported coiling for intra-cranial aneurysm treatment. Despite encouraging outcomes, some matters are yet to be addressed. In particular closed stent designs are influenced by the delivery technique and may suffer from under-expansion, with the typical effect of “hugging” the inner curvature of the vessel which seems related to adverse events. In this study we propose a novel finite element (FE) environment to study potential failure able to reproduce the microcatheter “pull-back” delivery technique. We first verified our procedure with published in vitro data and then replicated the intervention on one patient treated with a 4.5 × 22 mm Enterprise microstent (Codman Neurovascular; Raynham MA, USA). Results showed good agreement with the in vitro test, catching both size and location of the malapposed area. A simulation of a 28 mm stent in the same geometry highlighted the impact of the delivery technique, which leads to larger area of malapposition. The patient specific simulation matched the global stent configuration and zones prone to malapposition shown on the clinical images with difference in tortuosity between actual and virtual treatment around 2.3%. We conclude that the presented FE strategy provides an accurate description of the stent mechanics and, after further in vivo validation and optimization, will be a tool to aid clinicians to anticipate the acute procedural outcome avoiding poor initial results.
KeywordsIntra-cranial Cerebral Aneurysm Stenting Hugging Apposition Microstent Incomplete
The authors gratefully acknowledge the Research Foundation—Flanders (FWO Grant 3G065910) for the financial support of this research.
Conflict of interest
The authors have no financial disclosures. M. De Beule and B. Verhegghe are shareholders of FEops, an engineering consultancy spin-off from Ghent University, and have served as consultants for several medical device companies. A. K. Wakhloo reports grants from Philips Healthcare during the conduct of the study. He received personal fees from Stryker Neurovascular, Harvard University, Miami Baptist Health, and reports other finacial activities with InNeuroCo Inc and Lazarus Effect outside the submitted work. M. J. Gounis reports grants from Codman Neurovascular and Philips Healthcare, personal fees from Codman Neurovascular during the conduct of the study. He received grants from Wyss Institute, Fraunhofer Institute, Stryker Neurovascular, NIH, Tay Sachs Foundation, Covidien eV3 Neurovascular, Lazarus Effect and personal fees from Stryker Neurovascular, Harvard University and Surpass Medical Inc outside the submitted work. I. M. J. van der Bom is currently employed by Philips Healthcare, and reports financial activities with InNeuroCo Inc outside the submitted work.
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