Intracranial aneurysms (IAs) occur in around 3% of the entire population. IA rupture is responsible for the most devastating type of hemorrhagic strokes, with high fatality and disability rates as well as healthcare costs. With increasing detection of unruptured aneurysms, clinicians are routinely faced with the dilemma whether to treat IA patients and how to best treat them. Hemodynamic and morphological characteristics are increasingly considered in aneurysm rupture risk assessment and treatment planning, but currently no computational tools allow routine integration of flow visualization and quantitation of these parameters in clinical workflow. In this paper, we introduce AView, a prototype of a clinician-oriented, integrated computation tool for aneurysm hemodynamics, morphology, and risk and data management to aid in treatment decisions and treatment planning in or near the procedure room. Specifically, we describe how we have designed the AView structure from the end-user’s point of view, performed a pilot study and gathered clinical feedback. The positive results demonstrate AView’s potential clinical value on enhancing aneurysm treatment decision and treatment planning.
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We thank the participants for the technology feasibility test of AView in the clinical workflow: Dr. Kenichi Kono from Wakayama Rosai Hospital; Dr. Ansaar Rai and Dr. Jeffrey Carpenter from West Virginia University; Dr. Shin-ichiro Sugiyama from Tohoku Kohnan hospital; Dr. Mandy Binning from Capital Health; Dr. Rabih G Tawk from Mayo Clinic (Florida); Dr. Hoon Choi and Dr. Eric Deshaies from SUNY-Upstate Medical University; Dr. Andrew Ringer from University of Cincinnati, and Dr. Adnan H. Siddiqui from University at Buffalo. We also thank Dr. Yiemeng Hoi for stimulating discussions and Nikhil Paliwal for assistance in figure preparation. This work was funded by Toshiba Medical Systems Corp.
Conflict of interest
Dr. Xiang: principal investigator of Dawn Brejcha Chair of Research Grant from Brain Aneurysm Foundation and co-investigator of NIH Grant (R01NS091075-01). Dr. Antiga and Nicole Varble: none. Dr. Snyder: consultant: Toshiba; speakers’ bureau: Toshiba, ev3/Covidien and The Stroke Group; honoraria: Toshiba, ev3/Covidien and The Stroke Group. Dr. Levy: shareholder/ownership interests: Intratech Medical Ltd., Mynx/Access Closure, Blockade Medical LLC. Principal investigator: Covidien US SWIFT PRIME Trials. Other financial support: Abbott for carotid training for physicians. Dr. Siddiqui: research Grants: co-investigator of NIH Grants (R01NS091075-01and 5R01EB002873) and Research Development Award from the University at Buffalo; financial interests: Blockade Medical, Hotspur, Intratech Medical, Lazarus Effect, StimSox, Valor Medical; consultant: Blockade Medical, Codman & Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Lazarus Effect, MicroVention, Penumbra, Stryker, Pulsar Vascular; National Steering Committee: 3D Separator Trial (Penumbra, Inc.), SWIFT PRIME Trial (Covidien), FRED Trial (MicroVention); speakers’ bureau: Codman & Shurtleff, Inc.; advisory board: Codman& Shurtleff, Inc., Covidien Neurovascular; honoraria: Abbott Vascularand Codman & Shurtleff, Inc. for training other physicians in carotid stenting and endovascular stenting for aneurysms, and Penumbra, Inc. Dr. Meng: principal investigator of NIH Grant (R01NS091075-01), the Grant from Toshiba Medical Systems and The Carol W. Harvey Memorial Chair of Research Grant from Brain Aneurysm Foundation.
Associate Editor Diego Gallo oversaw the review of this article.
Jianping Xiang and Luca Antiga are co-first authors.
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Xiang, J., Antiga, L., Varble, N. et al. AView: An Image-based Clinical Computational Tool for Intracranial Aneurysm Flow Visualization and Clinical Management. Ann Biomed Eng 44, 1085–1096 (2016). https://doi.org/10.1007/s10439-015-1363-y
- Intracranial aneurysm
- Computational fluid dynamics
- Image segmentation
- Clinical tool