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Flow diverters treatment planning of small- and medium-sized intracranial saccular aneurysms on the internal carotid artery via constraint-based virtual deployment

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

The internal carotid artery (ICA) is a region with a high incidence for small- and medium-sized saccular aneurysms. However, the treatment relies heavily on the surgeon’s experience to achieve optimal outcome. Although the finite element method (FEM) and computational fluid dynamics can predict the postoperative outcomes, due to the computational complexity of traditional methods, there is an urgent need for investigating the fast but versatile approaches related to numerical simulations of flow diverters (FDs) deployment coupled with the hemodynamic analysis to determine the treatment plan.

Methods

We collected the preoperative and postoperative data from 34 patients (29 females, 5 males; mean age 55.74 ± 9.98 years) who were treated with a single flow diverter for small- to medium-sized intracranial saccular aneurysms on the ICA. The constraint-based virtual deployment (CVD) method is proposed to simulate the FDs expanding outward along the vessel centerline while be constrained by the inner wall of the vessel.

Results

The results indicate that there were no significant differences in the reduction rates of wall shear stress and aneurysms neck velocity between the FEM and methods. However, the solution time of CVD was greatly reduced by 98%.

Conclusion

In the typical location of small- and medium-sized saccular aneurysms, namely the ICA, our virtual FDs deployment simulation effectively balances the computational accuracy and efficiency. Combined with hemodynamics analysis, our method can accurately represent the blood flow changes within the lesion region to assist surgeons in clinical decision-making.

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Data availability

Data are available from the corresponding author upon reasonable request.

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Funding

The work was partially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project Reference Number: T45-401/22-N), in part by grants from National Natural Science Foundation of China (62372441, U22A2034, 82302300), in part by Guangdong Basic and Applied Basic Research Foundation (2023A1515030268), in part by Shenzhen Fundamental Research Program (JCYJ20200109110420626) and in part by Guangzhou Municipal Key R &D Program (2024B03J0947).

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Author notes

  1. Zehua Liu and Meng Zhang have contributed equally to this work.

Authors and Affiliations

  1. Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Xueyuan street 1068, Shenzhen University Town, Nanshan District, Shenzhen, 518000, China

    Zehua Liu, Xiangyun Liao & Weixin Si

  2. Department of Neurosurgery, Shenzhen Second People’s Hospital, Sungang West Road 3002, Futian District, Guangdong, 510000, China

    Meng Zhang

  3. Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, TiantanXili 6, Dongcheng District, Beijing, 100000, China

    Chao Wang & Zhongxiao Wang

  4. Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Zhongshan 2nd Road 106, Yuexiu District, Guangdong, 510000, China

    Chubin Ou

Authors
  1. Zehua Liu
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  2. Meng Zhang
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  3. Chao Wang
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  4. Zhongxiao Wang
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  5. Xiangyun Liao
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  7. Weixin Si
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Contributions

ZL and MZ designed and carried out the experiments as well as wrote the manuscript. CW, ZW and CO collected and analyzed the data. XL and WS supervised the project.

Corresponding authors

Correspondence to Chubin Ou or Weixin Si.

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Conflict of interest

We have no conflicts of interest to declare.

Ethics approval

All patients data were collected retrospectively with informed patient consent and approval from the institutional ethics review board.

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We consent to the publication of this article in IJCARS.

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Our code will be available on request.

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Appendix A: Patients’ data description

Appendix A: Patients’ data description

See Table 3.

The summary of baseline characteristics is presented in Table 4. Among the 34 patients, 5 cases (14.7\(\%\)) were male, with an average age of 54.97 ± 9.98 years. 29 cases were female, with an average age of 60.20 ± 13.03 years. 12 cases (35.3\(\%\)) had ophthalmic artery IA and 22 cases (64.7\(\%\)) had communicating artery IA. The mean aneurysm size, mean parent diameter and mean follow-up time were 5.89 ± 2.11 mm, 4.03 ± 0.60 mm and 7.74 ± 2.14 months, respectively. Among them, 28 cases were completely occluded, and 6 cases had residual neck.

Table 4 The summary of baseline characteristics
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Liu, Z., Zhang, M., Wang, C. et al. Flow diverters treatment planning of small- and medium-sized intracranial saccular aneurysms on the internal carotid artery via constraint-based virtual deployment. Int J CARS (2024). https://doi.org/10.1007/s11548-024-03124-z

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