title: An automatic CFD-based flow diverter optimization principle for patient-specific intracranial aneurysms.
abstract: The optimal treatment of intracranial aneurysms using flow diverting devices is a fundamental issue for neuroradiologists as well as neurosurgeons. Due to highly irregular manifold aneurysm shapes and locations, the choice of the stent and the patient-specific deployment strategy can be a very difficult decision. To support the therapy planning, a new method is introduced that combines a three-dimensional CFD-based optimization with a realistic deployment of a virtual flow diverting stent for a given aneurysm. To demonstrate the feasibility of this method, it was applied to a patient-specific intracranial giant aneurysm that was successfully treated using a commercial flow diverter. Eight treatment scenarios with different local compressions were considered in a fully automated simulation loop. The impact on the corresponding blood flow behavior was evaluated qualitatively as well as quantitatively, and the optimal configuration for this specific case was identified. The virtual deployment of an uncompressed flow diverter reduced the inflow into the aneurysm by 24.4% compared to the untreated case. Depending on the positioning of the local stent compression below the ostium, blood flow reduction could vary between 27.3% and 33.4%. Therefore, a broad range of potential treatment outcomes was identified, illustrating the variability of a given flow diverter deployment in general. This method represents a proof of concept to automatically identify the optimal treatment for a patient in a virtual study under certain assumptions. Hence, it contributes to the improvement of virtual stenting for intracranial aneurysms and can support physicians during therapy planning in the future.
authors.affiliation: Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg "Otto von Guericke" Universitätsplatz, 2 D-39106 Magdeburg, Germany. Electronic address: janiga@ovgu.de.
authors.forename: Gábor
authors.initials: G
authors.lastname: Janiga
authors.affiliation: Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg "Otto von Guericke" Universitätsplatz, 2 D-39106 Magdeburg, Germany.
authors.forename: László
authors.initials: L
authors.lastname: Daróczy
authors.affiliation: Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg "Otto von Guericke" Universitätsplatz, 2 D-39106 Magdeburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Berg
authors.affiliation: Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg "Otto von Guericke" Universitätsplatz, 2 D-39106 Magdeburg, Germany.
authors.forename: Dominique
authors.initials: D
authors.lastname: Thévenin
authors.affiliation: Institute for Neuroradiology, University of Magdeburg "Otto von Guericke", Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Skalej
authors.affiliation: Institute for Neuroradiology, University of Magdeburg "Otto von Guericke", Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Beuing
mesh_terms: D000465:Algorithms; D002533:Cerebral Angiography; D003198:Computer Simulation; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D008955:Models, Cardiovascular; D010347:Patient Care Planning; D015607:Stents
keywords: CFD-based optimization; Computational fluid dynamics; Flow diverter; Intracranial aneurysm; Patient-specific; Stent deployment