title: A Finite Element Method to Predict Adverse Events in Intracranial Stenting Using Microstents: In Vitro Verification and Patient Specific Case Study.
abstract: 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.
authors.affiliation: IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT, Ghent University, 9000, Ghent, Belgium. francesco.iannaccone@ugent.be.|Department of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, 3000 CA, Rotterdam, The Netherlands. francesco.iannaccone@ugent.be.
authors.forename: Francesco
authors.initials: F
authors.lastname: Iannaccone
authors.affiliation: IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT, Ghent University, 9000, Ghent, Belgium.|FEops bvba, 9000, Ghent, Belgium.
authors.forename: Matthieu
authors.initials: M
authors.lastname: De Beule
authors.affiliation: IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT, Ghent University, 9000, Ghent, Belgium.
authors.forename: Sander
authors.initials: S
authors.lastname: De Bock
authors.affiliation: Image-Guided Therapy Systems, Philips Healthcare, 01810, Andover, MA, USA.
authors.forename: Imramsjah M J
authors.initials: IM
authors.lastname: Van der Bom
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 01655, Worcester, MA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 01655, Worcester, MA, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Wakhloo
authors.affiliation: Department of Physics and Astronomy, Ghent University Center for X-ray Tomography, 9000, Ghent, Belgium.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Boone
authors.affiliation: IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT, Ghent University, 9000, Ghent, Belgium.|FEops bvba, 9000, Ghent, Belgium.
authors.forename: Benedict
authors.initials: B
authors.lastname: Verhegghe
authors.affiliation: IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT, Ghent University, 9000, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
mesh_terms: D016022:Case-Control Studies; D016208:Databases, Factual; D019544:Equipment Failure Analysis; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D015607:Stents
keywords: Aneurysm; Apposition; Cerebral; Hugging; Incomplete; Intra-cranial; Microstent; Stenting