title: Virtual stenting workflow with vessel-specific initialization and adaptive expansion for neurovascular stents and flow diverters.
abstract: Endovascular intervention using traditional neurovascular stents and densely braided flow diverters (FDs) have become the preferred treatment strategies for traditionally challenging intracranial aneurysms. Modeling stent and FD deployment in patient-specific aneurysms and its flow modification results prior to the actual intervention can potentially predict the patient outcome and treatment optimization. We present a clinically focused, streamlined virtual stenting workflow that efficiently simulates stent and FD treatment in patient-specific aneurysms based on expanding a simplex mesh structure. The simplex mesh is generated using an innovative vessel-specific initialization technique, which uses the patient's parent artery diameter to identify the initial position of the simplex mesh inside the artery. A novel adaptive expansion algorithm enables the acceleration of deployment process by adjusting the expansion forces based on the distance of the simplex mesh from the parent vessel. The virtual stenting workflow was tested by modeling the treatment of two patient-specific aneurysms using the Enterprise stent and the Pipeline Embolization Device (commercial FD). Both devices were deployed in the aneurysm models in a few seconds. Computational fluid dynamics analyses of pre- and post-treatment aneurysmal hemodynamics show flow reduction in the aneurysmal sac in treated aneurysms, with the FD diverting more flow than the Enterprise stent. The test results show that this workflow can rapidly simulate clinical deployment of stents and FDs, hence paving the way for its future clinical implementation.
authors.affiliation: Department of Mechanical & Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Paliwal
authors.affiliation: School of Biomedical Engineering, Capital Medical University, Beijing, China.
authors.forename: Hongyu
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Computer Science & Engineering, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Jianping
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Adnan
authors.initials: A
authors.lastname: Siddiqui
authors.affiliation: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing, China.
authors.forename: Xinjian
authors.initials: X
authors.lastname: Yang
authors.affiliation: School of Biomedical Engineering, Capital Medical University, Beijing, China.
authors.forename: Haiyun
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Mechanical & Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, NY.|Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY.|Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY.
authors.forename: Hui
authors.initials: H
authors.lastname: Meng
mesh_terms: D001808:Blood Vessels / Q000503:physiopathology*; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm; D015607:Stents; D014584:User-Computer Interface
keywords: Cerebral aneurysm; Enterprise stent; Pipeline Embolization Device; endovascular device; flow diverter; simplex mesh