Title

A Finite Element Method to Predict Adverse Events in Intracranial Stenting Using Microstents: In Vitro Verification and Patient Specific Case Study

UMMS Affiliation

Department of Radiology

Date

11-30-2015

Document Type

Article

Disciplines

Biomedical Devices and Instrumentation | Cardiovascular Diseases | Medical Biophysics | Nervous System Diseases | Radiology

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 x 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.

Rights and Permissions

Citation: Ann Biomed Eng. 2015 Nov 30. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Keywords

Aneurysm, Apposition, Cerebral, Hugging, Incomplete, Intra-cranial, Microstent, Stenting

PubMed ID

26620777