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Rehearsals using patient-specific 3D-printed aneurysm models for simulation of endovascular embolization of complex intracranial aneurysms: 3D SIM study - 21/12/21

Doi : 10.1016/j.neurad.2021.11.008 
Anthony LEBRAS, MD, PhD a, b, Fakhreddine BOUSTIA, MD b, Kevin JANOT, MD c, Estelle LEPABIC, PhD d, Mathilde OUVRARD, PhD e, Claire FOUGEROU-LEURENT, MD f, Jean-Christophe FERRE, MD, PhD b, Jean-Yves GAUVRIT, MD, PhD b, François EUGENE, MD b,
a Service de Radiologie, Centre Hospitalier Bretagne Atlantique, France 
b Service de Radiologie, Centre Hospitalier Universitaire de Rennes, France 
c Service de Radiologie, Centre Hospitalier Universitaire de Tours, France 
d Service de Biostatistiques, Centre Hospitalier Universitaire de Rennes, France 
e Direction de la Recherche, Centre Hospitalier Universitaire de Rennes, France 
f Service de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, France 

Corresponding author.
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Tuesday 21 December 2021

Highlights

Challenging embolization of complex intracranial aneurysms, with advanced devices (WEB, flow diverters).
Pre-operative rehearsals could be helpful for advanced device selection.
Patient-specific 3D-printed models bring haptic feedback and reliable model.
Implantation failure of advanced device and radiation dose of procedure could be reduced by EVIAS solution rehearsals.

El texto completo de este artículo está disponible en PDF.

Abstract

Background

In neurovascular treatment planning, endovascular devices to manage complex intracranial aneurysms requiring intervention are often selected based on conventional measurements and interventional neuroradiologist experience. A recently developed technology allows a patient-specific 3D-printed model to mimic the navigation experience. The goal of this study was to assess the effect of pre-procedure 3D simulation on procedural and clinical outcomes for wide-neck aneurysm embolization.

Materials & methods

In this unblinded, non-randomized, prospective, multicenter study conducted from November 18 through December 20, patients with complex intracranial aneurysms (neck > 4 mm or ratio < 21) were treated by WEB or flow diverter stents (FDS). The primary endpoint was concordance between simulation and procedure, 3D-printed model accuracy as well as embolization outcomes including complications, procedure times, and radiation dose were also assessed. Secondary endpoint was to compare versus a retrospective WEB cohort.

Results

Twenty-one patients were treated, 76% of cases by WEB and 24% by FDS. Concordance between post-simulation and real procedure efficiency was 0.85 [0.69 – 1.00] for size device selection and 0.93 [0.79 – 1.00] for wall-apposition/aneurysm neck closure. Geometrical accuracy of the 3D-printed model showed a mean absolute shift of 0.11 mm. Two complications without major clinical impact were reported with a post-operative mRS similar to pre-procedure mRS for all patients.

Conclusions

Rehearsal using accurate 3D-printed patient-specific aneurysm models enabled optimization of embolization strategy, resulting in reduced procedure duration and cumulative fluoroscopy time which translated to reduced radiation exposure compared to procedures performed without simulation.

El texto completo de este artículo está disponible en PDF.

Graphical abstract

Rehearsals Using Patient-Specific 3d-Printed Aneurysm Models For Simulation Of Endovascular Embolization Of Complex Intracranial Aneurysms: 3d Sim Study



Image, graphical abstract

El texto completo de este artículo está disponible en PDF.

Keywords : Interventional neuroradiology, Simulation, Intracranial aneurysm, 3D-printed


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© 2021  Elsevier Masson SAS. Reservados todos los derechos.
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