Matching Items (3)

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Customized Endovascular Treatment Fixture Construction for Patient-Specific Cerebral Aneurysm Repair

Description

Cerebral aneurysms are pathological bulges in blood vessels of the brain that can rupture and cause brain damage or death. Treating aneurysms by isolating them from circulation can prevent aneurysm

Cerebral aneurysms are pathological bulges in blood vessels of the brain that can rupture and cause brain damage or death. Treating aneurysms by isolating them from circulation can prevent aneurysm rupture. Endovascular techniques for cerebral aneurysm treatment are preferred because they are minimally invasive and have a shorter recovery time, and endovascular coiling is considered the gold standard as a result. The coils used in endovascular treatment come in standard shapes and sizes, mass-manufactured by medical device companies. Clinicians select the coils for treatment based on the aneurysm volume. However, cerebral aneurysms have unique shapes and dimensions, and vary on a patient-specific basis. Therefore, customizing the coils to fit a unique aneurysm morphology by using shape memory alloys could potentially improve endovascular treatment outcomes. In order to shape set a shape memory alloy into a customized coil configuration a fixture based on the aneurysm morphology must first be developed. Digital surface models of aneurysm patient cases were collected from an online repository and isolated from surrounding vasculature. Anchors used to assist in winding coils around these models were then added to create a computational fixture model. These fixtures were 3D printed in stainless steel, and tested on their ability to maintain their shape after being exposed to high temperatures needed in shape setting processes. The study demonstrated that customized fixtures can be created from patient-specific images or models, and manufactured with high levels of accuracy without deformation at high temperatures. The results suggest that 3D printed stainless steel fixtures could be used to develop customized endovascular coils for cerebral aneurysm treatment.

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Date Created
  • 2017-05

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PIV ANALYSIS OF BASILAR TIP ANEURYSM HEMODYNAMICS, AND THE EFFECTS OF ENTERPRISE STENT TREATMENT

Description

Intracranial aneurysms, which form in the blood vessels of the brain, are particularly dangerous because of the importance and fragility of the human brain. When an intracranial aneurysm gets large

Intracranial aneurysms, which form in the blood vessels of the brain, are particularly dangerous because of the importance and fragility of the human brain. When an intracranial aneurysm gets large it poses a significant risk of bursting and causing subarachnoid hemorrhaging (SAH), a possibly fatal condition. One possible treatment involves placing a stent in the vessel to act as a flow diverter. In this study we look at the hemodynamics of two geometries of idealized basilar tip aneurysms, at 2,3, and 4 ml/s pulsatile flow, at three different points in the cardiac cycle. The smaller model had neck and dome diameters of 2.67 mm and 4 mm respectively, while the larger aneurysm had neck and dome diameters of 3 mm and 6 mm respectively. Both diameters and the dome to neck ratio increased in the second model, representing growth over time. Flow was analyzed using stereoscopic particle image velocimetry (PIV) for both geometries in untreated models, as well as after treatment with a high porosity Enterprise stent (Codman and Shurtleff Inc.). Flow in the models was characterized by root mean square velocity in the aneurysm and neck plane, cross neck flow, max aneurysm vorticity, and total aneurysm kinetic energy. It was found that in the smaller aneurysm model (model 1), Enterprise stent treatment reduced all flow parameters substantially. The smallest reduction was in max vorticity, at 42.48%, and the largest in total kinetic energy, at 75.69%. In the larger model (model 2) there was a 52.18% reduction in cross neck flow, but a 167.28% increase in aneurysm vorticity. The other three parameters experienced little change. These results, along with observed velocity vector fields, indicate a noticeable diversion of flow away from the aneurysm in the stent treated model 1. Treatment in model 2 had a small flow diversion effect, but also altered flow in unpredictable ways, in some cases having a detrimental effect on aneurysm hemodynamics. The results of this study indicate that Enterprise stent treatment is only effective in small, relatively undeveloped aneurysm geometries, and waiting until an aneurysm has grown too large can eliminate this treatment option altogether.

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Date Created
  • 2013-05

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Characterization of the effects of cerebral aneurysm geometry on hemodynamics and endovascular treatment outcomes

Description

Cerebral aneurysms are pathological balloonings of blood vessels in the brain, commonly found in the arterial network at the base of the brain. Cerebral aneurysm rupture can lead to a

Cerebral aneurysms are pathological balloonings of blood vessels in the brain, commonly found in the arterial network at the base of the brain. Cerebral aneurysm rupture can lead to a dangerous medical condition, subarachnoid hemorrhage, that is associated with high rates of morbidity and mortality. Effective evaluation and management of cerebral aneurysms is therefore essential to public health. The goal of treating an aneurysm is to isolate the aneurysm from its surrounding circulation, thereby preventing further growth and rupture. Endovascular treatment for cerebral aneurysms has gained popularity over traditional surgical techniques due to its minimally invasive nature and shorter associated recovery time. The hemodynamic modifications that the treatment effects can promote thrombus formation within the aneurysm leading to eventual isolation. However, different treatment devices can effect very different hemodynamic outcomes in aneurysms with different geometries.

Currently, cerebral aneurysm risk evaluation and treatment planning in clinical practice is largely based on geometric features of the aneurysm including the dome size, dome-to-neck ratio, and parent vessel geometry. Hemodynamics, on the other hand, although known to be deeply involved in cerebral aneurysm initiation and progression, are considered to a lesser degree. Previous work in the field of biofluid mechanics has demonstrated that geometry is a driving factor behind aneurysmal hemodynamics.

The goal of this research is to develop a more combined geometric/hemodynamic basis for informing clinical decisions. Geometric main effects were analyzed to quantify contributions made by geometric factors that describe cerebral aneurysms (i.e., dome size, dome-to-neck ratio, and inflow angle) to clinically relevant hemodynamic responses (i.e., wall shear stress, root mean square velocity magnitude and cross-neck flow). Computational templates of idealized bifurcation and sidewall aneurysms were created to satisfy a two-level full factorial design, and examined using computational fluid dynamics. A subset of the computational bifurcation templates was also translated into physical models for experimental validation using particle image velocimetry. The effects of geometry on treatment were analyzed by virtually treating the aneurysm templates with endovascular devices. The statistical relationships between geometry, treatment, and flow that emerged have the potential to play a valuable role in clinical practice.

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Date Created
  • 2016