Rehearsals using patient-specific 3d-printed aneurysm models for simulation of endovascular embolization of complex intracranial aneurysms: 3D SIM Study

Anthony Lebras (1, 2) , Fakhreddine Boustia (2) , Kevin Janot (3) , Estelle Lepabic (2) , Mathilde Ouvrard (2) , Claire Fougerou-Leurent (2) , Jean-Christophe Ferre (2) , Jean-Yves Gauvrit (2) , François Eugene (2)

1 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
3 Hôpital Bretonneau

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.

Mots clés: 3D-printed; Interventional neuroradiology; Intracranial aneurysm; Simulation

Domaines: Sciences du Vivant [q-bio]

Anthony Lebras, Fakhreddine Boustia, Kevin Janot, Estelle Lepabic, Mathilde Ouvrard, et al.. Rehearsals using patient-specific 3d-printed aneurysm models for simulation of endovascular embolization of complex intracranial aneurysms: 3D SIM Study. Journal de Neuroradiologie / Journal of Neuroradiology, 2021, ⟨10.1016/j.neurad.2021.11.008⟩. ⟨hal-03833132⟩