Interactive virtual stent planning for the treatment of coarctation of the aorta

Neugebauer, Martin; Glöckler, Martin; Goubergrits, Leonid; Kelm, Marcus; Küehne, Titus; Hennemuth, Anja

doi:10.1007/s11548-015-1220-3

Cited by 19 publications

(11 citation statements)

References 24 publications

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“…However, as we mentioned earlier, this procedure is associated with several complications. Recently Neugebauer et al, developed a virtual stenting tool that enables an interactive placement of stents into the narrowed aortic region . Combining this with an LBM‐based flow simulation, provides a means for a computer‐aided treatment planning and predicting possible hemodynamic alterations.…”

Section: Discussionmentioning

confidence: 99%

“…Recently Neugebauer et al, developed a virtual stenting tool that enables an interactive placement of stents into the narrowed aortic region. 36 Combining this with an LBM-based flow simulation, provides a means for a computer-aided treatment planning and predicting possible hemodynamic alterations. Our first validation study in this work, provides evidence on the applicability of such tools in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

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MRI-based computational hemodynamics in patients with aortic coarctation using the lattice Boltzmann methods: Clinical validation study

Mirzaee

Henn

Krause

et al. 2016

J. Magn. Reson. Imaging

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PurposeTo introduce a scheme based on a recent technique in computational hemodynamics, known as the lattice Boltzmann methods (LBM), to noninvasively measure pressure gradients in patients with a coarctation of the aorta (CoA). To provide evidence on the accuracy of the proposed scheme, the computed pressure drop values are compared against those obtained using the reference standard method of catheterization.Materials and MethodsPre‐ and posttreatment LBM‐based pressure gradients for 12 patients with CoA were simulated for the time point of peak systole using the open source library OpenLB. Four‐dimensional (4D) flow‐sensitive phase‐contrast MRI at 1.5 Tesla was used to acquire flow and to setup the simulation. The vascular geometry was reconstructed using 3D whole‐heart MRI. Patients underwent pre‐ and postinterventional pressure catheterization as a reference standard.ResultsThere is a significant linear correlation between the pretreatment catheter pressure drops and those computed based on the LBM simulation, r=.85, P<.001. The bias was ‐0.58 ± 4.1 mmHg and was not significant ( P=0.64) with a 95% confidence interval (CI) of ‐3.22 to 2.06. For the posttreatment results, the bias was larger and at ‐2.54 ± 3.53 mmHg with a 95% CI of ‐0.17 to ‐4.91 mmHg.ConclusionThe results indicate a reasonable agreement between the simulation results and the catheter measurements. LBM‐based computational hemodynamics can be considered as an alternative to more traditional computational fluid dynamics schemes for noninvasive pressure calculations and can assist in diagnosis and therapy planning. Level of Evidence: 3J. Magn. Reson. Imaging 2017;45:139–146.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI-based computational hemodynamics in patients with aortic coarctation using the lattice Boltzmann methods: Clinical validation study

Mirzaee

Henn

Krause

et al. 2016

J. Magn. Reson. Imaging

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“…Just as in other areas of personalized medicine, potential benefits are manifold and include improving mortality and morbidity, and reducing health care expenditures. In patients with CoA, image-based modelling of the aorta was recently used to create a virtual stenting tool which could aid clinical decision-making by simulating post-treatment blood flows in various scenarios [24, 25]. Given the overall good performance of stenting repair of CoA, cost effectiveness of this approach will be conditional on improved identification of selected, high-risk populations for whom tailored interventions can prevent future high-cost complications and treatments.…”

Section: Discussionmentioning

confidence: 99%

Avoidable costs of stenting for aortic coarctation in the United Kingdom: an economic model

Salcher‐Konrad¹,

McGuire²,

Muthurangu³

et al. 2017

BMC Health Serv Res

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BackgroundUndesirable outcomes in health care are associated with patient harm and substantial excess costs. Coarctation of the aorta (CoA), one of the most common congenital heart diseases, can be repaired with stenting but requires monitoring and subsequent interventions to detect and treat disease recurrence and aortic wall injuries. Avoidable costs associated with stenting in patients with CoA are unknown.MethodsWe developed an economic model to calculate potentially avoidable costs in stenting treatment of CoA in the United Kingdom over 5 years. We calculated baseline costs for the intervention and potentially avoidable complications and follow-up interventions and compared these to the costs in hypothetical scenarios with improved treatment effectiveness and complication rates.ResultsBaseline costs were £16 688 ($25 182) per patient. Avoidable costs ranged from £137 ($207) per patient in a scenario assuming a 10% reduction in aortic wall injuries and reinterventions at follow-up, to £1627 ($2455) in a Best-case scenario with 100% treatment success and no complications. Overall costs in the Best-case scenario were 90.2% of overall costs at Baseline. Reintervention rate at follow-up was identified as most influential lever for overall costs. Probabilistic sensitivity analysis showed a considerable degree of uncertainty for avoidable costs with widely overlapping 95% confidence intervals.ConclusionsSignificant improvements in the treatment effectiveness and reductions in complication rates are required to realize discernible cost savings. Up to 10% of total baseline costs could be avoided in the best-case scenario. This highlights the need to pursue patient-specific treatment approaches which promise optimal outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2215-2) contains supplementary material, which is available to authorized users.

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“…other studies by Xiong et al 29 and Neugebauer et al, 30 proposed to create the virtual postoperative model manipulating the preoperative surface of the aortic wall by elaboration of the centerline of the vessel based on design parameters of the prostheses. although such an approach creates a more accurate representation of the surface when compared to previous studies, 27,31 it has a limited capability of capturing undesired protrusions of the stent-graft into the lumen, as in the case of the bird-beak.…”

Section: Simulations and Clinical Casesmentioning

confidence: 99%

Computational tools for thoracic endovascular aortic repair planning

Auricchio

Conti

Romarowski

et al. 2019

Ital J Vasc Endovasc Surg

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Endovascular treatment in the thoracic aorta has mostly replaced open surgery in subjects with given anatomical requirements, showing excellent postoperative results. the selection of the right stent-graft is based on aortic morphology and operator skills, with the goal of guaranteeing good apposition and long-term stability. However, complications such as endoleak and migration can occur after thoracic endovascular aortic repair, mostly caused by a weakened mechanical interaction between the wall, the blood and the device. the goal of this review is to explore the current effort of the biomechanics community to predict in-hospital and long-term outcomes by means of computational simulations. Benchtop tests, finite element analysis and computational fluid dynamics will be explored together with several examples in order to show the current state-of-the-art for surgical planning and complications prediction. our analysis shows the potentiality of numerical tools not only to foresee problems which cannot be diagnosed by current tools, but also that the proof-of-concept stage has been passed and that the technology is ready for the bedside.

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Interactive virtual stent planning for the treatment of coarctation of the aorta

Abstract: Our approach enables a medical user to easily generate a plausibly deformed vessel mesh which is necessary as input for a simulation-based treatment planning of CoA.

Cited by 19 publications

References 24 publications

MRI-based computational hemodynamics in patients with aortic coarctation using the lattice Boltzmann methods: Clinical validation study

MRI-based computational hemodynamics in patients with aortic coarctation using the lattice Boltzmann methods: Clinical validation study

Avoidable costs of stenting for aortic coarctation in the United Kingdom: an economic model

Computational tools for thoracic endovascular aortic repair planning

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