Patient-specific numerical simulation of …...2018/12/02 · Patient-specific numerical simulation...
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Patient-specific numerical simulation of endovascular aneurysm repair Dr Lucie Derycke, Dr David Perrin, Prof Frédéric Cochenec, Prof Jean-Noël Albertini, Prof Stéphane Avril [email protected]
Transcript of Patient-specific numerical simulation of …...2018/12/02 · Patient-specific numerical simulation...
Patient-specific numerical simulation of endovascular aneurysm repair
Dr Lucie Derycke, Dr David Perrin, Prof Frédéric Cochenec, Prof Jean-Noël Albertini,
Prof Stéphane Avril [email protected]
Disclosures
D. Perrin, J.-N. Albertini and S. Avril are cofounders of the company Predisurge SAS.
Prof Stéphane [email protected]
EVAR simulation history in our group
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Simulation validation and assessment
Red: simulationGrey: postoperative scan
Patient-specificsimulations
Stent-graftmodelling
Generic simulation of stent-graftdeployment
Research: from basic models to clinically relevant simulations
2008 2012 2015
Prof Stéphane [email protected]
Branched
FenestratedMy project
Bifurcated
Tubular
Infra-renal aorta-Simple-Low clinical interest
Coeliac artery-Complex-Collateral arteries
Ascending aorta-Straight zone-Limited interest
Aortic arch-Complex-Tortuosity-Collateral arteries
Arokiaraj et al 2016
FEA and stent-graft deployment simulation in aorta
SG
Aort
ic s
ectio
n
com
plex
ity
complexityVirtual anatomy Patient-specific
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Perrin et al. 2018Un-published
Perrin et al 2015bPerrin et al 2016
Hemmler et al 2018
De Bock et al 2012
De Bock et al 2014Perrin et al 2015a Auricchio et al 2013
Prof Stéphane [email protected]
Branched
Fenestrated
Bifurcated
Tubular
Infra-renal aorta-Simple-Low clinical interest
Coeliac artery-Complex-Collateral arteries
Ascending aorta-Straight zone-Limited interest
Aortic arch-Complex-Tortuosity-Collateral arteries
Arokiaraj et al 2016
FEA and stent-graft deployment simulation in aorta
SG
Aort
ic s
ectio
n
com
plex
ity
complexityVirtual anatomy Patient-specific
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Perrin et al. 2018Un-published
Perrin et al 2015bPerrin et al 2016
Hemmler et al 2018
De Bock et al 2012
De Bock et al 2014Perrin et al 2015a Auricchio et al 2013
Double Branch project
Prof Stéphane [email protected]
Pathologies of the aortic arch (aneurysm, dissection…)Rare (5-10 cases for 100000/yr) , high risk of mortality
A significant fraction of patient population = high-risk patients deemed unfit for open surgery
Erbel R et al. 2014 Maurel B et al. 2015Cao P et al. 2012Tian DH et al 2013
General information:
Various treatment options Open surgery = complex
Significant morbidity and mortality rates30 days-mortality: until 15%
6Prof Stéphane [email protected]
Various treatment options: arch branched devices
Double Branch
endograftBolton Relay®
Custom-made device
7Prof Stéphane [email protected]
Main Objective
AIM:
To develop a patient specific FE model of double branch Bolton® device deployment in aortic arch aneurysm
8Prof Stéphane [email protected]
Geometry & Material Simulation strategy Validation
10Gasser et al 2006Perrin et al 2015b
Perrin et al 2016 De Bock et al 2012Demanget et al 2012 & 2013
PERSONALIZED
GRAFT STENTS AORTA
Software FreeCAD® Matlab® VMTK®
Mesh Quad, 0.5mm Beam, 0.3 mm Triangular shell, 1.5 mm
Material PET Orthotropicelastic
Nitinol Isotropicelastic
Constant thickness, Isotropic elastic
Prof Stéphane [email protected]
Patients: N=3
Graftplans and fabrics data provided by the manufacturer
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Preop & Postop CT-scanCase Age Sexe ASA Aneurysm
diameter, mm
Ishimaruzone
Distal aorticneck
1 64 M 3 62 0 Aorticbifurcation
2 73 M 3 58 0Descending
thoracicaorta
3 73 M 4 59 1 Iliacarteries
Prof Stéphane [email protected]
Geometry & Material Simulation strategy Validation
Geometry & Material Simulation strategy Validation
Stentgraft assembly and pre-stressed: - Oversizing: tie constraint- Radial compression: bridging stents placement & stent-grafts crimping
SG assembly& Pre-
stressedDeployment Morphing Mechanical
equilibrium
Ties Bridging stents placement &
Radial compression12Prof Stéphane Avril
Pre-stressed Deployment Morphing Mechanicalequilibrium
Ao: idealized tubular shell
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Geometry & Material Simulation strategy Validation
Prof Stéphane [email protected]
Pre-stressed Deployment Morphing Mechanicalequilibrium
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SGs placed in the intended position:-Global rotation-Proximal landing zone
Bridging stents bending (1)Stent-grafts released (2)
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2
Geometry & Material Simulation strategy Validation
Prof Stéphane [email protected]
The tubular shell of the aorta is deformed to come back to its preoperative geometry
Pre-stressed Deployment Morphing Mechanicalequilibrium
SGs are maintained in the shell => submitted to deformations15
Geometry & Material Simulation strategy Validation
Prof Stéphane [email protected]
Mechanical equilibriumSG: stressedAo: stressed
Pre-stressed Deployment Morphing Mechanicalequilibrium
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Boundary conditions:- Aortic extremities fixed- Friction coefficient SG/Aorta(0.4 + proximal: rough)
Geometry & Material Simulation strategy Validation
Prof Stéphane [email protected]
Sensitivity analysis(1 case)
Quantitative analysis (3 cases)Stent segmentation on post operative CT and comparison with Matlab®x 3 error values: eD, eL, eT
Qualitative analysis (3 cases)SuperimpositionDefect of apposition Kink…
Geometry & Material Simulation strategy Validation
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Diameter_SimuDiameter_Postop
Diameter_Simu Diameter_Postop
eD =
eL
eT
Prof Stéphane [email protected]
Results: sensitivity analysis
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Friction coefficient
=0,4
=0,4=0,4/0,1
=rough
Prof Stéphane [email protected]
Results: qualitative analysis
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Rotation 0°
Rotation 135°
0°
135°
TORSION case n°2
Prof Stéphane [email protected]
Results : BRIDGING STENTS CONFIGURATION
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-60° -30° -0° +30° +60° +75°
-75°
Prof Stéphane [email protected]
Endovascular Aortic Arch Challenges
Device alignmentSecure device
Device durabilityNew set of physiological loads
Custom-made deviceMeasures on preop CT
Tools are needed for planning to help the practitioner and to improve the
device properties
37Prof Stéphane [email protected]
Discussion
Promising potential and ability of numerical simulation:
- to predict complex stent-graft deployment in challenging anatomy like aortic arch aneurysms
- to detect potential complication, such as collapse
-to understand stent-graft behavior and conformability, such as in torsion configuration
Tool compatible with clinical decision-making model
Overall satisfying agreement between simulations and post-operative CT scans:
Mean error values: eD = 1.95% ; eL = 2.9 mm ; eT = 5.45 mm
38Prof Stéphane [email protected]
Derycke et al, Annals of Biomedical Eng, 2018, in revision
Transfer
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- Company founded in May 2017- Focus on endovascular repair (EVAR) of aortic aneurysms- Graphical user interface- Over 200 cases- On-going clinical trials for CE and FDA approval
Software solutions assisted by numerical simulation
Optimize design, preoperative planning and implantationof medical devices
www.predisurge.com
Prof Stéphane [email protected]
DANKE SCHÖN!
Dr Lucie DERYCKE, Dr David PERRIN, Prof Jean-Noël Albertini, Prof Stéphane AVRIL
Funding: ERC-2014-CoG BIOLOCHANICS
