In Vitro Modeling of Human Brain Arteriovenous Malformation for Endovascular Simulation and Flow Analysis

Naoki Kaneko; Henrik Ullman; Fadil Ali; Philipp Berg; Yinn Cher Ooi; Satoshi Tateshima; Geoffrey P Colby; Yutaro Komuro; Peng Hu; Kasra Khatibi; Lucido L Ponce Mejia; Viktor Szeder; May Nour; Lea Guo; Aichi Chien; Fernando Vinuela; Shigeru Nemoto; Toshihiro Mashiko; Yoshihide Sehara; Jason D Hinman; Gary Duckwiler; Reza Jahan

doi:10.1016/j.wneu.2020.06.084

In Vitro Modeling of Human Brain Arteriovenous Malformation for Endovascular Simulation and Flow Analysis

World Neurosurg. 2020 Sep:141:e873-e879. doi: 10.1016/j.wneu.2020.06.084. Epub 2020 Jun 18.

Authors

Naoki Kaneko¹, Henrik Ullman², Fadil Ali², Philipp Berg³, Yinn Cher Ooi², Satoshi Tateshima², Geoffrey P Colby⁴, Yutaro Komuro⁵, Peng Hu², Kasra Khatibi², Lucido L Ponce Mejia², Viktor Szeder², May Nour⁶, Lea Guo², Aichi Chien², Fernando Vinuela², Shigeru Nemoto⁷, Toshihiro Mashiko⁸, Yoshihide Sehara⁹, Jason D Hinman⁵, Gary Duckwiler², Reza Jahan²

Affiliations

¹ Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA. Electronic address: nkaneko@ucla.edu.
² Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
³ Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany.
⁴ Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA; Department of Neurosurgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
⁵ Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
⁶ Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA; Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
⁷ Kanto Rosai Hospital, Kawasaki, Japan.
⁸ Department of Neurosurgery, Jichi Medical University, Shimotsuke, Japan.
⁹ Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan.

PMID: 32565379
DOI: 10.1016/j.wneu.2020.06.084

Abstract

Background: Current in vitro models for human brain arteriovenous malformation (AVM) analyzing the efficacy of embolic materials or flow conditions are limited by a lack of realistic anatomic features of complex AVM nidus. The purpose of this study was to evaluate a newly developed in vitro AVM model for embolic material testing, preclinical training, and flow analysis.

Methods: Three-dimensional (3D) images of the AVM nidus were extracted from 3D rotational angiography from a patient. Inner vascular mold was printed using a 3D printer, coated with polydimethylsiloxanes, and then was removed by acetone, leaving a hollow AVM model. Injections of liquid embolic material and 4-dimensional (4D) flow magnetic resonance imaging (MRI) were performed using the AVM models. Additionally, computational fluid dynamics analysis was performed to examine the flow volume rate as compared with 4D flow MRI.

Results: The manufacture of 3D in vitro AVM models delivers a realistic representation of human nidus vasculature and complexity derived from patients. The injection of liquid embolic agents performed in the in vitro model successfully replicated real-life treatment conditions. The model simulated the plug and push technique before penetration of the liquid embolic material into the AVM nidus. The 4D flow MRI results were comparable to computational fluid dynamics analysis.

Conclusions: An in vitro human brain AVM model with realistic geometric complexities of nidus was successfully created using 3D printing technology. This AVM model offers a useful tool for training of embolization techniques and analysis of hemodynamics analysis, and development of new devices and materials.

Keywords: AVM; Endovascular treatment; Hemodynamics; In vitro model; Simulation.

MeSH terms

Cerebral Angiography
Embolization, Therapeutic / methods*
Endovascular Procedures / methods*
Hemodynamics
Humans
Hydrodynamics
Imaging, Three-Dimensional
Intracranial Arteriovenous Malformations / physiopathology*
Intracranial Arteriovenous Malformations / surgery*
Models, Neurological*
Printing, Three-Dimensional

Grants and funding

R01 HL152270/HL/NHLBI NIH HHS/United States