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. 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.
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.
BACKGROUND: Current in vitro models for humanbrain 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.
Authors: José Cornejo; Jorge A Cornejo-Aguilar; Mariela Vargas; Carlos G Helguero; Rafhael Milanezi de Andrade; Sebastian Torres-Montoya; Javier Asensio-Salazar; Alvaro Rivero Calle; Jaime Martínez Santos; Aaron Damon; Alfredo Quiñones-Hinojosa; Miguel D Quintero-Consuegra; Juan Pablo Umaña; Sebastian Gallo-Bernal; Manolo Briceño; Paolo Tripodi; Raul Sebastian; Paul Perales-Villarroel; Gabriel De la Cruz-Ku; Travis Mckenzie; Victor Sebastian Arruarana; Jiakai Ji; Laura Zuluaga; Daniela A Haehn; Albit Paoli; Jordan C Villa; Roxana Martinez; Cristians Gonzalez; Rafael J Grossmann; Gabriel Escalona; Ilaria Cinelli; Thais Russomano Journal: Biomed Res Int Date: 2022-03-24 Impact factor: 3.411