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Electronic poster abstracts
E-143 Virtual AVM embolization – A tool for advanced interventional treatment planning
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  1. D Behme1,
  2. U Sprengel2,
  3. J Stahl2,
  4. P Saalfeld3,
  5. B Behrendt3,
  6. M Thormann1,
  7. A Mpotsaris1,
  8. B Preim3,
  9. P Berg4,
  10. S Saalfeld5
  1. 1Neuroradiology, University Clinic Magdeburg, Magdeburg, Germany
  2. 2Research Campus Stimulate, University Magdeburg, Magdeburg, Germany
  3. 3Department of Simulation and Graphics, University Magdeburg, Magdeburg, Germany
  4. 4Research Campus Stimulate; Department of Fluid Mechanics and Technical Flows, University Magdeburg, Magdeburg, Germany
  5. 5Research Campus Stimulate; Department of Simulation and Graphics, University Magdeburg, Magdeburg, Germany

Abstract

Introduction/Purpose Interventional treatment of arteriovenous malformations (AVMs) using liquid embolics is challenging especially in larger AVMs with multiple feeding arteries. Premature occlusion of the draining vein(s) may lead to fatal AVM rupture and sequential occlusion of different feeding arteries is associated with the risks of incomplete AVM occlusion or may increase rupture risk by causing hemodynamic imbalance during the embolization procedure. Virtual AVM embolization is a tool that may help for a better understanding of hemodynamic changes during embolization and thus may reduce procedural complications.

Material and Methods 3D AVM surface models were extracted from multimodal image data (3D digital subtraction image and MRA). For the virtual embolisation, all feeders of each AVM were identified and blocked separately. For n feeder arteries each blocked or unblocked, a total amount of n² blood flow simulations via computational fluid dynamics (CFD) was carried out. A custom visualization and exploration tool was developed using the Game Engine Unity where blood flow was illustrated via millions of small particles based on the CFD results.

Results The virtual embolisation software prototype allows the clinical expert to explore patient specific AVM models in 3D. Furthermore, the user can select and deselect feeder arteries to block (i.e. to embolize) or unblock them, respectively. Thus, the effects of an individual embolization strategy can be explored by analyzing the subsequent blood flow as well as by interpreting the resulting pressure gradients.

Abstract E-143 Figure 1
Abstract E-143 Figure 1

Depiction of the introduced AVM blood flow visualization. The user chooses a starting point of blood flow particles in the internal carotid artery and can follow the spread of particles along the feeder arteries to get an impression how the different feeders contribute to the blood supply of the nidus

Conclusion Because the success and safety of AVM treatment is a matter of hemodynamic balance until the draining veins are occluded by the embolization material, virtual AVM embolization is a powerful tool to simulate and explore the hemodynamic changes that occur at different embolization steps prior to AVM treatment.

Disclosures D. Behme: None. U. Sprengel: None. J. Stahl: None. P. Saalfeld: None. B. Behrendt: None. M. Thormann: None. A. Mpotsaris: None. B. Preim: None. P. Berg: None. S. Saalfeld: None.

https://doi.org/10.1136/neurintsurg-2021-SNIS.238

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