SPP2311

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Multi-scale algorithms and simulation for the patient-specific optimization of endovascular interventions in cerebral aneurysms

PIs: Prof. Alexander Popp, Prof. Barbara Wohlmuth, Prof. Jan Kirschke

Aim:

Scientific objective
The main objective of this project is to develop methods and simulation tools that map the course of endovascular cerebral aneurysm treatment and support interventionalists in treatment planning – from diagnosis to intervention optimization and assessment of the long-term perspective.

Outreach & Networking: In addition to the purely scientific aspect, cooperation within, but also networking beyond the boundaries of the SPP is a central goal, which we pursue in the hope of bringing together scientists and physicians with clinical/practical experience in order to strengthen the active exchange between these groups on the topic of cerebral aneurysm treatment in Germany. For our organized thematic workshops, see below under “Activities within the SPP”, as well as under “Collaborations” for our networking and collaboration activities within the SPP and internationally.

Teaching & training: With the vision of a practically applicable tool for doctors in everyday clinical practice, our coil simulation tool is already being used by Prof. Leonid Goubergrits (Charité Berlin) in the training of students, who can use it to perform and assess virtual coiling.

Angiography image during an aneurysm coiling procedure.

Relapse of a coiled aneurysm.

Streamlines through a coil configuration

Cross-section through the porosity field of a coil

Tracer particles in flow through a coiled aneurysm

Description:

Medical background:

Definition and relevance: Cerebral aneurysms are protrusions of blood vessels in the brain, often caused by high blood pressure or arteriosclerosis, whose wall structure is exposed to an increased risk of rupture. If such an aneurysm ruptures, this can have drastic consequences for the patient, with almost half a million fatal cases every year. With a prevalence of around 3% in the EU, there is a high urgency for the further development of diagnostic and treatment methods.

Treatment: If an aneurysm is detected during an angiographic, CT or MRI examination, a decision must be made as to whether and, if so, how it should be treated. In particular, endovascular techniques such as aneurysm coiling or the insertion of flow diverters are increasingly being considered.

– Coiling: Coiling involves inserting an extremely soft microwire into the aneurysm via a catheter until it is filled as volumetrically as possible. The coil thus formed in the aneurysm prevents or at least reduces further blood flow in the critical area, with the formation of a thrombus around the coil further enhancing this effect.

– Flow-Diverter: A flow diverter is a very narrow-meshed stent and is placed in the vessel in front of the aneurysm. It directs the blood flow past the aneurysm, also with the aim of reducing the blood flow in the aneurysm, whereby the position in the vessel is held by pressing firmly against the vessel wall.

Risks and long-term prognosis: When selecting the specific endovascular device, e.g. when choosing a suitable coil, many parameters play a role, from length, thickness and insertion position to complex microstructures in the coil material. Risks are, for example, that parts of the coil protrude from the aneurysm if it is not placed ideally or that parts of the aneurysm are not completely covered or closed. Such cases are categorized according to the Raymond-Roy classification. The consequences of such incomplete occlusion can be residual blood flow in the aneurysm with pulsation-induced further weakening of the wall and even regrowth of the aneurysm, but also the formation of edema in the tissue behind the aneurysm. However, even in the case of a completely occluded aneurysm, the inflammation of the aneurysm wall or the complex interaction of the device material with the thrombus that forms can lead to shrinkage of the coil (coil compactification) with similar long-term consequences.
This makes the analysis of the long-term prognosis of treated aneurysms an essential aspect of research, in addition to the optimization of direct intervention.

Methods:

Using appropriate multi-scale models, this project selects optimal treatment strategies for endovascular intervention, including in-silico testing of different devices or surgical approaches, and predicts long-term treatment outcomes. For this purpose, porous media approaches are used as surrogate models for endovascular devices and for bio-active thrombus modeling, mixed-dimensional models for fluid-structure (vessel wall pulsation), structure-structure (device-wall interaction) and structure-solid (vessel wall-tissue) coupling. Highly parallel Lattice-Boltzmann solvers coupled with finite elements ensure the efficient numerical solution of the resulting equations even in realistic scenarios.

Phase I: In the first phase of the SPP project, the focus is on direct intervention planning. This includes the realistic simulation of blood flow dynamics in patient-specific geometries with aneurysm position-dependent boundary conditions and evaluation of relevant parameters such as wall shear stress for rupture risk analysis. The modeling of endovascular devices, including the statistical consideration of uncertainties, is also a decisive aspect in order to be able to make clinically relevant statements on the optimal choice of devices. Porous media and poroelastic approaches can be used to model and evaluate the influence of the devices used on the bluff flow dynamics and thus their occlusion quality. They also provide a basis for modeling and simulating thrombus formation, which will be another core component of the second project phase. The Lattice-Boltzmann to finite element coupling in the direction of vessel wall pulsation and dynamics and their implementation in corresponding high-performance frameworks will also lay the foundation for correspondingly more complex models in phase II.

Phase II: In Phase II, the focus is on the long-term perspective of the patient and the prediction of recurrence. The in-silico Raymond-Roy occlusion quality criteria developed in Phase I will be calibrated and validated using experimental data from our cooperation partners. In the field of endovascular devices, our complexity-reduced mechanical models are extended to include bioactive components such as HydroCoils or coated flow diverters, and structural-structural interactions with the vessel wall are included in addition to the fluid. Based on a reduced wall model, biomechanical models are implemented with inflammation processes that change the material properties of the wall. Our implementation of coupled fluid-structure interaction using Lattice-Boltzmann/Finite elements is extended to a fluid-structure-solid-state approach that considers the outer tissue to capture the edema formation process and the thrombus inside. To quantify and predict potential coil compaction, a phenomenological contraction model for the thrombus is developed and coupled with wall and coil mechanics. To improve clinical applicability in terms of simulation speed and to provide practical benefits to neurointerventionalists, machine learning will be used as a predictive tool.

Applicants:

Publications

2024

Schwarting, Julian; Holzberger, Fabian; Muhr, Markus; Renz, Martin; Boeckh-Behrens, Tobias; Wohlmuth, Barbara; Kirschke, Jan

Numerical simulation of individual coil placement – A proof-of-concept study for the prediction of recurrence after aneurysm coiling Artikel

In: [PrePrint], arXiv, 2024.

Abstract | Links | BibTeX

Duswald, Tobias; Keith, Brendan; Lazarov, Boyan; Petrides, Socratis; Wohlmuth, Barbara

Finite elements for Matérn-type random fields: Uncertainty in computational mechanics and design optimization Artikel

In: [PrePrint], arXiv, 2024.

Abstract | Links | BibTeX

Horvat, Medeea; Lunowa, Stephan B.; Sytnyk, Dmytro; Wohlmuth, Barbara

A lattice Boltzmann method for non-Newtonian blood flow in coiled intracranial aneurysms Artikel

In: [PrePrint], arXiv, 2024.

Abstract | Links | BibTeX

Holzberger, Fabian; Muhr, Markus; Wohlmuth, Barbara

A Comprehensive Numerical Approach to Coil Placement in Cerebral Aneurysms: Mathematical Modeling and In Silico Occlusion Classification Artikel

In: [PrePrint], arXiv, 2024.

Abstract | Links | BibTeX

Frank, Martin; Holzberger, Fabian; Horvat, Medeea; Kirschke, Jan; Mayr, Matthias; Muhr, Markus; Nebulishvili, Natalia; Popp, Alexander; Schwarting, Julian; Wohlmuth, Barbara

Numerical simulation of endovascular treatment options for cerebral aneurysms Artikel

In: [PrePrint], arXiv, 2024.

Abstract | Links | BibTeX

2023

Gjerde, Ingeborg G.; Kuchta, Miroslav; Rognes, Marie E.; Wohlmuth, Barbara

Directional flow in perivascular networks: Mixed finite elements for reduced-dimensional models on graphs Artikel

In: [PrePrint], arXiv, 2023.

Abstract | Links | BibTeX

Holzberger, Fabian; Kirschke, Jan; Muhr, Markus; Nebulishvili, Natalia; Schwarting, Julian; Wohlmuth, Barbara

Breaking Blood Flow with Wires in Aneurysm Coiling Treatment Simulations Online

SIAM, News (Hrsg.): 2023, besucht am: 19.12.2023.

Links | BibTeX

2022

Fritz, Marvin; Köppl, Tobias; Oden, John Tinsley; Wagner, Andreas; Wohlmuth, Barbara; Wu, Chengyue

A 1D–0D–3D coupled model for simulating blood flow and transport processes in breast tissue Artikel

In: International Journal for Numerical Methods in Biomedical Engineering, Bd. 38, Ausg. 7, S. e3612, 2022.

Abstract | Links | BibTeX