In this study, we develop reliable and practical virtual coiling and stenting methods for intracranial aneurysm surgical planning. Since the purpose of deploying coils and stents is to provide device geometries for subsequent accurate post-treatment computational fluid dynamics analysis, we do not need to accurately capture all the details such as the stress and force distribution for the devices and vessel walls. Our philosophy for developing these methods is to balance accuracy and practicality. We consider the mechanical properties of the devices and recapitulate the clinical practice using a finite element method (FEM) approach. At the same time, we apply some simplifications for FEM modeling to make our methods efficient. For the virtual coiling, the coils are modeled as 3D Euler–Bernoulli beam elements, which is computationally efficient and provides good geometry representation. During the stent deployment process, the stent–catheter system is transformed according to the centerline of the parent vessel since the final configuration of the stent is not dependent of the deployment history. The aneurysm and vessel walls are assumed to be rigid and are fully constrained during the simulation. All stent–catheter system and coil–catheter system are prepared and packaged as a library which contains all types of stents, coils and catheters, which improves the efficiency of surgical planning process. The stent was delivered to the suitable position during the clinical treatment, achieving good expansion and apposition of the stent to the arterial wall. The coil was deployed into the aneurysm sac and deformed to different shapes because of the stored strain energy during coil package process and the direction of the microcatheter. The method which we develop here could become surgical planning for intracranial aneurysm treatment in the clinical workflow.

The authors evaluated the impact of morphological and hemodynamic factors on the rupture of matched-pairs of ruptured-unruptured intracranial aneurysms on one patient’s ipsilateral anterior circulation with 3D reconstruction model and computational fluid dynamic method simulation. 20 patients with intracranial aneurysms pairs on the same-side of anterior circulation but with different rupture status were retrospectively collected. Each pair was divided into ruptured-unruptured group. Patient-specific models based on their 3D-DSA images were constructed and analyzed. The relative locations, morphologic and hemodynamic factors of these two groups were compared. There was no significant difference in the relative bleeding location. The morphological factors analysis found that the ruptured aneurysms more often had irregular shape and had significantly higher maximum height and aspect ratio. The hemodynamic factors analysis found lower minimum wall shear stress (WSSmin) and more low-wall shear stress-area (LSA) in the ruptured aneurysms than that of the unruptured ones. The ruptured aneurysms more often had WSSmin on the dome. Intracranial aneurysms pairs with different rupture status on unilateral side of anterior circulation may be a good disease model to investigate possible characteristics linked to rupture independent of patient characteristics. Irregular shape, larger size, higher aspect ratio, lower WSSmin and more LSA may indicate a higher risk for their rupture.