Predictive Simulation for the Planning of Interventional Neuroradiology procedures – PreSPIN

Ischemic stroke is a major cause of disability and death worldwide. The induced severe disability cannot be reversed but with rapid treatment action. Recent clinical trials have demonstrated Endovascular Thrombectomy (EVT) to be highly effective, which has led to its widespread adoption in clinical routine. However, the conditions for a safe and efficient treatment are a strict management timeline and highly expert interventionalists. Training is a key element of performance and process improvement, and simulation plays an increasing and essential role, but there still lacks evidence that the commercial simulators can help improve clinical performance. In other words, the experience they convey is hardly transferable to the intervention room. PreSPIN (Predictive Simulation for the Planning of Interventional Neuroradiology procedures) aims at bridging the gap between training and intervention by addressing the planning phase. Here, numerical simulation can play a fundamental role on the condition that it is predictive, i.e. capable of rendering events that are critical to medical doctors.

The project brings together a multidisciplinary team of researchers in numerical simulation, image processing and clinical medicine in order to tackle theoretical, technological and medical issues standing in the way towards a predictive planning system for the therapeutic management of acute ischemic stroke. The overall objective is to develop original methods to allow for high-fidelity and interactive simulation of catheter navigation and placement in the intracranial circulation, and real time synthesis of perfusion MRI images that takes advantage of an accurate simulation of blood flow in both the large vessels, as well as the capillary brain tissue. New blood vessel models will be designed, dedicated to the considered numerical simulations, and able to accurately capture the complex topology and geometry of the tortuous brain vasculature.

In that context, PreSPIN will: 
• Objective 1: develop new solutions for segmenting and modeling the brain vasculature of the patient from MRA data, to provide geometric boundary conditions to forthcoming simulations;
• Objective 2: propose new blood vessel models adapted to interactive simulation of interventional devices navigation, for a more informed choice of medical devices and treatment options; and fast blood flow simulation, to prevent potential risks associated with blood flow restoration;
• Objective 3: progress in computational fluid dynamics (CFD) and investigate new and refined means of simulating perfusion imaging, to better predict treatment outcome.

These advances will be supported by experimental data acquisitions with the aim of providing open-source in vitro data and reproducible setups to the community. Such data will be designed in close collaboration with interventional neuroradiologists who belong to the project’s partner teams, to both ensure critical phenomena are captured and make advances towards an engineered definition and assessment of medical predictivity.

The project will have a definite impact on the clinical use of simulation for planning, but also for post-operative case review, which will constitute a situation of choice for our validation purpose. The results will directly be applicable to training and will enable a seamless integration of patient data in simulators, which is a major achievement to bring training experience closer to actual clinical conditions and make it transferable to the intervention. A longer term objective is to leverage simulation during the intervention to complement intra-operative data with unseen simulated information (e.g. blood pressure, device friction force, or full 3D view).