Faculty Collaboration Database

Initial Clinical Experience with AView-A Clinical Computational Platform for Intracranial Aneurysm Morphology, Hemodynamics, and Treatment Management. World Neurosurg 2017 Dec;108:534-542

Date

09/19/2017

Pubmed ID

28919570

Pubmed Central ID

PMC5705258

DOI

10.1016/j.wneu.2017.09.030

Scopus ID

2-s2.0-85030721007 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND: The management of intracranial aneurysm (IA) is challenging. Clinicians often rely on varied and intuitively disparate ways of evaluating rupture risk that may only partially take into account complex hemodynamic and morphologic factors. We developed a prototype of a clinically oriented, streamlined, computational platform, AView, for rapid assessment of hemodynamics and morphometrics in clinical settings. To show the potential clinical utility of AView, we report our initial multicenter experience highlighting the possible advantages of morphologic and hemodynamic analysis of IAs.

METHODS: AView software was deployed across 8 medical centers (6 in the United States, 2 in Japan). Eight clinicians were trained and used the AView software between September 2012 and January 2013.

RESULTS: We present 12 illustrative cases that show the potential clinical utility of AView. For all, morphology and hemodynamics, flow visualization, and rupture resemblance score (a surrogate for rupture risk) were provided. In 3 cases, AView could confirm the clinicians' decision to treat; in 3 cases, it could suggest which aneurysms may be at greater risk among multiple aneurysms; in 5 cases, AView could provide additional information for use during treatment decisions for ambiguous situations. In one stent-assisted coiling case, flow visualization predicted that the intuitive choice for stent placement could have resulted in sacrifice of an anterior cerebral artery due to blockage by coils and led clinicians to reconsider treatment plans.

CONCLUSIONS: AView has the potential to confirm decisions to treat IAs, suggest which among multiple aneurysms to treat, and guide treatment decisions. Furthermore, the flow visualization it affords can inform aneurysm treatment planning and potentially avoid poor outcomes.

Author List

Xiang J, Varble N, Davies JM, Rai AT, Kono K, Sugiyama SI, Binning MJ, Tawk RG, Choi H, Ringer AJ, Snyder KV, Levy EI, Hopkins LN, Siddiqui AH, Meng H

MESH terms used to index this publication - Major topics in bold

Aged
Cerebral Angiography
Cerebral Arteries
Computed Tomography Angiography
Decision Support Systems, Clinical
Disease Management
Feasibility Studies
Female
Hemodynamics
Humans
Image Interpretation, Computer-Assisted
Intracranial Aneurysm
Japan
Magnetic Resonance Angiography
Male
Middle Aged
Pilot Projects
Software
Stents
United States