Feasibility of Creating a Patient-Specific Neuro-Endovascular Procedural Simulator Using Advanced Manufacturing Techniques

Introduction: Fabricating a patient-specific modular, complete, and fluid-enabled neuro-endovascular simulator (NEVS) using three-dimensional printing (3DP).
Patient-specific simulations based on 3DP models are being used more frequently in clinical training and hold promise in procedural simulation. This study aimed to develop a fabrication approach for a patient-specific endovascular simulator for cerebrovascular disease.

Methods: Digital Imaging and Communications in Medicine (DICOM) files were obtained from the Ochsner Radiology Department and segmented to create Stereolithography (STL) files of aortic arch anatomy to connect to our previous 3DP intracranial (IC) vasculature. An STL file was 3DP using Formlabs Flexible 80A Resin on a Formlabs Form 2 printer. The 3DP was cured in UV light, leaving a hollow silicone vascular model, which was then connected to the simulator platform. The platform used an Arduino-controlled peristaltic pump to propel water through the circuit composed of silicone tubes, 3DP vasculature, and a port for the Seldinger technique.

Results: Four Type III aortic arches were selected for modeling based on procedures requiring adjustment of initial access from the femoral to the brachial artery. Creating the 3DP required 4 hours of digital processing, and development for the simulator required 12.5 hours of printing time effort and $28.40 in materials. All 3 branches from the aortic arch, including both vertebral and common carotid arteries were fabricated. This proof-of-concept study established the feasibility of constructing a low-cost patient-specific NEVS platform inferior to the Circle of Willis.

Conclusion : Future iterations of patient-specific endovascular simulators will mimic in vivo procedural experiences with added anatomy, biomimetic materials, and physiological fluid dynamics. The next studies will assess the authenticity, efficacy, and scalability of 3DP patient-specific NEVS training.