Design and Physical Properties of 3-Dimensional Printed Models Used for Neurointervention: A Systematic Review of the Literature

Abstract

Background Three-dimensional (3D) printing has revolutionized training, education, and device testing. Understanding the design and physical properties of 3D-printed models is important. Objective To systematically review the design, physical properties, accuracy, and experimental outcomes of 3D-printed vascular models used in neurointervention. Methods We conducted a systematic review of the literature between January 1, 2000 and September 30, 2018. Public/Publisher MEDLINE (PubMed), Web of Science, Compendex, Cochrane, and Inspec databases were searched using Medical Subject Heading terms for design and physical attributes of 3D-printed models for neurointervention. Information on design and physical properties like compliance, lubricity, flow system, accuracy, and outcome measures were collected. Results A total of 23 articles were included. Nine studies described 3D-printed models for stroke intervention. Tango Plus (Stratasys) was the most common material used to develop these models. Four studies described a population-representative geometry model. All other studies reported patient-specific vascular geometry. Eight studies reported complete reconstruction of the circle of Willis, anterior, and posterior circulation. Four studies reported a model with extracranial vasculature. One prototype study reported compliance and lubricity. Reported circulation systems included manual flushing, programmable pistons, peristaltic, and pulsatile pumps. Outcomes included thrombolysis in cerebral infarction, post-thrombectomy flow restoration, surgical performance, and qualitative feedback. Conclusion Variations exist in the material, design, and extent of reconstruction of vasculature of 3D-printed models. There is a need for objective characterization of 3D-printed vascular models. We propose the development of population representative 3D-printed models for skill improvement or device testing.

A Thrombectomy Model Based on Ex Vivo Whole Human Brains

“…In addition to the human brain model herein described, another 3 main categories of thrombectomy models have been reported and reviewed in the literature: benchtop phantoms, 11 in vivo animal models, 12 and emerging computational models. 13 Benchtop phantoms leverage recent advances in high-resolution medical imaging and 3D printing techniques to replicate patientspecific anatomy in a consistent fashion.…”

“…Transparent phantoms also allow direct visualization of the device-clot interaction, though the "vascular" walls are much stiffer than human arteries (or totally rigid), lack submillimeter arteries, and do not adhere well to the clots. 11 Animal models have been extensively used and are critical to test device safety. These models provide a more realistic device-artery-clot interaction, but it can only be visualized using fluoroscopy, with a limited resolution and frame rate.…”

Pulsatile Flow-Induced Fatigue-Resistant Photopolymerizable Hydrogels for the Treatment of Intracranial Aneurysms

“…Silicone aneurysms models are commonly used to test new devices (Waqas et al, 2020), because they exhibit better transparency, resistance and navigability compared to others materials such as flexible resins like TangoPlus or VeroClear (Torres and De Luccia, 2017). The technique developed herein has been used to fabricate intracranial aneurysm models in previous studies.…”

Conventional and advanced MRI evaluation of brain vascular malformations

“…Neuroimages play a major role as they are the source of most 3D printed models. The use of 3D modeling and 3D printing techniques for VMs assessment goes beyond the use of conventional volume rendering, MIP, or the recently developed solution based on cinematic rendering from source MRI images 89,90 . 3D modeling techniques use advanced algorithms for tissue segmentation and reconstruction of VMs, which are usually applied to raw data from 3D CE T1WI, SWI, or MRA studies.…”