• Naoki Kaneko, Henrik Ullman, Fadil Ali, Philipp Berg, Yinn Cher Ooi, Satoshi Tateshima, Geoffrey P Colby, Yutaro Komuro, Peng Hu, Kasra Khatibi, Lucido L Ponce Mejia, Viktor Szeder, May Nour, Lea Guo, Aichi Chien, Fernando Vinuela, Shigeru Nemoto, Toshihiro Mashiko, Yoshihide Sehara, Jason D Hinman, Gary Duckwiler, and Reza Jahan.
• Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA. Electronic address: nkaneko@ucla.edu.
• World Neurosurg. 2020 Sep 1; 141: e873-e879.

BackgroundCurrent in vitro models for human brain arteriovenous malformation (AVM) analyzing the efficacy of embolic materials or flow conditions are limited by a lack of realistic anatomic features of complex AVM nidus. The purpose of this study was to evaluate a newly developed in vitro AVM model for embolic material testing, preclinical training, and flow analysis.MethodsThree-dimensional (3D) images of the AVM nidus were extracted from 3D rotational angiography from a patient. Inner vascular mold was printed using a 3D printer, coated with polydimethylsiloxanes, and then was removed by acetone, leaving a hollow AVM model. Injections of liquid embolic material and 4-dimensional (4D) flow magnetic resonance imaging (MRI) were performed using the AVM models. Additionally, computational fluid dynamics analysis was performed to examine the flow volume rate as compared with 4D flow MRI.ResultsThe manufacture of 3D in vitro AVM models delivers a realistic representation of human nidus vasculature and complexity derived from patients. The injection of liquid embolic agents performed in the in vitro model successfully replicated real-life treatment conditions. The model simulated the plug and push technique before penetration of the liquid embolic material into the AVM nidus. The 4D flow MRI results were comparable to computational fluid dynamics analysis.ConclusionsAn in vitro human brain AVM model with realistic geometric complexities of nidus was successfully created using 3D printing technology. This AVM model offers a useful tool for training of embolization techniques and analysis of hemodynamics analysis, and development of new devices and materials.Copyright © 2020 Elsevier Inc. All rights reserved.

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