Patient-specific brain arteries molded as a flexible phantom model using 3D printed water-soluble resin

Rapid Manufacturing Method of Cardiovascular Models for Experimental Flow Analysis

Physical anatomical models constructed from medical images are valuable research tools for evaluating patient-specific clinical circumstances. For example, 3D models replicating a patient's internal anatomy in the cardiovascular system can be used to validate Computational Fluid Dynamics (CFD) models, which can then be used to identify potential hemodynamic consequences of surgical decisions by providing insight into how blood and vascular tissue mechanics may contribute to disease progression and post-operative complications. Patient-specific models have been described in the literature; however, rapid prototyping models that achieve anatomical accuracy, optical transparency, and thin-walled compliance in a cost and time-effective approach have proven challenging. This limits their utility for modeling flows in vessels, e.g., the aorta, where compliance is particularly important. The work described herein is focused on a unique design and fabrication process implemented to produce physical patient-specific models that replicate the original anatomy dimensions and compliance with optical properties consistent with clinical imaging techniques. The patient-specific models are produced for under $150 of easily accessible consumable raw materials within 30 h using a relatively basic approach.•This method can be tuned for anatomies with different shapes and compliance.•This method can produce models to investigate medical device performance in vitro.

3-Dimensional printing and bioprinting in neurological sciences: applications in surgery, imaging, tissue engineering, and pharmacology and therapeutics

The rapid evolution of three-dimensional printing (3DP) has significantly impacted the medical field. In neurology for instance, 3DP has been pivotal in personalized surgical planning and education. Additionally, it has facilitated the creation of implants, microfluidic devices, and optogenetic probes, offering substantial implications for medical and research applications. Additionally, 3D printed nasal casts are showing great promise for targeted brain drug delivery. 3DP has also aided in creating 3D "phantoms" aligning with advancements in neuroimaging, and in the design of intricate objects for investigating the neurobiology of sensory perception. Furthermore, the emergence of 3D bioprinting (3DBP), a fusion of 3D printing and cell biology, has created new avenues in neural tissue engineering. Effective and ethical creation of tissue-like biomimetic constructs has enabled mechanistic, regenerative, and therapeutic evaluations. While individual reviews have explored the applications of 3DP or 3DBP, a comprehensive review encompassing the success stories across multiple facets of both technologies in neurosurgery, neuroimaging, and neuro-regeneration has been lacking. This review aims to consolidate recent achievements of both 3DP and 3DBP across various neurological science domains to encourage interdisciplinary research among neurologists, neurobiologists, and engineers, in order to promote further exploration of 3DP and 3DBP methodologies to novel areas of neurological science research and practice.

Understanding the Impact of Synthetic Hematocrit Levels and Biomimetic Channel Widths on Bubble Parameters in Vascular Systems on a Chip

Gas embolism is a rare but life-threatening process characterized by the presence of gas bubbles in the venous or arterial systems. These bubbles, if sufficiently large or numerous, can block the delivery of oxygen to critical organs, in particular the brain, and subsequently they can trigger a cascade of adverse biochemical reactions with severe medical outcomes. Despite its critical nature, gas embolism remains poorly understood, necessitating extensive investigation, particularly regarding its manifestations in the human body and its modulation by various biological conditions. However, given its elusive nature, as well as potential lethality, gas embolism is extremely difficult to study in vivo, and nearly impossible to be the subject of clinical trials. To this end, we developed a microfluidic device designed to study in vitro the impact of blood properties and vascular geometries on the formation and evolution of gas bubbles. The system features a biomimetic vascular channel surrounded by two pressure chambers, which induce the genesis of bubbles under varying circumstances. The bubble parameters were correlated with different input parameters, i.e., channel widths, wall thicknesses, viscosities of the artificial blood, and pressure levels. Smaller channel widths and higher equivalent hematocrit concentrations in synthetic blood solutions increased the nucleation density and bubble generation frequencies. Small channel widths were also more prone to bubble formation, with implications for the vulnerability of vascular walls, leading to increased risks of damage or compromise to the integrity of the blood vessels. Larger channel widths, along with higher equivalent hematocrit concentrations, translated into larger bubble volumes and decreased bubble velocities, leading to an increased risk of bubble immobilization within the blood vessels. This biomimetic approach provides insights into the impact of patient history and biological factors on the incidence and progression of gas embolism. Medical conditions, such as anemia, along with anatomical features related to age and sex-such as smaller blood vessels in women and children or larger vascular widths in adult men-affect the susceptibility to the initiation and progression of gas embolism, explored here in vitro through the development of a controlled, physiological-like environment. The analysis of the videos that recorded gas embolism events in vitro for systems where pressure is applied laterally on the microvasculature with thin walls, i.e., 50 μm or less, suggests that the mechanism of gas transfer for the pressure area to the blood is based on percolation, rather than diffusion. These findings highlight the importance of personalized approaches in the management and prevention of gas embolism.

Influence of the orientation of constructed blood vessels during the 3D printing on the measurement of the pseudo-oxygen saturation of an artificial blood substitute using conventional oxygen sensors: a test series

BACKGROUND

The development of phantoms to reduce animal testing or to validate new instruments or operation techniques is of increasing importance. For this reason, a blood circulation phantom was developed to test a newly designed retractor system with an integrated oxygen sensor. This phantom was used to evaluate the impact of the 3D printed blood vessel on the measurement of the oxygen saturation.

METHODS

A solution of nickel sulfate and copper sulfate was prepared as a substitute for real blood. The absorption spectra of these solutions were recorded and compared with those of blood. Subsequently, the oxygen sensor used was calibrated to the blood substitute. Additionally, blood vessels with a simplified geometry were designed and manufactured using inverted vat polymerization and an elastic material (Formlabs Elastic 50 A). To determine the orientation during the printing process, various vessels were printed. Measurements to assess the effects of disturbance (rotation of the vessels during measurements) on the sensor readouts were prepared.

RESULTS

The impact of disturbances was verified through the rotation of the 3D printed vessels. It was demonstrated that a direct measurement on the disturbances led to outliers and higher values. An optimal orientation was determined to be a lateral placement (90° or 270°) of the sensor. Regarding the orientation of the vessels within the printing space, an orientation of 45° yielded the best results, as the individual layers had the least impact on the light emitted and received by the oxygen sensor.

CONCLUSION

The achieved results demonstrate the influence of the orientation of the vessel during 3D printing as well as the influence of the position of the vessel during the measurement using a conventional oxygen sensor.

Bioengineered human arterial equivalent and its applications from vascular graft to in vitro disease modeling

Arterial disorders such as atherosclerosis, thrombosis, and aneurysm pose significant health risks, necessitating advanced interventions. Despite progress in artificial blood vessels and animal models aimed at understanding pathogenesis and developing therapies, limitations in graft functionality and species discrepancies restrict their clinical and research utility. Addressing these issues, bioengineered arterial equivalents (AEs) with enhanced vascular functions have been developed, incorporating innovative technologies that improve clinical outcomes and enhance disease progression modeling. This review offers a comprehensive overview of recent advancements in bioengineered AEs, systematically summarizing the bioengineered technologies used to construct these AEs, and discussing their implications for clinical application and pathogenesis understanding. Highlighting current breakthroughs and future perspectives, this review aims to inform and inspire ongoing research in the field, potentially transforming vascular medicine and offering new avenues for preclinical and clinical advances.

Modeling human atherosclerotic lesions in the test tube: Are we there yet?

Atherosclerotic cardiovascular diseases remain a leading cause of morbidity and mortality worldwide. Atherogenesis is a slow and life-long process characterized by the accumulation of lipoproteins and immune cells within the arterial wall. Atherosclerosis has been successfully modeled in animals: However, there are economic, ethical, and translational concerns when using these models. There is also growing recognition of the need for robust human-based in vitro systems that can faithfully recapitulate key aspects of human atherosclerosis. Such systems may offer advantages in terms of scalability, reproducibility, and ability to manipulate specific variables, thereby facilitating a deeper understanding of disease mechanisms and accelerating the development of targeted therapeutics. Leveraging innovative in vitro platforms holds promise in complementing traditional animal models of atherosclerosis. In the present review, we discuss the advantages and disadvantages of recently developed models of atherosclerosis and propose ideas to be considered when developing future generations of models.

Patient-Specific Vascular Flow Phantom for MRI- and Doppler Ultrasound Imaging

OBJECTIVE

Intraoperative Doppler ultrasound imaging of human brain vasculature is an emerging neuro-imaging modality that offers vascular brain mapping with unprecedented spatiotemporal resolution. At present, however, access to the human brain using Doppler Ultrasound is only possible in this intraoperative context, posing a significant challenge for validation of imaging techniques. This challenge necessitates the development of realistic flow phantoms outside of the neurosurgical operating room as external platforms for testing hardware and software. An ideal ultrasound flow phantom should provide reference-like values in standardized topologies such as a slanted pipe, and allow for measurements in structures closely resembling vascular morphology of actual patients. Additionally, the phantom should be compatible with other clinical cerebrovascular imaging modalities. To meet these criteria, we developed and validated a versatile, multimodal MRI- and ultrasound Doppler phantom.

METHODS

Our approach incorporates the latest advancements in phantom research using tissue-mimicking material and 3D-printing with water-soluble resin to create wall-less patient-specific lumens, compatible for ultrasound and MRI.

RESULTS

We successfully produced three distinct phantoms: a slanted pipe, a y-shape phantom representing a bifurcating vessel and an arteriovenous malformation (AVM) derived from clinical Digital Subtraction Angiography (DSA)-data of the brain. We present 3D ultrafast power Doppler imaging results from these phantoms, demonstrating their ability to mimic complex flow patterns as observed in the human brain. Furthermore, we showcase the compatibility of our phantom with Magnetic Resonance Imaging (MRI).

CONCLUSION

We developed an MRI- and Doppler Ultrasound-compatible flow-phantom using customizable, water-soluble resin prints ranging from geometrical forms to patient-specific vasculature.

Biomimicking Atherosclerotic Vessels: A Relevant and (Yet) Sub-Explored Topic

Atherosclerosis represents the etiologic source of several cardiovascular events, including myocardial infarction, cerebrovascular accidents, and peripheral artery disease, which remain the leading cause of mortality in the world. Numerous strategies are being delineated to revert the non-optimal projections of the World Health Organization, by both designing new diagnostic and therapeutic approaches or improving the interventional procedures performed by physicians. Deeply understanding the pathological process of atherosclerosis is, therefore, mandatory to accomplish improved results in these trials. Due to their availability, reproducibility, low expensiveness, and rapid production, biomimicking physical models are preferred over animal experimentation because they can overcome some limitations, mainly related to replicability and ethical issues. Their capability to represent any atherosclerotic stage and/or plaque type makes them valuable tools to investigate hemodynamical, pharmacodynamical, and biomechanical behaviors, as well as to optimize imaging systems and, thus, obtain meaningful prospects to improve the efficacy and effectiveness of treatment on a patient-specific basis. However, the broadness of possible applications in which these biomodels can be used is associated with a wide range of tissue-mimicking materials that are selected depending on the final purpose of the model and, consequently, prioritizing some materials' properties over others. This review aims to summarize the progress in fabricating biomimicking atherosclerotic models, mainly focusing on using materials according to the intended application.

Fabricating a dielectrophoretic microfluidic device using 3D-printed moulds and silver conductive paint

Dielectrophoresis is an electric field-based technique for moving neutral particles through a fluid. When used for particle separation, dielectrophoresis has many advantages compared to other methods, like providing label-free operation with greater control of the separation forces. In this paper, we design, build, and test a low-voltage dielectrophoretic device using a 3D printing approach. This lab-on-a-chip device fits on a microscope glass slide and incorporates microfluidic channels for particle separation. First, we use multiphysics simulations to evaluate the separation efficiency of the prospective device and guide the design process. Second, we fabricate the device in PDMS (polydimethylsiloxane) by using 3D-printed moulds that contain patterns of the channels and electrodes. The imprint of the electrodes is then filled with silver conductive paint, making a 9-pole comb electrode. Lastly, we evaluate the separation efficiency of our device by introducing a mixture of 3 μm and 10 μm polystyrene particles and tracking their progression. Our device is able to efficiently separate these particles when the electrodes are energized with ±12 V at 75 kHz. Overall, our method allows the fabrication of cheap and effective dielectrophoretic microfluidic devices using commercial off-the-shelf equipment.

Fabrication of Compliant and Transparent Hollow Cerebral Vascular Phantoms for In Vitro Studies Using 3D Printing and Spin-Dip Coating

Endovascular surgery through flow diverters and coils is increasingly used for the minimally invasive treatment of intracranial aneurysms. To study the effectiveness of these devices, in vitro tests are performed in which synthetic vascular phantoms are typically used to reproduce in vivo conditions. In this paper, we propose a manufacturing process to obtain compliant and transparent hollow vessel replicas to assess the mechanical behaviour of endovascular devices and perform flow measurements. The vessel models were obtained in three main steps. First, a mould was 3D-printed in a water-soluble material; two techniques, fusion deposition modelling and stereolithography, were compared for this purpose. Then, the mould was covered with a thin layer of silicone through spin-dip coating, and finally, when the silicone layer solidified, it was dissolved in a hot water bath. The final models were tested in terms of the quality of the final results, the mechanical properties of the silicone, thickness uniformity, and transparency properties. The proposed approach makes it possible to produce models of different sizes and complexity whose transparency and mechanical properties are suitable for in vitro experiments. Its applicability is demonstrated through idealised and patient-specific cases.

Development of a 3D simulator for training the mouse in utero electroporation

In utero electroporation (IUE) requires high-level training in microinjection through the mouse uterine wall into the lateral ventricle of the mouse brain. Training for IUE is currently being performed in live mice as no artificial models allow simulations yet. This study aimed to develop an anatomically realistic 3D printed simulator to train IUE in mice. To this end, we created embryo models containing lateral ventricles. We coupled them to uterus models in six steps: (1) computed tomography imaging, (2) 3D model segmentation, (3) 3D model refinement, (4) mold creation to cast the actual model, (5) 3D mold printing, and (6) mold casting the molds with a mix of soft silicones to ensure the hardness and consistency of the uterus and embryo. The results showed that the simulator assembly successfully recreated the IUE. The compression test did not differ in the mechanical properties of the real embryo or in the required load for uterus displacement. Furthermore, more than 90% of the users approved the simulator as an introduction to IUE and considered that the simulator could help reduce the number of animals for training. Despite current limitations, our 3D simulator enabled a realistic experience for initial approximations to the IUE and is a real alternative for implementing the 3Rs. We are currently working on refining the model.

Frictional force analysis of stent retriever devices using a realistic vascular model: Pilot study

Objective

To date, no vascular model to analyze frictional forces between stent retriever devices and vessel walls has been designed to be similar to the real human vasculature. We developed a novel in vitro intracranial cerebrovascular model and analyzed frictional forces of three stent retriever devices.

Methods

A vascular mold was created based on digital subtraction angiography of a patient's cerebral vessels. The vascular model was constructed using polydimethylsiloxane (PDMS, Dow Corning, Inc.) as a silicone elastomer. The vascular model was coated on its inner surface with a lubricating layer to create a low coefficient of friction (~0.037) to closely approximate the intima. A pulsatile blood pump was used to produce blood flow inside the model to approximate real vascular conditions. The frictional forces of Trevo XP, Solitaire 2, and Eric 4 were analyzed for initial and maximal friction retrieval forces using this vascular model. The total pulling energy generated during the 3 cm movement was also obtained.

Results

Results for initial retrieval force were as follows: Trevo, 0.09 ± 0.04 N; Solitaire, 0.25 ± 0.07 N; and Eric, 0.33 ± 0.21 N. Results for maximal retrieval force were as follows: Trevo, 0.36 ± 0.07 N; Solitaire, 0.54 ± 0.06 N; and Eric, 0.80 ± 0.13 N. Total pulling energy (N·cm) was 0.40 ± 0.10 in Trevo, 0.65 ± 0.10 in Solitaire, and 0.87 ± 0.14 in Eric, respectively.

Conclusions

Using a realistic vascular model, different stent retriever devices were shown to have statistically different frictional forces. Future studies using a realistic vascular model are warranted to assess SRT devices.