Background Carotid Artery Stenting (CAS) is increasingly being used in selected patients as a minimal invasive approach to carotid endarterectomy. Despite the abundance of performed endovascular treatments, the concept of stent-placement is still unclear to many patients. Furthermore, visual feedback on stent-deployment is difficult to obtain as it is always performed under radiographic feedback. Three-Dimensional (3D) printing might tackle both challenges. A particular use case of Point-of-Care 3D Printing is the pretreatment printing of vascular anatomy in support of endovascular procedures.
Purpose This study reports the first use of a low-cost patient-specific 3D printed model for CAS education to both experienced surgeons and patients.
Methodology An angio computed tomography (CT) scan was segmented and converted to STL format using Mimics inPrint™ software. The carotid arteries were bilaterally truncated to fit the whole model on a Formlabs 2 printer without omitting the internal vessel diameter. Next, this model was offset using a 1 mm margin. A ridge was modelled on the original vessel anatomy which was subsequently subtracted from the offset model in order to obtain a deroofed 3D model. All vessels were truncated as to facilitate flow on the inside.
Results Date-expired carotid artery stents were successfully deployed inside the vessel. The deroofing allows for clear visualization of the bottlenecks and characteristics of CAS deployment and positioning, including foreshortening and tapering of the stent. This low-cost 3D model provides insights in stent deployment and positioning, and allows for patient-specific procedure planning.
Conclusion Printing patient-specific 3D models preoperatively could assist in accurate patient selection, a better preoperative planning and case-specific training. Furthermore, this 3D model also allows for better patient education and informed consent. However, more research is warranted to evaluate the added value of these models.