JMIR Publications

ABSTRACT

Background:

The prevalence, clinical burden, and healthcare costs (>$100 billion) associated with cerebrovascular disease (CVD) will increase significantly as the U.S. population grows and ages over the next 25 years. Existing two-dimensional (2D) imaging modalities have inherent limitations in visualizing complex CVD which may be mitigated with the use of three-dimensional (3D) Advanced Visualization (AV) technologies. There remain gaps in knowledge, however, regarding how and with what impact these technologies are being used in CVD.

Objective:

The aim of this study is to characterize the clinical attributes and reported utility associated with the use of 3D AV modeling in cerebrovascular diseases (CVD), specifically intracerebral arterio-venous malformations (iAVMs).

Methods:

This pilot study employed a combination of retrospective analysis and survey-based assessments to describe the utilization and utility of patient-specific AV models at a single high-volume Certified Comprehensive Stroke center.

Results:

Between July 2017 to February 2023, 25 AV models were created for 4 different clinicians. Average patient age was 37.4 years, 42.3% (n=11) were African American, 68.4% (n=13) were on public insurance, and 56.0% (n=14) were associated with a neurovascular procedure.18 clinician subjects with diverse experience responded to AV model surveys with a 92.2% completion rate with an average reported utility of 8.0 on a 0-10 scale with higher scores reflecting increased utility. Compared to 2D viewing, staff reported that AV models allowed them to appreciate novel abnormal anatomy and would have changed their therapeutic approach in 45.1% of cases.

Conclusions:

AV models were used in complex CVD associated with young, publicly insured individuals requiring resource-intensive interventions. There was strong and diverse clinician engagement with overall report of substantial utility of AV models. Staff clinicians frequently reported novel anatomical and therapeutic insights based on AV models compared to traditional 2D viewing. This study established the infrastructure for future larger randomized studies that can be repeated in CVD or other disease states and/or incorporate assessments of other AV modalities like 3D Printing (3DP), virtual, and augmented reality (VR/AR).