Patient-Inspired In Vitro and CFD Modeling of Hepatic Intraarterial Microballoon Interventions

Objective: While microballoon interventions (MBIs) have emerged as a safe treatment for hepatocellular carcinoma, they also lead to blood flow alterations that are not well understood and could decrease the treatment's effectiveness. In this study, we developed patient-inspired in vitro and in silico models (IVM and ISM). The IVM was used to study the influence of using a microballoon vs. a standard catheter on the tumor targeting and to validate the ISM; the ISM was used to study the influence of the size of a communicating arcade on the tumor targeting. Methods: Two IVM (with a literature-based collateral artery and without collateral artery), two catheter modes (a microballoon catheter with inflated and deflated balloon), and three occlusion locations were combined to conduct an experimental, parametric analysis. Furthermore, the ISM was validated and used to study four collateral artery diameters. Results: The IVM generated realistic hemodynamic alterations, and the ISM replicated the experimental results with an average difference of 4 percent points on the flow distribution per outlet. The designed collateral artery did not affect the simulated intervention negatively. Conclusion: Patient-inspired IVMs and ISMs can be used to better understand the complex hemodynamic phenomena after balloon occlusion and help determine collateral artery sizes that generate successful MBIs. Significance: Combined patient-inspired IVM and ISM of the hepatic artery hemodynamics during MBIs were developed for the first time. This modeling approach could potentially lead to a better assessment of patients with liver cancer not eligible for standard chemoembolization or radioembolization.