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NOVA Non-invasive Optimal Vessel Analysis

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Q mra MRA + NOVA Quantitative Magnetic Resonance Angiography

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VasSol was founded in 1999 by Dr. Fady T. Charbel, Professor and Head of the Department of Neurosurgery at the University of Illinois at Chicago. Dr. Charbels groundbreaking work on the cerebrovascular flow modeling led to VasSol, the first commercial company to emerge from the College of Medicine at UIC. Among his many accomplishments Dr. Charbel is the inventor of the Charbel Micro-Flowprobe and has developed many surgical techniques, including C-FAST (Charbel flow assisted surgical technique). President and Chief Scientific Officer Dr. Fady T. Charbel, MD, FACS

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Imaging Diagnostic Treatment Planning MRI Image Registration FEM AIM PCMR CT Angio OR Surgical Planning Radiology Thin Internet Server Multimedia Notebook Rapid Prototype CANVAS (Computer Aided Neuro Vascular Analysis and Simulation) Group

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Phase-contrast MR (PCMR) Phase shift proportional to velocity Cross sectional area from vessel contour Flow = Velocity x Area = x

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NOVA technique for QMRA Axial 3-D TOF MRA with 3-D surface rendering of cerebral vasculature 3D

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NOVA technique for QMRA Cuts placed perpendicular to axis of vessel

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NOVA technique for QMRA Gated 2D phase contrast MR scan perpendicular to the vessel axis 2D PCMR

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PCMR is a highly accurate method, however it requires: Perpendicular measurement plane Laminar flow Appropriate Venc setting VENC

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NOVA 3D Quick, accurate vessel identification Optimal, perpendicular cut Auto Venc detects Venc mismatch and determines correct setting Venc The NOVA Solution

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NOVA is Easy to Use NOVA 3D Localizer Nova 3D Auto prescription Auto Transfer of 3D Coordinates 3D Auto Contouring of Vessel Border VENC Check Takes away the guesswork VENC

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Phase contrast MRA Nova Results

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Q mra Protocol for Head and Neck

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NOVA Validation In Vitro multi- tube phantom In Vivo animal model Steady flow different flow rates Pulsatile flow different flow rates Different vendors GE, Philips and SIEMENS Gated/non-gated sequences Gated/non-gated sequences In Vivo Validation of Quantitative Magnetic Resonance Angiography in Canine Carotid Artery Model Mateo Calderon Arnulphi MD

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Phantom Validation Setup

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Phantom Actual Flow vs. NOVA

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Normative Flow Ranges Baseline Cerebral Blood Flow Study (UIC): (Amin-Hanjani et al, International Stroke Conference, 2011) 326 healthy subjects 326 Age range 18-84 (mean 47) 18-84 ( 47 ) 48% female/ 52% male 48% / 52% Three age groups : 18-40 41-60 >60

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NOVA Applications Cerebrovascular disease and disorders : Extracranial and intracranial arterial stenosis and occlusion Moyamoya Disease Arterial dissection Cerebral Aneurysm Venous stenosis Arteriovenous Malformation Monitor pre/post treatment / : Angioplasty and stenting EC-IC bypass flow augmentation for ischemia and flow replacement (aneurysm, tumor) Carotid revascularization Embolization and surgical resection of AVMs Flow diversion for cerebral aneurysm Evaluate effectiveness of medical therapy, and select patients for intervention

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Role of Quantitative Flow Assessment: Patient selection/ decision-making / Long-term monitoring/ post-treatment follow-up / Accumulation of knowledge

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Basilar Artery Stent

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April 3 April 12 April 21 April 25 Serial Follow up post basilar artery stenting

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MCA Aneurysm 10M post stent assisted coiling in- stent stenosis within the right M1 segment measuring 50 - 70%.

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NOVA 2/2012 vessel map, 3D RMCA flow in normal range

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NOVA QMRA Evaluate individual vessels: Right AVM Primary Draining Vein: 768 ml/min 68 cc/min MCA: 953 cc/min 184 cc/min

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NOVA Flow Rate (ml/min) of Feeding Artery and Draining Vein During the Treatment process

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PREOP Right ICA Occlusion

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Right middle cerebral artery flow measurements, pre (left) and post (right) diamox.

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NOVA Vessel Map Pre diamox Post diamox % change RACA and RPCA flows decrease after diamox RMCA increases only marginally, 6%

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POST OP ANGIO AND NOVA

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VERiTAS study Vertebral flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study VERiTAS Prospective multicenter observational study of patients with symptomatic vertebrobasilar disease using QMRA: Does flow compromise stratify stroke risk?

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NOVA (QMRA) for Symptomatic VBD

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Normal Flow Basilar stenosis

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Low Flow Basilar occlusion

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MyRIAD Study - Mechanisms of early Recurrence of Intracranial Atherosclerotic Disease MyRIAD Start Date: July 2014 175 patients 3 imaging modalities to elucidate the mechanisms of recurrent stroke: NOVA QMRA MR Perfusion Transcranial Doppler http://clinicaltrials.gov/show/NCT02121028

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Validation of a Robust PCMR Method for Quantifying CSF Flow in Human Subjects Kezhou Wang, Xinjian Du, Wei Sun, Hagai Ganin, Yi Sui, Lauren Ostergren, Fady T. Charbel, William G. Bradley, Xiaohong Joe Zhou Department of Neurosurgery, University of Illinois at Chicago Medical Center; VasSol, Inc.; GE Healthcare; Department of Radiology, University of California at San Diego FIES TA image showing the CSF. (b) 3D model of aqueduct with flow measurement location shown in yellow. (c) 2D PCMR phase image perpendicular to aqueduct.

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Quantitative Flow Assessment Intracranial atherosclerotic occlusive disease : Current focus on anatomy of the disease Consider the physiology of the disease FLOW MATTERS

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Thank you!