Among minimally invasive surgical techniques, endovascular therapies have in recent years experienced a very important development for the treatment of neurovascular and cardiovascular diseases. During access to the treatment site, catheterization involves a technical gesture that can be very difficult in complex anatomical configurations. The aim of the DEEP project is to develop hardware and software devices to offer interventional practitioners innovative solutions for augmented endovascular navigation. These must allow the crossing of complex pathways as well as secured and controlled access to target sites that are difficult or impossible to reach at present. The research jointly exploits the analysis of imaging data and numerical simulation to design a new range of multi-curve catheters embedding active elements, and of decision support software tools to augment the performance of catheterization. Beyond the tasks related to scientific and technological developments (specifications and evaluations, information analysis and rendering, numerical simulation, hardware and software integration), a task specifically dedicated to the industrial exploitation of results is planned. DEEP project brings together a very complementary consortium. Academic partners have expertise in medical imaging and image-guided cardiovascular interventions (LTSI), contact and structural mechanics for biomedical applications (LaMCoS). Industrial partners have proven expertise in developing software solutions for interventional decision support (Therenva SAS), active catheter design and development (BCV) and multi-domain finite element software (ANSYS France). Clinical expertise is also integrated into the consortium (A. de Rothschild Ophthalmological Foundation, LTSI clinicians). Expected results are innovative medical devices (software and hardware) associated with care. They are spread over three levels: scientific, clinical and economic. The scientific production will result in original publications in the fields of information processing and predictive simulation for computer-aided medical interventions (CAMI). From a clinical point of view, DEEP aims to meet the demand of practitioners that is very strong for new medical devices ensuring a safe, fast and efficient catheterization in all configurations (tortuous anatomies or complex anatomical variations). The expected benefits are therefore primarily a clinical benefit by improving the endovascular treatment of patients. The DEEP project should contribute to strengthening France's competitiveness in the health technology sector. Proposed major innovations relate to the access phase during endovascular procedures. This "access" market is very important with an annual growth rate of 5% to 10%. BCV's active catheters are, to our knowledge, the only endovascular instruments with embedded activation currently in the industrialization phase. This integration of the actuation at the distal part of the catheters is an opening to the design of revolutionary tools capable of performing complex endovascular gestures, still impossible today. In addition to the development by Therenva of software solutions dedicated to active catheters, the development of decision support systems for the patient-specific choice of ancillaries currently available (passive catheters and guidewires) and augmented reality guidance of these tools, would represent a major and unprecedented advance. In a partnership strategy, ANSYS France aims to integrate its simulation and real-time calculation components into the Therenva and BCV solutions.

ENDOSIM is a research project in the field of predictive simulation and computer-aided medical interventions (CAMI). It focuses on the treatment of aortic aneurisms and valvular stenoses. In a previous ANR TecSan project (ANGIOVISION, ended in February 2013), the partners of the ENDOSIM project have developed operative assistance tools using augmented angio-navigation for the treatment of abdominal aortic aneurysms (AAA). The results demonstrated, on more than 20 patients, the accuracy of the patient-specific simulation approach. Based on these developments and results, the team aims to move forward and tackle the problem of predictive planning, in order to maximize the accuracy and reliability of two complex endovascular procedures: • the implantation of fenestrated stent-grafts for the treatment of thoraco-abdominal aneurysms, • the endovascular implantation of cardiac valves for the treatment of aortic stenoses. For these two minimally invasive procedures, atheromatous plaques are sources of numerous, unsolved so far, difficulties among which: navigability issues in the vicinity of the lesions, risk of plaque rupture due to ancillary contacts, complexity for positioning the device on the lesion site, brittleness of the vasculature, crushing of the native valves… These issues currently constitute a major obstacle for a more massive use of endovascular techniques. The goal of ENDOSIM is to develop the first predictive endovascular surgery planning software in the world. This will lead to optimize the pre-operative planning and to secure per-operative navigation, through the following points: • tool navigability estimation from the patient’s imaging data, • improvement of the pre-operative device sizing reliability, • pre-operative prediction of the device positioning and per-operative visualization, • decision-making help for patient eligibility and device selection. In order to reach these objectives, the novel approach featured in ENDOSIM relies upon the joint use of image analysis techniques and biomechanical numerical simulation techniques, both being patient-specific and predictive. The scientific breakthroughs of ENDOSIM comprise mainly accurate and predictive patient-specific simulations of the endovascular ancillary insertion and device deployment. These simulations will be based on pre-operative imaging data and validated using per- and post-operative data on a group of atheromatous patients. The prediction of the risk of surgery-induced injury at the atheromatous sites is also very original. The numerical simulations developed through the project will be systematically enhanced and validated thanks to 3D imaging data obtained on real patients with the per-operative multi-incidence equipment of the TherA-Image platform. From a clinical point of view, the benefits of the ENDOSIM project will relate to securing the surgical planning thanks to simulations based on pre-operative data and improved positioning accuracy thanks augmented navigation tools. This should allow a more massive use of endovascular treatments and hence make the most of these minimally invasive procedures for the patients. From the industrial point of view, ENDOSIM will lead Therenva® (French leader in endovascular surgery software) to market the first predictive endovascular planning software solution. This will also be complemented by a visualization system for per-operative assistance. The close partnership with Ansys® (worldwide leader in numerical simulation) will promote a widespread adoption of Therenva® software solutions by endovascular device companies, as a first step, and by the worldwide clinical community as a second step.

The RESIIST project proposes a methodology and tools for (a) data collection, (b) modelling, (c) decision support (d) simulation and visualization (e) help with the implementation of decisions to evaluate in time the resilience of critical infrastructures in order to define the possible strategies and to carry out analyses on original criteria. In order to supply goods and services to populations, various socio-technical changes allow us to draw the following conclusions: Statement 1: stakeholders’ needs evolve and tend to make these infrastructures more complex to manage and understand. They are pushed into their operating limits and suddenly become critical. Statement 2: Whatever is the type of these infrastructures (production system or territory), they are increasingly connected and interconnected which further contributes to their complexity. Statement 3: Various and numerous disruptive events can affect the proper functioning of these infrastructures are. Instability of such infrastructures becomes then the norm. This instability is exacerbated by influences and interactions between infrastructures and the territories on which they operate. Statement 4: The loss rate related to the occurrence of disturbances then impacts several dimensions (human, economic, ecological, technical ...) These statements highlight the role, relevance and importance of the resilience of these critical infrastructures for companies, communities and managers involved and concerned with managing the consequences of disturbances. This clearly demonstrates the need for a continuous resilience assessment approach. This is indeed requested to feed decision-making tools enabling these stakeholders to effectively manage their infrastructures and to limit the consequences of disturbances with regard to the different dimensions mentioned above. The RESIIST project makes the assumption that a certain number of heterogeneous data are relevant, available and then must be exploitable. It proposes in response to the previous observations: •A critical infrastructure modelling and resilience assessment approach based on six activities: (i) continuous collection of data issued from various sources, (ii) processing and analysis of these data to derive relevant information on multiple dimensions (human, social, financial, technical), (iii) development of a model of critical infrastructure that is as faithful as possible, under the form of a Digital Twin of the critical infrastructure, making it possible to structure, organize and facilitate access to data, information and knowledge, (iv) evaluation of resilience, (v) behavioural simulation of the model and visualization of results, (vi) decision-making and assistance to implementation of decisions; •The definition and use of resilience indicators for multi criteria decision support; •The development of tools supporting the modeling, evaluation and simulation process; •Smart visualization according to the need expressed by the stakeholders. RESIIST proposes then to manage, share and use heterogeneous and numerous data and models to assess the resilience of a critical infrastructure considering diverse analysis dimensions. As a result, resilience will be more fully estimated, and decision makers will be supported by using RESIIST deliverables to make the most relevant decisions based on multiple perspectives and criteria. On the scientific level, RESIIST is based on the problems concerning research, definition, formalization and validation of: •New indicators based on the available data and corresponding to Economic, Technical, Environmental, Regulatory, Social, or Human dimensions; •Procedures for interpreting and exploiting these indicators; •Potential occurrences of disturbances (causes and effects) modelling and analysis •Models of representation of critical infrastructures integrating these indicators to assess resilience; •Decision-making process support and follow-up of the implementation of the decisions.

Since the work of Thomas Young in 1808, it is well established that strain energy can be guided along a tube as a symmetric wave: it is the pulse wave created by heart beatings and felt by palpation along arteries. However, strain energy can also propagate as an antisymmetric wave, the so-called flexion pulse wave. This latter wave, although barely hidden by the first one, has never been reported up to now in blood vessels. Our long-term vision is that this new flexion pulse wave can bring a technology breakthrough in angiography, shall it be in ultrasounds, in magnetic resonance imaging, in optics or in scanner radiology. The advantage conveyed by the new flexion pulse wave when compared to the standard pulse wave is its slowness. For this reason, the estimation speed is easier, more reliable and can conduct to a more accurate biomarker of blood vessel aging and cardiovascular risks. The ambitious short-term targeted application is thus the development of an ultrasound medical device for early detection, screening and monitoring of cardiovascular risks, a major issue in the world. Already demonstrated at capillary scale level in retina and at a macroscale level in the carotid within UCBL laboratory in Lyon, this novel approach now needs clinical validation in CHU-Rennes and technologic maturation with the help of industrial partners, E-Scopics and ANSYS. This innovation strategy follows the logic of the ANR-PRCE funding.