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Rai AT, Boo S, Downer J, DuPlessis J, Rautio R, Sinisalo M, Pekkola J, Carraro do Nascimento V, Given C, Patankar T. High variability in physician estimations of flow-diverting stent deployment versus PreSize Neurovascular software simulation: a comparison study. J Neurointerv Surg 2024; 16:559-566. [PMID: 37355257 PMCID: PMC11187387 DOI: 10.1136/jnis-2023-020527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Physician variablity in preoperative planning of endovascular implant deployment and associated inaccuracies have not been documented. This study aimed to quantify the variability in accuracy of physician flow diverter (FD) planning and directly compares it with PreSize Neurovascular (Oxford Heartbeat Ltd) software simulations. METHODS Eight experienced neurointerventionalists (NIs), blinded to procedural details, were provided with preoperative 3D rotational angiography (3D-RA) volumetric data along with images annotated with the distal landing location of a deployed Surpass Evolve (Stryker Neurovascular) FD from 51 patient cases. NIs were asked to perform a planning routine reflecting their normal practice and estimate the stent's proximal landing using volumetric data and the labeled dimensions of the FD used. Equivalent deployed length estimation was performed using PreSize software. NI- and software-estimated lengths were compared with postprocedural observed deployed stent length (control) using Bland-Altman plots. NI assessment agreement was assessed with the intraclass correlation coefficient (ICC). RESULTS The mean accuracy of NI-estimated deployed FD length was 81% (±15%) versus PreSize's accuracy of 95% (±4%), demonstrating significantly higher accuracy for the software (p<0.001). The mean absolute error between estimated and control lengths was 4 mm (±3.5 mm, range 0.03-30.2 mm) for NIs and 1 mm (±0.9 mm, range 0.01-3.9 mm) for PreSize. No discernable trends in accuracy among NIs or across vasculature and aneurysm morphology (size, vessel diameter, tortuousity) were found. CONCLUSIONS The study quantified experienced physicians' significant variablity in predicting an FD deployment with current planning approaches. In comparison, PreSize-simulated FD deployment was consistently more accurate and reliable, demonstrating its potential to improve standard of practice.
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Affiliation(s)
- Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - SoHyun Boo
- Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Jonathan Downer
- Department of Clinical Neurosciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | | | - Riitta Rautio
- Department of Radiology, Turku University Hospital (TYKS), Turku, Finland
| | - Matias Sinisalo
- Department of Radiology, Turku University Hospital (TYKS), Turku, Finland
| | | | | | - Curtis Given
- Neurointerventional, Baptist Health Lexington, Lexington, Kentucky, USA
| | - Tufail Patankar
- Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Rehearsals using patient-specific 3D-printed aneurysm models for simulation of endovascular embolization of complex intracranial aneurysms: 3D SIM study. J Neuroradiol 2023; 50:86-92. [PMID: 34914933 DOI: 10.1016/j.neurad.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND In neurovascular treatment planning, endovascular devices to manage complex intracranial aneurysms requiring intervention are often selected based on conventional measurements and interventional neuroradiologist experience. A recently developed technology allows a patient-specific 3D-printed model to mimic the navigation experience. The goal of this study was to assess the effect of pre-procedure 3D simulation on procedural and clinical outcomes for wide-neck aneurysm embolization. MATERIALS & METHODS In this unblinded, non-randomized, prospective, multicenter study conducted from November 18 through December 20, patients with complex intracranial aneurysms (neck > 4 mm or ratio < 21) were treated by WEB or flow diverter stents (FDS). The primary endpoint was concordance between simulation and procedure, 3D-printed model accuracy as well as embolization outcomes including complications, procedure times, and radiation dose were also assessed. Secondary endpoint was to compare versus a retrospective WEB cohort. RESULTS Twenty-one patients were treated, 76% of cases by WEB and 24% by FDS. Concordance between post-simulation and real procedure efficiency was 0.85 [0.69 - 1.00] for size device selection and 0.93 [0.79 - 1.00] for wall-apposition/aneurysm neck closure. Geometrical accuracy of the 3D-printed model showed a mean absolute shift of 0.11 mm. Two complications without major clinical impact were reported with a post-operative mRS similar to pre-procedure mRS for all patients. CONCLUSIONS Rehearsal using accurate 3D-printed patient-specific aneurysm models enabled optimization of embolization strategy, resulting in reduced procedure duration and cumulative fluoroscopy time which translated to reduced radiation exposure compared to procedures performed without simulation.
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Tong X, Shan Y, Leng X, Chen J, Fiehler J, Siddiqui AH, Hu X, Liu A, Xiang J. Predicting flow diverter sizing using the AneuGuide TM software: a validation study. J Neurointerv Surg 2023; 15:57-62. [PMID: 35039401 DOI: 10.1136/neurintsurg-2021-018353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Stent sizing remains a challenging task for flow diverter implantation because of stent foreshortening. In this study, we aimed to quantify the change in length after implantation and assess the error in length prediction using AneuGuideTM software. METHODS In a retrospective cohort of 101 patients with 102 aneurysms undergoing treatment with a pipeline embolization device (PED; Covidien, Irvine, California, USA), we used AneuGuideTM software to obtain measured lengths (ML) and calculated lengths (CL) after stent implantation. Stent elongation was defined as the ratio of ML-LL to the labeled length (LL). Simulation error was defined as the ratio of the absolute value of CL-ML to ML. The correlation and consistency between ML and LL and between ML and CL were analyzed using Pearson's correlation test and the Bland-Altman plot. Statistical significance was set at p<0.05. RESULTS The mean elongation of ML was 32.6% (range 26.3-109.2%). Moderate consistency was observed between LL and ML (ρ=0.74, p<0.001). With the AneuGuideTM software, the mean simulation error was 6.6% (range 0.32-21.2%). Pearson's correlation test and the Bland-Altman plot showed a high correlation and consistency between ML and CL (ρ=0.96, p<0.001). CONCLUSION Labeled length provides only a low reference value for predicting the actual length of the flow diverter after implantation. The high consistency between ML and CL obtained from AneuGuideTM software shows its great potential for the optimization of the flow diverter sizing process.
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Affiliation(s)
- Xin Tong
- Neurointervention Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Yejie Shan
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | | | - Jigang Chen
- Neurointervention Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Adnan H Siddiqui
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aihua Liu
- Neurointervention Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
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Optimal Woven EndoBridge (WEB) Device Size Selection Using Automated Volumetric Software. Brain Sci 2021; 11:brainsci11070901. [PMID: 34356135 PMCID: PMC8307121 DOI: 10.3390/brainsci11070901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Selecting the appropriate Woven EndoBridge (WEB) device sizing for the treatment of wide-neck bifurcation aneurysms (WNBAs) remains challenging. The aim of this study was to evaluate different volumetric-based imaging methodologies to predict an accurate WEB device size selection to result in a successful implantation. METHODS All consecutive patients treated with WEB devices for intracranial aneurysms from January 2019 to June 2020 were included. Aneurysm dimensions to calculate aneurysm volumes were measured using three different modalities: automated three-dimensional (3D) digital subtraction angiography (DSA), manual 3D DSA, and two-dimensional (2D) DSA. The device-aneurysm volume (DAV) ratio was defined as device volume divided by the aneurysm volume. WEB volumes and the DAV ratios were used for assessing the device implantation success and follow-up angiographic outcomes at six months. Pearson correlation, Wilcoxon Rank Sum test, and density approximations were used for estimating the WEB volumes and the imaging modality volumes for successful implantation. RESULTS A total of 41 patients with 43 aneurysms were included in the study. WEB device and aneurysm volume correlation coefficient was highest for 3D automatic (r = 0.943), followed by 3D manual (r = 0.919), and 2D DSA (r = 0.882) measurements. Measured median volumes were significantly different for 3D automatic and 2D DSA (p = 0.017). The highest rate of successful implantation (87.5%) was between 0.6 and 0.8 DAV ratio. CONCLUSION Pre-procedural assessment of DAV ratios may increase WEB device implantation success. Our results suggest that volumetric measurements, especially using automated 3D volumes of the aneurysms, can assist in accurate WEB device size selection.
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Rai AT, Brotman RG, Hobbs GR, Boo S. Semi-automated cerebral aneurysm segmentation and geometric analysis for WEB sizing utilizing a cloud-based computational platform. Interv Neuroradiol 2021; 27:828-836. [PMID: 33823619 DOI: 10.1177/15910199211009111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Accurate aneurysm measurements are important for selecting the WEB device. The objective was to validate a cloud-based platform, SurgicalPreview (SP) against manual measurements for aneurysm analysis. METHODS Two sets of measurements each for SP and manual methods were obtained for 40 aneurysms. Reliability and agreement were assessed with intra-class correlation coefficient (ICC) and Bland-Altman plots respectively. Kappa coefficient was used to assess agreement for predicting WEB size. RESULTS There was good reliability for repeat SP measurements: aneurysm diameter (ICC-1, 95%CI 0.98-1), height (ICC-1, 95%CI 0.99-1) and neck diameter (ICC-0.96, 95%CI 0.93-0.98). There was good reliability for the two manual diameter (ICC-0.97, 95%CI 0.9-0.97) and height (ICC-0.93, 95%CI 0.87-0.96) measurements and moderate for neck diameter (ICC-0.76, 95%CI 0.54-0.87). There was greater agreement for SP versus manual repeat measurements on Bland-Altman plots. Reliability between the SP and manual methods was good for aneurysm diameter (ICC-0.98, 95%CI 0.95-1) and height (ICC-0.96, 95%CI-0.93-0.98) and moderate for neck. (ICC-0.6, 95%CI -0.22-0.87). The Bland-Altman plots confirmed better agreement between the two methods for the aneurysm diameter and height than the neck. There was strong agreement between the methods for predicting the WEB diameter (Kappa-0.84, 95%CI 0.71-0.97) and moderate for predicting WEB height (Kappa-0.66, 95%CI 0.43-0.89). There was moderate agreement for predicted versus deployed WEB diameter: SP (Kappa-0.56, 95%CI 0.38-0.74), Manual (Kappa-0.53, 95%CI 0.34-0.71). CONCLUSION The SurgicalPreview® had greater agreement for repeat measurements. There was good reliability between the two methods for predicting WEB diameter and height and moderate agreement between predicted versus deployed WEB diameter.
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Affiliation(s)
- Ansaar T Rai
- Interventional Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ryan G Brotman
- Neuroradiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Gerald R Hobbs
- Statistics, West Virginia University School of Medicine, Morgantown, WV, USA
| | - SoHyun Boo
- Interventional Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
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Cagnazzo F, Marnat G, Ferreira I, Daube P, Derraz I, Dargazanli C, Lefevre PH, Gascou G, Riquelme C, Morganti R, Berge J, Gariel F, Barreau X, Costalat V. Comparison of Woven EndoBridge device sizing with conventional measurements and virtual simulation using the Sim&Size software: a multicenter experience. J Neurointerv Surg 2020; 13:924-929. [PMID: 33361275 DOI: 10.1136/neurintsurg-2020-017060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Selection of the appropriate device size mandatory during aneurysm treatment with a Woven EndoBridge (WEB). We aimed to investigate if virtual simulation with Sim&Size software may have an impact on technical, angiographic, and clinical outcomes after WEB treatment. METHODS Data from two large-volume centers were collected and compared (January 2017-January 2020). Virtual simulation was systematically adopted in one center, while conventional sizing was used in the other one. Outcomes were the duration of intervention, the radiation dose (in milligrays, the number of corrective interventions for inappropriate WEB size, the number of WEBs not deployed, angiographic occlusion, and complications. Univariate and multivariate linear models were adopted. RESULTS A total of 186 aneurysms were treated with WEB (109 with and 77 without virtual simulation). Patient characteristics and aneurysm features were comparable among virtual and conventional sizing, except for mean age (62.2±11.8 years and 56.2±10.1 years, P=0.0004) and median aspect ratio (1.6, IQR=1.2-2 and 1.2, IQR=1-1.6, P=0.0001). Years of operator experience were comparable. Virtual simulation was independently associated with shorter intervention time (45 min, IQR=33-63.5 min vs 63.5 min, IQR=41-84.7 min, P=0.0001), lower radiation dose (1051 mGy, IQR=815-1399 mGy vs 1207 mGy, IQR=898-2084 mGy, P=0.0001), and lower number of WEBs not deployed (26/77=33.7% vs 8/109=7.3%, P=0.0001). The need for additional maneuvers was significantly lower in the virtual simulation group (5/109=4.6% vs 12/77=15.6%, P=0.021). Angiographic outcomes and complications were comparable. CONCLUSIONS In this multicenter experience, virtual simulation with Sim&Size software seems to facilitate the selection of the appropriate WEB device for aneurysm treatment, reducing the time of intervention, the radiation dose, the number of devices not deployed, and the need for corrective interventions. TRIAL REGISTRATION NUMBER clinicaltrials.gov Identifier: NCT04621552.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Ivan Ferreira
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Pierre Daube
- Interventional Radiology, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France
| | - Imad Derraz
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Pierre-Henri Lefevre
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Gregory Gascou
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | - Carlos Riquelme
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
| | | | - Jérôme Berge
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Florent Gariel
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Xavier Barreau
- Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Vincent Costalat
- Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
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Dandapat S, Mendez-Ruiz A, Martínez-Galdámez M, Macho J, Derakhshani S, Foa Torres G, Pereira VM, Arat A, Wakhloo AK, Ortega-Gutierrez S. Review of current intracranial aneurysm flow diversion technology and clinical use. J Neurointerv Surg 2020; 13:54-62. [PMID: 32978269 DOI: 10.1136/neurintsurg-2020-015877] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
Endovascular treatment of intracranial aneurysms (IAs) has evolved considerably over the past decades. The technological advances have been driven by the experience that coils fail to completely exclude all IAs from the blood circulation, the need to treat the diseased parent vessel segment leading to the aneurysm formation, and expansion of endovascular therapy to treat more complex IAs. Stents were initially developed to support the placement of coils inside wide neck aneurysms. However, early work on stent-like tubular braided structure led to a more sophisticated construct that then later was coined as a flow diverter (FD) and found its way into clinical application. Although FDs were initially used to treat wide-neck large and giant internal carotid artery aneurysms only amenable to surgical trap with or without a bypass or endovascular vessel sacrifice, its use in other types of IAs and cerebrovascular pathology promptly followed. Lately, we have witnessed an explosion in the application of FDs and subsequently their modifications leading to their ubiquitous use in endovascular therapy. In this review we aim to compile the available FD technology, evaluate the devices' peculiarities from the authors' perspective, and analyze the current literature to support initial and expanded indications, recognizing that this may be outdated soon.
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Affiliation(s)
- Sudeepta Dandapat
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan Macho
- Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences, Queen's University Hospital, Romford, Greater London, UK.,Department of Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Shahram Derakhshani
- Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences, Queen's University Hospital, Romford, Greater London, UK
| | | | - Vitor M Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anil Arat
- Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey
| | - Ajay K Wakhloo
- Department of Neurointerventional Radiology, Beth Israel Lahey Health, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA .,Department of Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Ospel JM, Kashani N, Mayank A, Liebig T, Kaesmacher J, Holtmannspötter M, Shankar J, Almekhlafi MA, Mitha AP, Wong JH, Goyal M. Current and future usefulness and potential of virtual simulation in improving outcomes and reducing complications in endovascular treatment of unruptured intracranial aneurysms. J Neurointerv Surg 2020; 13:251-254. [PMID: 32669397 DOI: 10.1136/neurintsurg-2020-016343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Simulation training has been used in the aviation industry and surgical specialties for many years, but integration into neurointerventional practice is lagging behind. OBJECTIVE To investigate how neurointerventionalists perceive the usefulness and limitations of simulation tools for the treatment of unruptured intracranial aneurysms (UIAs), and to identify simulation applications that were perceived to be most valuable for endovascular UIA treatment. METHODS A web-based international multidisciplinary survey was conducted among neurointerventionalists. Participants were asked for their perceptions on the usefulness of current simulation tools and the potential impact of future simulation tools in endovascular UIA treatment. They identified simulation applications that could add most value to endovascular UIA treatment and help to specifically reduce endovascular UIA treatment complications. RESULTS 233 neurointerventionalists from 38 countries completed the survey, most of whom (157/233 (67.4%)) had access to a simulator as a trainee, but only 15.3% used it frequently. Most participants (117/233 (50.2%)) considered currently available simulation tools relatively useful for endovascular UIA treatment, with greater value for trainees than for staff. Simulation of new devices (147/233 (63.1%)) and virtual practice runs in individual patient anatomy (119/233 (51.1%)) were considered most valuable for reducing endovascular UIA treatment complications. CONCLUSION Although neurointerventionalists perceived currently available simulation tools relatively useful, they did not use them regularly during their training. A priori testing of new devices and practice runs in individual patient anatomy in a virtual environment were thought to have the greatest potential for reducing endovascular UIA treatment complications.
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Affiliation(s)
- Johanna Maria Ospel
- Department of Radiology, Universitatsspital Basel, Basel, Switzerland.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nima Kashani
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Arnuv Mayank
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Liebig
- Department of Neuroradiology, LMU Munich, Munich, Germany
| | | | | | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Nova Scotia, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Alim P Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - John H Wong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada .,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Piergallini L, Cagnazzo F, Conte G, Dargazanli C, Derraz I, Lefevre PH, Gascou G, Mantilla D, Riquelme C, Bonafe A, Costalat V. Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact. J Neurointerv Surg 2020; 12:968-973. [DOI: 10.1136/neurintsurg-2020-015813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/26/2022]
Abstract
IntroductionDuring flow diversion, the choice of the length, diameter, and location of the deployed stent are critical for the success of the procedure. Sim&Size software, based on the three-dimensional rotational angiography (3D-RA) acquisition, simulates the release of the stent, suggesting optimal sizing, and displaying the degree of the wall apposition.ObjectiveTo demonstrate technical and clinical impacts of the Sim&Size simulation during treatment with the Pipeline Flex Embolization Device.MethodsConsecutive patients who underwent aneurysm embolization with Pipeline at our department were retrospectively enrolled (January 2015–December 2017) and divided into two groups: treated with and without simulation. Through univariate and multivariate models, we evaluated: (1) rate of corrective intervention for non-optimal stent placement, (2) duration of intervention, (3) radiation dose, and (4) stent length.Results189 patients, 95 (50.2%) without and 94 (49.7%) with software assistance were analyzed. Age, sex, comorbidities, aneurysm characteristics, and operator’s experience were comparable among the two groups. Procedures performed with the software had a lower rate of corrective intervention (9% vs 20%, p=0.036), a shorter intervention duration (46 min vs 52 min, p=0.002), a lower median radiation dose (1150 mGy vs 1558 mGy, p<0.001), and a shorter stent length (14 mm vs 16 mm, p<0.001).ConclusionsIn our experience, the use of the virtual simulation during Pipeline treatment significantly reduced the need for corrective intervention, the procedural time, the radiation dose, and the length of the stent.
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10
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Chong BW, Bendok BR, Krishna C, Sattur M, Brown BL, Tawk RG, Miller DA, Rangel-Castilla L, Babiker H, Frakes DH, Theiler A, Cloft H, Kallmes D, Lanzino G. A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning. AJNR Am J Neuroradiol 2019; 40:1759-1765. [PMID: 31558504 PMCID: PMC7028542 DOI: 10.3174/ajnr.a6222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/05/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Selection of the correct flow-diverter size is critical for cerebral aneurysm treatment success, but it remains challenging due to the interplay of device size, anatomy, and deployment. Current convention does not address these challenges well. The goals of this pilot study were to determine whether computational modeling improves flow-diverter sizing over current convention and to validate simulated deployments. MATERIALS AND METHODS Seven experienced neurosurgeons and interventional neuroradiologists used computational modeling to prospectively plan 19 clinical interventions. In each patient case, physicians simulated 2-4 flow-diverter sizes that were under consideration based on preprocedural imaging. In addition, physicians identified a preferred device size using the current convention. A questionnaire on the impact of computational modeling on the procedure was completed immediately after treatment. Rotational angiography image data were acquired after treatment and compared with flow-diverter simulations to validate the output of the software platform. RESULTS According to questionnaire responses, physicians found the simulations useful for treatment planning, and they increased their confidence in device selection in 94.7% of cases. After viewing the simulations results, physicians selected a device size that was different from the original conventionally planned device size in 63.2% of cases. The average absolute difference between clinical and simulated flow-diverter lengths was 2.1 mm. In 57% of cases, average simulated flow-diverter diameters were within the measurement uncertainty of clinical flow-diverter diameters. CONCLUSIONS Physicians found computational modeling to be an impactful and useful tool for flow-diverter treatment planning. Validation results showed good agreement between simulated and clinical flow-diverter diameters and lengths.
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Affiliation(s)
- B W Chong
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
- Department of Biological and Health Systems Engineering (B.W.C., D.H.F.), Arizona State University, Tempe, Arizona
| | - B R Bendok
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
| | - C Krishna
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
| | - M Sattur
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
| | - B L Brown
- Department of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
| | - R G Tawk
- Department of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
| | - D A Miller
- Department of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
| | - L Rangel-Castilla
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - H Babiker
- Endovantage, LLC (H.B.), Phoenix, Arizona
| | - D H Frakes
- Department of Biological and Health Systems Engineering (B.W.C., D.H.F.), Arizona State University, Tempe, Arizona
| | - A Theiler
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - H Cloft
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - D Kallmes
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - G Lanzino
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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11
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Kellermann R, Serowy S, Beuing O, Skalej M. Deployment of flow diverter devices: prediction of foreshortening and validation of the simulation in 18 clinical cases. Neuroradiology 2019; 61:1319-1326. [PMID: 31473786 DOI: 10.1007/s00234-019-02287-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Flow diverter (FD) devices show severe shortening during deployment in dependency of the vessel geometry. Valid information regarding the geometry of the targeted vessel is therefore mandatory for correct device selection, and to avoid complications. But the geometry of diseased tortuous intracranial vessels cannot be measured accurately with standard methods. The goal of this study is to prove the accuracy of a novel virtual stenting method in prediction of the behavior of a FD in an individual vessel geometry. METHODS We applied a virtual stenting method on angiographic 3D imaging data of the specific vasculature of patients, who underwent FD treatment. The planning tool analyzes the local vessel morphology and deploys the FD virtually. We measured in 18 cases the difference between simulated FD length and real FD length after treatment in a landmark-based registration of pre-/post-interventional 3D angiographic datasets. RESULTS The mean value of length deviation of the virtual FD was 2.2 mm (SD ± 1.9 mm) equaling 9.5% (SD ± 8.2%). Underestimated cases present lower deviations compared with overestimated FDs. Flow diverter cases with a nominal device length of 20 mm had the highest prediction accuracy. CONCLUSION The results suggest that the virtual stenting method used in this study is capable of predicting FD length with a clinically sufficient accuracy in advance and could therefore be a helpful tool in intervention planning. Imaging data of high quality are mandatory, while processing and manipulation of the FD during the intervention may impact the accuracy.
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Affiliation(s)
- Robert Kellermann
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany
| | - Steffen Serowy
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany.
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany
| | - Martin Skalej
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39112, Magdeburg, Germany
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12
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Becske T. Pipeline Sizing Based on Computer Simulation. AJNR Am J Neuroradiol 2019; 40:531-532. [PMID: 30819767 DOI: 10.3174/ajnr.a5998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T Becske
- Neuroendovascular Surgeon UNC Rex Hospital Raleigh, NC Adjunct Associate Professor of Neurology University of North Carolina - Chapel Hill Chapel Hill, NC
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