Predicting flow diverter sizing using the AneuGuide^TMsoftware: a validation study

Abstract

BackgroundStent 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.MethodsIn 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.ResultsThe 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).ConclusionLabeled 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.

Effects of different stent size selection on pipeline embolization device treatment of intracranial aneurysms

“…In addition, as previously reported, a longer PED may also increase the risk of arterial side branch and perforator occlusion. 13 , 15 , 17 , 20 From this aspect, virtual stent software 16 , 17 should be encouraged given that they may provide distinct advantages in PED length selection and deployment. According to the results of this study, it is recommended that the DL could be as small as possible yet at least greater than 0 mm (this means that the length of the stent is usually larger than the neck of the aneurysm and covers the proximal and distal ends of the aneurysm by at least 5 mm).…”

“…Software with virtual stent release technology – such as Sim&Size (Sim and Cure, France), 14 Ankyras (Galgo Medical SL, Spain), 14 and AneuGuide™ (ArteryFlow Technology, Hangzhou, China) 15 – were developed to assist clinicians in selecting the braided stent size, as a means to improve the intervention process. Interestingly, some studies have found that the application of these software can reduce the stent size.…”

Functional evaluation of intracranial atherosclerotic stenosis by pressure ratio measurements

“…1 A–D) using the DSA DICOM image series. The vessel model was then reconstructed based on the level set segmentation method [ 29 ], which is a robust approach and has been applied widely in the area of medical image segmentation [ 30 ].Each case had more than 1 million volume elements containing hexahedra (hex) and split-hexahedra (split-hex) elements. The mesh-independence analysis was done for a patient with a diameter stenosis of 80%.…”

Computational Flow Diverter Implantation—A Comparative Study on Pre-Interventional Simulation and Post-Interventional Device Positioning for a Novel Blood Flow Modulator

“…In a recent preliminary study on 101 patients, Tong et al used AneuGuide software, which applies a similar algorithm to ANKYRAS to simulate implantation with the pipeline embolization device. They found a mean simulation error of 6.2% with a good correlation between measured and simulated stent length [32]. Stent length measurements were performed on post-treatment 2D images.…”