Introduction Flow diversion is an effective treatment option for cerebral aneurysms (CAs). Appropriately sizing flow diverters (FDs) is critical for treatment success.¹ However, FDs can be difficult to size. They can elongate by more than 50% of their nominal length after deployment and vessel diameters may vary considerably along the trajectory of the vessel.² Current convention does not address these challenges well. Here we present our preliminary evaluation of a computer modeling system that uses real-time FD deployment simulations and the three-dimensional (3D) model of the patient’s vessel to size FDs.

Materials and methods The computational modeling system was evaluated for a series of 7 CAs that were planned for treatment with the Pipeline Flex (Medtronic, USA) FD. Evaluation was performed retrospectively in 2 CAs and prospectively in 5 CAs. In each case, rotational angiography image data were first uploaded to the SurgicalPreview® (EndoVantage, USA) computational modeling software. The image data were then segmented by the software and used to reconstruct a 3D model of the vessel. Next, FD sizes that were being considered for treatment were virtually deployed into the vessel model in real-time and the appropriate FD size for each vessel was selected. Simulated and clinical FD deployments were then compared using post-treatment angiography images.

Results Good qualitative agreement was observed between simulated and clinical FD deployments based on device length and aneurysmal neck-coverage, as shown in figure 1. In the prospective cases, the simulations helped narrow the list of device sizes being considered and improved confidence in device selection.

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Abstract E-025 Figure 1

(a) Pre-treatment angiogram showing 8 mm aneurysm, (b) virtual deployment of 2.75×12 mm Pipeline FD, (c) placement of the same FD size across the aneurysm neck with the vessel opacified.

Conclusion Our early experience with the computational modeling system suggests that the technology can potentially accurately predict FD behavior and facilitate the selection of the optimal FD size for a vessel. The technology has great potential to reduce technical complications during FD treatment and improve treatment outcomes.

References

1. Aquarius R, et al. ‘The Importance of Wall Apposition in Flow Diverters. NeurosurgeryApril 2018.

2. Narata AP, et al. ‘Early Results in Flow Diverter Sizing by Computational Simulation: Quantification of Size Change and Simulation Error Assessment’. Oper Neurosurg 2018: 9.

Disclosures C. Baccin: None. H. Babiker: 4; C; EndoVantage. 5; C; EndoVantage.