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Comparison of Woven EndoBridge device sizing with conventional measurements and virtual simulation using the Sim&Size software: a multicenter experience
  1. Federico Cagnazzo1,
  2. Gaultier Marnat2,
  3. Ivan Ferreira1,
  4. Pierre Daube3,
  5. Imad Derraz1,
  6. Cyril Dargazanli1,
  7. Pierre-Henri Lefevre1,
  8. Gregory Gascou1,
  9. Carlos Riquelme1,
  10. Riccardo Morganti4,
  11. Jérôme Berge2,
  12. Florent Gariel2,
  13. Xavier Barreau2,
  14. Vincent Costalat1
  1. 1 Neuroradiology Department, Centre Hospitalier Regional Universitaire (CHRU) Montpellier, Montpellier, France
  2. 2 Interventional and Diagnostic Neuroradiology, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
  3. 3 Interventional Radiology, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France
  4. 4 Section of Statistics, University Hospital of Pisa, Pisa, Italy
  1. Correspondence to Dr Federico Cagnazzo, Neuroradiology Department, CHRU de Montpellier, Montpellier 34000, France; f.cagnazzo86{at}


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 Identifier: NCT04621552.

  • aneurysm
  • angiography
  • intervention
  • subarachnoid

Data availability statement

Data are available upon reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request to the corresponding author.

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  • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: FC, GM, ID, CD, RM, IF, PHL, XB, FG, JB, GG, CR, VC. Drafting the work or revising it critically for important intellectual content: FC, GM, XB, VC. Final approval of the version to be published: FC, GM, PD, XB, VC. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: FC, GM, PD, JB, FG, ID, CD, PHL, GG, CR, XB, VC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.