Introduction Evaluating the final length and positioning of flow diverting (FD) stents inside patient arteries for optimal device size selection remains a challenging, yet crucial, task in complex aneurysm treatment.
Aim This study reports the accuracy of PreSize Neurovascular software in predicting FD deployed length and impact of PreSize’s use on device size selection. PreSize (Oxford Heartbeat Ltd) is a visualisation/simulation software for neurovascular FD intervention planning in aneurysm treatment.
Methods Imaging data from 80 FD cases using Derivo Embolisation Device (Acandis GmbH), collected from University Medical Center Hamburg-Eppendorf, were retrospectively analysed. Prediction accuracy was defined as agreement between PreSize simulation and actual deployed FD length measured in angiography. Two experienced Interventional Neuroradiologists (INRs), blinded to post-deployment angiographies, selected optimal sizes using PreSize in a subset of 25 cases. PreSize-informed device choices (diameter/length) were compared to deployed devices (informed by conventional planning).
Results Investigated FDs had a mean nominal length of 26.9 mm (15–50 mm). PreSize predicted deployed FD length with a mean accuracy of 94% (95% confidence interval [93%,95%]). PreSize-informed devices were shorter (Wilcoxon signed-rank test, Z=21.5, p<0.01) by 5.2 mm on average (up to 20 mm) compared to conventionally chosen devices. In 32% of cases, shorter PreSize-informed devices would have resulted in fewer FD-covered vessel bends while achieving sufficient aneurysm coverage. In 88% of cases, PreSize’s automatic size suggestion was INR’s selection.
Conclusions PreSize predicted deployed FD lengths with high accuracy. Results indicate INRs’ propensity to select shorter devices with PreSize, supported by its precise deployment simulation and visualisation.
Disclosure Outside of the submitted work Dr. Fiehler reports grants and personal fees from Acandis, grants and personal fees from Cerenovus, grants and personal fees from Medtronic, grants and personal fees from Microvention, personal fees from Penumbra, and personal fees from Phenox outside the submitted work; shareholder Tegus, CEO Eppdata. Outside of the submitted work Dr. Bester reports personal fees as proctor and consultant from Acandis.
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