Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact

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.

Pipeline Embolization Device Versus Stent-Assisted Coiling for Intracranial Aneurysm Treatment: A Retrospective Propensity Score-Matched Study

“…We found a significant reduction in stent length in the group treated using the software 16 mm (12-20), compared to the group that did not use it 20mm (20-20); this decrease was statistically significant p <.001. Our results show a higher reduction in the median than that found by Piergallini et al(7) 8 , and Ospel et al (10) 11 . Ospel compared simulated patients with the Sim & Size program to nonsimulated patients who underwent manual measurements with 2D angiographic acquisitions(10) 11 .…”

“…Piergallini et al (7) 8 , like in our study, compared the management of cerebral unruptured aneurysms with pipeline flow diverter with and without simulation software. They found a shorter procedure duration in cases that used simulation compared to those that did not (46-52 p=.002).…”

“…In the present study, patients that underwent simulation had a greater stent diameter: 4mm (3.5-4.4 mm) compared to the non-simulated group 3.75mm (3-4 mm) p = .20, in contrast to studies that showed that the use of simulation decreased in diameter. Piergallini et al found a decrease in the median of 0.25mm between simulated (3.75mm) and non-simulated (4.00mm); however, the result was not statistically significant (p = .11)(7) 8 . Ospel et al found a mean (mean) 3.89mm in the non-simulated and 3.94mm in the simulated, with a median that did not show differences (10) 11 ; a result that may be explained by physicians' decision to have a better apposition.…”

Semi-automated cerebral aneurysm segmentation and geometric analysis for WEB sizing utilizing a cloud-based computational platform

“…More recently virtual simulation has been utilized to predict the deployment of flow diverters in the treatment of cerebral aneurysms. [15][16][17] As computational imaging technologies and artificial intelligence platforms evolve it is likely that more of these will be utilized in cerebral aneurysm treatment planning especially for single implants such as currently for the WEB and for similar devices in the future. 18…”

Impact of Design and Deployment Technique on the Hydrodynamic Resistance of Flow Diverters

“…In vitro measurements and computational fluid dynamics (CFD) investigating the flow patterns in the aneurysm sac have been used to quantify the efficacy of FDs [ 14 , 15 ]. Complex and valid simulation of both the mechanical behavior of the FD during deployment and its flow effect is desirable to provide guidance for the operator in choosing the most appropriate technique and device [ 16 , 17 ]. This can be achieved by directly modelling the individual struts of the FD; however, the enormous computational need makes its use in practice questionable [ 18 ].…”