Software-based simulation for preprocedural assessment of braided stent sizing: a validation study

J Neurosurg. 2018 Nov 1:1-7. doi: 10.3171/2018.5.JNS18976. Online ahead of print.

Abstract

OBJECTIVEThe authors sought to validate the use of a software-based simulation for preassessment of braided self-expanding stents in the treatment of wide-necked intracranial aneurysms.METHODSThis was a retrospective, observational, single-center study of 13 unruptured and ruptured intracranial aneurysms treated with braided self-expanding stents. Pre- and postprocedural angiographic studies were analyzed. ANKYRAS software was used to compare the following 3 variables: the manufacturer-given nominal length (NL), software-calculated simulated length (SL), and the actual measured length (ML) of the stent. Appropriate statistical methods were used to draw correlations among the 3 lengths.RESULTSIn this study, data obtained in 13 patients treated with braided self-expanding stents were analyzed. Data for the 3 lengths were collected for all patients. Error discrepancy was calculated by mean squared error (NL to ML -22.2; SL to ML -6.14, p < 0.05), mean absolute error (NL to ML 3.88; SL to ML -1.84, p < 0.05), and mean error (NL to ML -3.81; SL to ML -1.22, p < 0.05).CONCLUSIONSThe ML was usually less than the NL given by the manufacturer, indicating significant change in length in most cases. Computational software-based simulation for preassessment of the braided self-expanding stents is a safe and effective way for accurately calculating the change in length to aid in choosing the right-sized stent for optimal placement in complex intracranial vasculature.

Keywords: 3DRA = 3D rotational angiography; BDF = braided device foreshortening; LVIS = low-profile visualized intraluminal support; MAE = mean absolute error; ME = mean error; MSE = mean squared error; aneurysm; braided stents; software simulation; vascular disorders.