Software-based simulation for pipeline vantage flow diverter preprocedural assessment: Method and validation study

BackgroundFlow diverters (FDs) have revolutionized intracranial aneurysm (IA) treatment. Proper FD sizing is crucial for aneurysm occlusion and complication prevention. Ankyras (Mentice, Gothenburg, Sweden) is a device-specific sizing software. We evaluated Ankyras' performance in predicting the final deployment of the Pipeline™ Vantage Embolization Device with Shield Technology™ (PVST) (Medtronic Neurovascular, Irvine, California, USA).MethodsWe analyzed with Ankyras software the three-dimensional rotational angiography (3DRA) images of 10 consecutive patients with unruptured IA treated with PVST. Conventional digital subtraction angiography (DSA) measurements were used for FD sizing, FD was implanted, and postprocedure DSA and 3DRA images were obtained. Ankyras software generated an aneurysm model and simulated the FD size used in actual procedures. We compared the simulated length (SL) from Ankyras and the labeled length (LL) provided by the vendor to the real-case postdeployment measured length. We also compared the expansion from Ankyras simulation (SE) with the real case measured expansion (ME).ResultsOur analysis revealed a mean accuracy for SL across all cases of 92.05% (SD: 4.93%; range: 81.60%-99.10%), while the LL accuracy was 78.71% (SD: 12.43%; range: 62.20%-98.38%). A Pearson R² test indicated a strong correlation for SL at 0.9818, compared to 0.8625 for LL. Furthermore, the mean accuracy for expansion prediction was 86.28% (SD: 4.88%; range: 79.34%-92.46%).ConclusionThe Ankyras software shows promise as a viable tool for sizing PVST. Enhancing the accuracy of expansion predictions may further improve the precision of device specific simulation.