Bouillot P, Brina O, Yilmaz H, Farhat M, Erceg G, Lovblad K-O, Vargas M I, Kulcsar Z, Pereira V M
From the Division of Neuroradiology (P.B., O.B., H.Y., G.E., K.-O.L., M.I.V., Z.K.), University Hospitals of Geneva, Geneva, Switzerland.
Laboratory for Hydraulic Machines (P.B., M.F.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
AJNR Am J Neuroradiol. 2016 Nov;37(11):2079-2086. doi: 10.3174/ajnr.A4845. Epub 2016 Jun 30.
Intracranial stents have become extremely important in the endovascular management of complex intracranial aneurysms. Sizing and landing zone predictions are still very challenging steps in the procedure. Virtual stent deployment may help therapeutic planning, device choice, and hemodynamic simulations. We aimed to assess the predictability of our recently developed virtual deployment model by comparing in vivo and virtual stents implanted in a consecutive series of patients presenting with intracranial aneurysms.
Virtual stents were implanted in patient-specific geometries of intracranial aneurysms treated with the Pipeline Embolization Device. The length and cross-section of virtual and real stents measured with conebeam CT were compared. The influence of vessel geometry modifications occurring during the intervention was analyzed.
The virtual deployment based on pre- and poststent implantation 3D rotational angiography overestimated (underestimated) the device length by 13% ± 11% (-9% ± 5%). These differences were highly correlated ( = 0.67) with the virtual-versus-real stent radius differences of -6% ± 7% (5% ± 4%) for predictions based on pre- and poststent implantation 3D rotational angiography. These mismatches were due principally to implantation concerns and vessel-shape modifications.
The recently proposed geometric model was shown to predict accurately the deployment of Pipeline Embolization Devices when the stent radius was well-assessed. However, unpredictable delivery manipulations and variations of vessel geometry occurring during the intervention might impact the stent implantation.
颅内支架在复杂颅内动脉瘤的血管内治疗中已变得极为重要。尺寸确定和着陆区预测在该过程中仍然是极具挑战性的步骤。虚拟支架植入可能有助于治疗规划、器械选择和血流动力学模拟。我们旨在通过比较一系列连续颅内动脉瘤患者体内植入的支架与虚拟植入的支架，评估我们最近开发的虚拟植入模型的可预测性。
在使用Pipeline栓塞装置治疗的颅内动脉瘤患者特定几何模型中植入虚拟支架。比较通过锥形束CT测量的虚拟支架和实际支架的长度及横截面。分析干预过程中发生的血管几何形状改变的影响。
基于支架植入前后三维旋转血管造影的虚拟植入对装置长度的估计偏高（偏低）13%±11%（-9%±5%）。这些差异与基于支架植入前后三维旋转血管造影预测的虚拟支架与实际支架半径差异-6%±7%（5%±4%）高度相关（=0.67）。这些不匹配主要归因于植入问题和血管形状改变。
当支架半径得到良好评估时，最近提出的几何模型能够准确预测Pipeline栓塞装置的植入情况。然而，干预过程中不可预测的输送操作和血管几何形状的变化可能会影响支架植入。
