Department of Neuroradiology, 9171University of Erlangen-Nuremberg, Erlangen, Germany.
42406Siemens Healthineers AG, Forchheim, Germany.
Interv Neuroradiol. 2022 Oct;28(5):581-587. doi: 10.1177/15910199211053131. Epub 2021 Oct 29.
Predicting final stent position can be challenging when treating cerebral aneurysms. Third-Party software proved helpful in selecting proper stents in treatment planning. Recent angiographic systems provide basic stent simulation capabilities integrated in the post-processing software to simulate stent position. Goal of this analysis was to evaluate the simulation process and correlation with definite stent position.
Thirty-three datasets with fusiform (n = 10) and saccular (n = 23) aneurysms, treated with stent or flow-diverter, were processed. A "virtual stent" of the same (nominal) size was simulated and its position was compared to the treatment result. Simulated length was rated in five grades (too short, shorter, equal, longer, too long), with regard to side-branches, anchoring zone etc. Simulation quality (centerline recognition/adherence to vessel margins) was rated in three grades (no, minor or major corrections required).
Simulation was successful in 32/33 cases (97%), with one abortive attempt (3%). In 27/33 simulations (82%), there was no need for centerline refinement. Minor corrections were necessary in four and major corrections in two cases. Simulated nominal length was rated "equal" in 14/33 (42%) cases and "shorter" or "longer" - but within acceptable range - in each 9/33 (27%) cases.
Basic stent simulation tools available with genuine angiographic workplace software can provide good simulation capabilities without need for third-party equipment. They can facilitate treatment planning and help to avoid shortage of devices. Yet, lack of calculation of foreshortening in large vessel diameters leaves the user to rely on their experience to account for device-specific properties.
在治疗脑动脉瘤时，预测最终支架位置具有挑战性。第三方软件在治疗计划中有助于选择合适的支架。最近的血管造影系统提供了基本的支架模拟功能，集成在用于模拟支架位置的后处理软件中。本分析的目的是评估模拟过程与明确支架位置的相关性。
对 33 例采用支架或血流导向装置治疗的梭形（n=10）和囊状（n=23）动脉瘤患者的数据进行处理。模拟相同（标称）尺寸的“虚拟支架”，并将其位置与治疗结果进行比较。模拟长度按五分制（太短、短、相等、长、太长）进行评分，考虑到侧支、锚固区等因素。模拟质量（中心线识别/贴合血管边缘）按三分制（无需、需要小的或大的修正）进行评分。
33 例中有 32 例（97%）成功进行了模拟，有 1 例（3%）失败。在 27 例（82%）模拟中，无需对中心线进行细化。有 4 例需要进行小的修正，2 例需要进行大的修正。在 14 例（42%）模拟中，标称长度被评为“相等”，9 例（27%）各被评为“短”或“长”，但都在可接受范围内。
真正的血管造影工作场所软件中提供的基本支架模拟工具可以提供良好的模拟功能，而无需使用第三方设备。它们可以为治疗计划提供便利，并有助于避免器械短缺。然而，在大直径血管中缺乏缩短的计算，使得用户需要依靠经验来考虑器械的特性。
