Abstract
Background: Flow-Diverter (FD) porosity has been pointed as a critical factor in the occlusion of cerebral aneurysms after treatment.Objective: Verification and Validation of computational models in terms of predictive capacity, relating FD porosity and occlusion after cerebral aneurysms treatment.Methods: Sixty-four aneurysms, with pre-treatment and follow-up images, were considered. Patient demographics and aneurysm morphological information were collected. The computational simulation provided by ANKYRAS provided FD porosity, expansion, and mesh angle. FD occlusion was assessed and recorded from follow-up images. Multiple regression Logit and analysis of covariance (ANCOVA) models were used to model the data with both categorical and continuous models.Results: Occlusion of the aneurysm after 12 months was affected by aneurysm morphology but not by FD mesh morphology. A Time-To-Occlusion (TTO) of 6.92 months on average was observed with an SE of 0.24 months in the aneurysm population surveyed. TTO was estimated with statistical significance from the resulting model for the data examined and was capable of explaining 92% of the data variation.Conclusions: Porosity was found to have the most correction power when assessing TTO, proving its importance in the process of aneurysm occlusion. Still, further Verification and Validation (V&V) of treatment simulation in more extensive, multi-center, and randomized databases is required.
Highlights
Flow-Diverter (FD) treatment of cerebral aneurysms is a standard in current medical practice for neurovascular treatment [1]
From the clinical database at each institution, we retrospectively identified cerebral aneurysm treatments using FDs that had a pre-treatment 3D Rotational Angiography (3DRA), a posttreatment angiogram (2D or 3D) with visible FD radiopaque markers and had undergone at least one follow-up catheter angiogram, irrespective of the follow-up time
A total of 44 patients with 64 aneurysms treated with FDs were considered in this study, namely, 8 (12.5%) patients were treated with DERIVO R Embolization Device (Acandis GmbH & Co, Pforzheim, Germany), 22 (34.4%) were treated with Surpass StreamlineTM FD (Stryker Corporation, Kalamazoo, MI, USA), 8 (12.5%) were treated with p64 R Flow Modulation Device (Phenox GmbH, Germany), and 26 (40.6%) were treated with PipelineTM Embolization Device (Medtronic, Minneapolis, MN, USA)
Summary
Flow-Diverter (FD) treatment of cerebral aneurysms is a standard in current medical practice for neurovascular treatment [1]. Obliteration of the aneurysm after FD treatment was above 73%, with a mean follow-up time ranging from 9.1 to 9.4 months [2]. Time-To-Occlusion (TTO), assessed from the time of the intervention until the total angiographic occlusion of the aneurysm observed in follow-up, has shown to be different from case to case. Various factors affect the occlusion of an aneurysm, ranging from the physiology of the patient, anti-aggregation used, and the aneurysm location to the FD design and morphology [3,4,5]. Understanding under which situations occlusion is favored and providing tools to assess the TTO will improve FD treatment and patient management understanding. Flow-Diverter (FD) porosity has been pointed as a critical factor in the occlusion of cerebral aneurysms after treatment
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