P122/250 Man Vs machine: high variability in physician estimations of flow diverting stent deployment vs presize neurovascular software simulation

Introduction

Clinician variability in preoperative planning of endovascular implant deployment and associated inaccuracies have not been yet documented.

Aim of Study

This study aims to quantify the accuracy of clinician flow diverter (FD) planning and directly compares it with PreSize® Neurovascular (Oxford Heartbeat Ltd.) software simulations.

Methods

Eight experienced neurointerventionalists (NIs), blinded to procedural details, were provided preoperative 3D-RA volumetric data along with images annotated with the distal landing location of a deployed Surpass Evolve (Stryker Neurovascular) FD from 51 retrospective patient cases. NIs were asked to perform a planning routine reflecting their normal practice and estimate the stent’s proximal landing using volumetric data and the labelled dimensions of the FD used. Deployed length estimation was also performed using PreSize software for the same cases. NI and software estimated lengths were compared to post-procedural observed deployed stent length (control) with Bland-Altman plots. Intraclass correlation coefficient (ICC) was used for NI agreement assessment.

Results

Mean NI accuracy of estimated deployed FD length was 81%(±15) versus PreSize’s accuracy of 95%(±4). Software demonstrated significantly higher accuracy (p<.001). The mean absolute error between estimated and control lengths was 4 mm(±3.5 mm, range 0.03–30.2 mm) for NIs and 1 mm(±0.9 mm, range 0.01–3.9 mm) for PreSize. No discernable accuracy trends among NIs or across vasculature and aneurysm morphology (size, vessel diameter, tortuosity) were found.

Conclusion

The study quantified experienced clinicians’ significant variability in predicting an FD deployment with current planning approaches. Comparatively, PreSize simulated FD deployment was consistently more accurate and reliable, demonstrating its potential to improve standard-of-practice.

Disclosure of Interest

AR, SB: Consulting agreement Stryker, Cerenovus, Microvention J Dower: PI for Oxford Heartbeat Multicentre Prospective Oxford Heartbeat PreSize study. Consulting agreement Stryker, Phenox, Microvention, Oxford Endovascular VN, CG: Consulting agreement Stryker and Medtronic RR: Consulting agreement Stryker, Balt, Medtronic, Microvention, Acandis JP, TP, MS, J DuPlessis: No disclosures