AneuGuidederived metal coverage ratio and pore density in Pipeline embolization devices: validation against VasoCT and association with aneurysm occlusion.

BACKGROUND: Metal coverage ratio (MCR) and pore density (PD) are key factors affecting the outcomes of intracranial aneurysms (IAs) treated with flow diverters (FDs), yet their in vivo quantitative assessment remains challenging. This study evaluated the accuracy of AneuGuide-derived MCR and PD against VasoCT-based measurements and explored their association with short-term aneurysm occlusion. METHODS: This retrospective study enrolled patients treated with a single pipeline embolization device (PED) between June 2022 and April 2024. PED wires were reconstructed from postoperative VasoCT images to calculate MCRCT and PDCT at the aneurysm neck. Corresponding values (MCRAG and PDAG) were obtained using AneuGuide simulations. Agreement and correlation between the two methods were assessed using Bland-Altman analysis and Pearson correlation. The association between AneuGuide-derived parameters and aneurysm occlusion was evaluated using receiver operating characteristic (ROC) curves. RESULTS: A total of 48 aneurysms were included. AneuGuide showed good agreement with VasoCT for both MCR (r=0.65, P<0.001) and PD (r=0.79, P<0.001), with no significant differences (P>0.05). A strong correlation was observed between MCR and PD (r=0.868, P<0.001). Non-occluded aneurysms exhibited lower MCR (22.05%±3.02% vs. 27.14%±7.65%, P=0.034) and PD (13.53±3.85 vs. 17.50±6.28 pores/mm2, P=0.058). ROC analysis yielded AUCs of 0.770 for MCR and 0.742 for PD. CONCLUSIONS: AneuGuide provided MCR and PD estimates that agreed well with VasoCT-derived measurements. Higher MCR and PD were associated with aneurysm occlusion at short-term follow-up. These findings support the utility of AneuGuide for geometric assessment of FD deployment and suggest a potential role in treatment-related evaluation.