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Wadhwa A, Mensah E, Young M, Ogilvy CS. Variability patterns in dual antiplatelet therapy following endovascular repair of intracranial aneurysms: Insight into regimen heterogeneity and the need for a consensus. Acta Neurochir (Wien) 2024; 166:271. [PMID: 38888678 DOI: 10.1007/s00701-024-06137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024]
Abstract
This comprehensive review delves into the evolving field of neurointervention for intracranial aneurysms, exploring the critical adjunct of Dual Antiplatelet Therapy (DAPT) to endovascular coiling, stent-assisted coiling (SAC), flow-diversion stents, and flow-disruption (intrasaccular) devices. Despite growing evidence supporting the success of DAPT in reducing thromboembolic events, the lack of consensus on optimal regimens, doses, and duration is evident. Factors contributing to this variability include genetic polymorphisms affecting treatment response and ongoing debates regarding the clinical significance of hemorrhagic complications associated with DAPT. This review analyzes pre- and post-procedural antiplatelet usage across various interventions. The imperative lies in ongoing research to define optimal DAPT durations, ensuring a nuanced approach to the delicate balance between thrombosis and hemorrhage in intracranial aneurysm management.
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Affiliation(s)
- Aryan Wadhwa
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Boston, MA, 02215, USA
| | - Emmanuel Mensah
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Boston, MA, 02215, USA
| | - Michael Young
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Boston, MA, 02215, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Boston, MA, 02215, USA.
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2
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Lee KB, Suh CH, Song Y, Kwon B, Kim MH, Yoon JT, Lee DH. Trends of Expanding Indications of Woven EndoBridge Devices for the Treatment of Intracranial Aneurysms: A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:227-235. [PMID: 36036257 DOI: 10.1007/s00062-022-01207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Woven EndoBridge (WEB) was introduced for the endovascular therapy of wide-neck intracranial aneurysms. The safety and efficacy have been evaluated through several meta-analyses. However, these reviews did not cover the expanding indications in detail. Therefore, we aimed to show the changing trends for intracranial aneurysm treatment using the WEB device. METHODS A systematic review and meta-analysis was conducted with PubMed, Embase, and Cochrane databases. We searched for studies that reported baseline characteristics of aneurysms and the WEB devices, which had treated more than 20 aneurysms consecutively. The pooled proportions of aneurysm indications and used WEB device types were obtained. To evaluate the changing indications for the treated aneurysm size, including the neck diameter, a trend line and linear regression model was measured. RESULTS A total of 27 cohorts were included encompassing 1831 aneurysms treated with the WEB. A total of 86% were used in the four major locations as on-label indications (middle cerebral artery bifurcation; 34%, anterior communicating artery; 26%, basilar tip; 18%, internal carotid artery terminus; 7%). Among off-label indications, the most common location was the posterior communicating artery (8%), followed by the anterior cerebral artery including the pericallosal artery (6%). The median aneurysm size and neck diameter was 7 mm and 4.6 mm, respectively. The WEB device has been used for the treatment of smaller aneurysms than the initial indication. Also, the proportion for ruptured aneurysm treatment was increased up to 15%. CONCLUSION The mechanical and technical development of the WEB resulted in expanding the indications for the treatment of intracranial aneurysms. The off-label indications accounted for 14% in total and an increasing number of small aneurysms are treated with WEB devices. Moreover, the proportion for ruptured aneurysm treatment was currently increased up to 14% more than in the beginning.
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Affiliation(s)
- Ki Baek Lee
- Department of Radiologic Technology, Chungbuk Health & Science University, Cheongju, Korea (Republic of)
| | - Chong Hyun Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Boseong Kwon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Mi Hyeon Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Jong-Tae Yoon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of).
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3
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Algin O, Corabay S, Ayberk G. Long-term efficacy and safety of WovenEndoBridge (WEB)-assisted cerebral aneurysm embolization. Interv Neuroradiol 2022; 28:695-701. [PMID: 35098767 PMCID: PMC9706260 DOI: 10.1177/15910199211060970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/24/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period. MATERIALS AND METHODS Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images. RESULTS The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group (p = 0.006, p = 0.019, respectively). There was a statistically significant positive relationship between preoperative height/neck measurements and the mean diameters of residual aneurysms (rs = 0.32 and p = 0.003; rs = 0.28 and p = 0.011, respectively). The WovenEndoBridge compaction/compression and migration were observed in 5 (45%) and 2 (18%) of the recurrent aneurysms. In 7 (64%) of the residual aneurysms, thrombosed areas were found within the aneurysm. In the follow-up period, four aneurysms (4.8%) were retreated due to widened residual aneurysm. Other aneurysms were improved or stable within 7 years. DISCUSSION Our adequate occlusion rate was 87%. Occlusion rates are less favorable than aneurysms with a long height, wide neck, or high neck-to-body ratio. Our study confirms the high safety and efficiency of the WovenEndoBridge. Compaction, compression, and/or migration of the WovenEndoBridge and the presence of intra-aneurysmal thrombosis are the main reasons for the recurrences.
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Affiliation(s)
- Oktay Algin
- Department of Radiology, City Hospital, Ankara, Turkey
- Department of Radiology, Yildirim Beyazit University, Ankara,
Turkey
- National MR Research Center, Bilkent University, Ankara, Turkey
| | - Seniha Corabay
- Biostatistics Department, Uludag University, Bursa, Turkey
| | - Gıyas Ayberk
- Department of Neurosurgery, Yildirim Beyazit University, Ankara,
Turkey
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4
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Simgen A, Weyrich A, Dietrich P, Roumia S, Mühl-Benninghaus R, Yilmaz U, Reith W, Kettner M. Treatment of Wide-Necked Cerebral Aneurysms Using the WEB Device Including Flow Alteration Assessment With Color-Coded Imaging: A Single Center Experience. World Neurosurg X 2022; 17:100143. [PMCID: PMC9626383 DOI: 10.1016/j.wnsx.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The Woven EndoBridge (WEB) device (MicroVention, Tustin, CA) has extended the treatment of cerebral aneurysms. Despite the fact that the WEB device has shown promising clinical results, little is known about the caused intra-aneurysmal flow alterations. Here we present our clinical experience with the WEB, including examining various syngo iFlow (Siemens AG, Erlangen, Germany) parameters to predict aneurysm occlusion. Methods We reviewed the data from patients with unruptured cerebral aneurysms treated with a WEB device between 2016 and 2020. Aneurysm occlusion and complications were assessed. Furthermore, different quantitative criteria were evaluated using syngo iFlow after digital subtraction angiography. Results A total of 26 patients hosting 26 cerebral aneurysms met the inclusion criteria. Follow-up was available for 21 patients, with a mean of 7.3 ± 6.3 months. A total of 71.4% (n = 15) of the aneurysms included were located in the anterior and 28.6% (n = 6) in the posterior circulation. Adequate aneurysm occlusion was achieved in 85.7% (n = 18). The iFlow parameters for reduced aneurysm outflow (ID-R) differed significantly from the parameters for reduced inflow (PI-R and PI-D) (P < 0.001). The parameters did not differ significantly between adequately and insufficiently occluded aneurysms. Only a trend towards a lower ID-R of insufficiently occluded aneurysms was observed (P = 0.063), indicating a potential predictive value for insufficient aneurysmal outflow. There was no treatment-related morbidity or mortality. Conclusions The applied syngo iFlow parameters confirmed that flow changes induced by the WEB device significantly affect outflow compared to inflow and have potential predictive value for adequate aneurysm occlusion.
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Key Words
- cerebral aneurysm
- syngo iflow
- web
- 2d, 2-dimensional
- boss, beaujon occlusion scale score
- cfd, computational fluid dynamics
- dsa, digital subtraction angiography
- id, intensity decrease
- id-r, intensity decrease ratio
- mrs, modified rankin scale
- pi, peak intensity
- pi-d, peak intensity delay
- pi-r, peak intensity ratio
- roi, region of interest
- tdc, time density curve
- ttp, time to peak
- web, woven endobridge
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Affiliation(s)
- Andreas Simgen
- To whom correspondence should be addressed: Andreas Simgen, M.D., Ph.D.
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5
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Chen CJ, Dabhi N, Snyder MH, Ironside N, Abecassis IJ, Kellogg RT, Park MS, Ding D. Intrasaccular flow disruption for brain aneurysms: a systematic review of long-term outcomes. J Neurosurg 2022; 137:360-372. [PMID: 34952523 DOI: 10.3171/2021.9.jns211706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The long-term safety and efficacy of intrasaccular flow disruption (IFD) for the treatment of brain aneurysms remain unclear. With accumulating experience and increasing use of IFD devices, recent studies have provided additional data regarding their outcomes. This review summarizes the long-term outcomes of IFD-treated brain aneurysms. METHODS A systematic literature review was performed on May 23, 2021, in PubMed, Web of Science, and Ovid MEDLINE for aneurysm treatment outcomes with IFD devices. Procedural details, including use of adjunctive devices and complications, were collected. The quality of studies was assessed using the Downs and Black checklist. Angiographic outcomes were classified as complete occlusion, residual neck, and residual aneurysm. Other outcomes included need for retreatment, permanent neurological deficit, and mortality. Pooled analyses were performed. RESULTS The final analysis comprised 1217 patients with 1249 aneurysms from 22 studies. The mean aneurysm diameter and neck width were 6.9 and 4.5 mm, respectively, and 27.6% of aneurysms were ruptured. The complete occlusion rates at 12 months and final follow-up (pooled mean duration 15.7 months) were 50.1% and 58.2%, respectively. Adjunctive devices were used in 6.4% of cases. The rates of hemorrhage, symptomatic infarction, permanent neurological deficit, and mortality were 1.2%, 2.8%, 1.0%, and 2.6%, respectively. CONCLUSIONS IFD is a very safe treatment for appropriately selected brain aneurysms with low complication and neurological deterioration rates. However, complete occlusion is achieved in only half of IFD-treated aneurysms at 1 year with a modest increase beyond this time point. As the majority of the studies were single arm, the pooled data are subject to selection and reporting biases. Future device developments, increased operator experience, and direct comparisons with alternative endovascular strategies and surgical clipping may clarify the role of IFD in aneurysm management.
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Affiliation(s)
- Ching-Jen Chen
- 1Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nisha Dabhi
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - M Harrison Snyder
- 3Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts; and
| | - Natasha Ironside
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Isaac Josh Abecassis
- 4Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Ryan T Kellogg
- 1Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Min S Park
- 1Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dale Ding
- 4Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Spelle L, Herbreteau D, Caroff J, Barreau X, Ferré JC, Fiehler J, Januel AC, Costalat V, Liebig T, Bourcier R, Möhlenbruch MA, Berkefeld J, Weber W, Mihalea C, Ikka L, Ozanne A, Cognard C, Narata AP, Bibi RE, Gauvrit JY, Raoult H, Velasco S, Buhk JH, Chalumeau V, Bester M, Desal H, du Mesnil de Rochemont R, Bohner G, Fischer S, Gallas S, Biondi A, Grimaldi L, Moret J, Byrne J, Pierot L. CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): 12-month angiographic results of a multicenter study. J Neurointerv Surg 2022:neurintsurg-2022-018749. [PMID: 35882550 DOI: 10.1136/neurintsurg-2022-018749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS) study has shown that the endovascular treatment of ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) is safe and effective and provides protection against rebleeding at 1 month and 1 year. The 12-month angiographic follow-up is an important endpoint of the study. METHODS The CLARYS study is a prospective multicenter study conducted in 13 European centers. The study enrolled 60 patients with 60 ruptured aneurysms of the anterior and posterior circulation. The study was conducted with an independent assessment of safety outcomes and imaging. RESULTS Sixty patients with 60 ruptured bifurcation aneurysms to be treated with the WEB were included. Fifty-three aneurysms (88.3%) had a broad base with a dome to neck ratio <2 (mean 1.6). Of these, 46 patients were evaluated by an independent core laboratory with follow-up imaging performed at 12 months or before eventual retreatment. At 1 year, 19/46 aneurysms (41.3%) were completely occluded (Raymond-Roy grade I), 21/46 (45.7%) had a residual neck and 6/46 (13.0%) had residual aneurysm filling. Adequate occlusion was reported in 40/46 (87%) aneurysms. Six patients underwent target aneurysm retreatment. CONCLUSIONS The CLARYS study has previously shown that the use of the WEB in the endovascular treatment of ruptured bifurcation aneurysms provides effective protection against rebleeding with a good safety profile. The angiographic occlusion rates at 1 year reported here are comparable to those already seen in previous multicenter studies which primarily included unruptured aneurysms.
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Affiliation(s)
- Laurent Spelle
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France .,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilians University, Munich Faculty of Medicine, Munchen, Germany
| | - Romain Bourcier
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | - Markus A Möhlenbruch
- Department of Neuroradiology, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Joachim Berkefeld
- Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Werner Weber
- Department of Neuroradiology, Ruhr-Universitat Bochum Medizinische Fakultat, Bochum, Germany
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Léon Ikka
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Augustin Ozanne
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Richard Edwige Bibi
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jean-Yves Gauvrit
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Hélène Raoult
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Stéphane Velasco
- Department of Radiology, Regional University Hospital, Poitiers, France
| | - Jan-Hendrik Buhk
- Department of Neuroradiology, Asklepios Hospital Group, Hamburg, Germany
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hubert Desal
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Georg Bohner
- Neuroradiology, Charite Universitatsmedizin, Berlin, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, Ruhr-Universitat Bochum Medizinische Fakultat, Bochum, Germany
| | - Sophie Gallas
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Jean Minjoz University Hospital, Besancon, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,CESP Anti-Infective Evasion and Pharmacoepidemiology Team, Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-Le-Bretonneux, France
| | - Jacques Moret
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - James Byrne
- Department of Neuroradiology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, Reims, France.,Champagne-Ardenne University, Reims, France
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Delayed rupture of an anterior communicating artery aneurysm after elective Woven EndoBridge embolization, re-treated with microsurgical clipping: operative technique and systematic review. World Neurosurg 2022; 165:188-197.e1. [PMID: 35697227 DOI: 10.1016/j.wneu.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is designed for intrasaccular flow disruption for embolization of intracranial aneurysms. In limited experience so far, the rate of rupture after adequate occlusion by embolization is low. TECHNICAL REPORT A 58-year-old man initially had an incidental, unruptured 10.4 mm anterior communicating artery (ACoA) aneurysm treated with WEB embolization. Although his 6-month follow-up angiogram showed adequate occlusion of the aneurysm, he presented to our facility with aneurysmal recurrence due to WEB compaction and rupture. This was treated with surgical clipping of the aneurysm. METHODS The literature was systematically reviewed for cases of delayed rupture after WEB embolization. Statistical analyses included studies with at least 20 patients and follow-up of 3 months. RESULTS We identified 36 studies, which were primarily retrospective observational studies. The rate of complete occlusion ranged from 33% to 89%, and the rate of re-treatment ranged from 1.5% to 27%. Across four studies, the rate of recanalization ranged from 8.7% to 13%. Two cases of delayed rupture were reported; an additional four cases were found in case reports and case series. In only one previous case, the aneurysm was reported as previously untreated. CONCLUSION Early retrospective data has begun to define the history of WEB-treated aneurysms. Rupture of a previously unruptured, WEB-treated aneurysm with adequate initial occlusion is rare. We describe such a case with techniques for management, demonstrating that aneurysm recurrence and delayed rupture is possible despite good interim angiographic result. This report raises questions about follow-up for WEB-treated aneurysms.
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8
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Essibayi MA, Lanzino G, Brinjikji W. Safety and Efficacy of the Woven EndoBridge Device for Treatment of Ruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2021; 42:1627-1632. [PMID: 34117016 DOI: 10.3174/ajnr.a7174] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Woven EndoBridge device has been increasingly used to treat wide-neck aneurysms, particularly ruptured ones. PURPOSE Our aim was to investigate the safety and efficacy of the Woven EndoBridge device in the treatment of ruptured intracranial aneurysms. DATA SOURCES All studies evaluating the outcomes of Woven EndoBridge device use in the treatment of ruptured intracranial aneurysms from inception through 2020 were searched on Ovid Evidence-Based Medicine Reviews, EMBASE, MEDLINE, Scopus, and the Web of Science Core Collection. STUDY SELECTION Eighteen studies encompassing 487 patients with 496 ruptured aneurysms treated with the Woven EndoBridge device were included. DATA ANALYSIS We studied rates of rerupture and retreatment, angiographic outcomes at the last follow-up point, complications, and mortality rates. Data were collected on anticoagulation and antiplatelet use. Meta-analysis was performed using the random effects model. DATA SYNTHESIS The rate of late rebleeding was 1.1% (95% CI, 0.1%-2.1%). The treatment-related perioperative complication rate and the overall clinical complication rate were 13.2% (95% CI, 9.2%-17.2%) and 3.2% (95% CI, 1.6%-4.7%), respectively. Thirteen hemorrhagic (2%; 95% CI, 0.8%-3.3%) and 41 thromboembolic (6.8%; 95% CI, 4.6%-9%) complications occurred. Favorable clinical outcomes were achieved in 85% of patients. Procedure-related mortality and overall mortality rates were 2.1% (95% CI, 0.8%-3.3%) and 11.5% (95% CI, 7%-16%), respectively. At last follow-up, an adequate occlusion rate was 87.3% (95% CI, 82.1%-92.4%) and the retreatment rate was 5.1% (95% CI, 3%-7.3%). LIMITATIONS Our meta-analysis is limited by selection bias and high heterogeneity. CONCLUSIONS This meta-analysis demonstrated the safety and efficacy of the Woven EndoBridge device in the management of ruptured aneurysms, but further studies are needed.
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Affiliation(s)
- M A Essibayi
- From the Department of Neurosurgery (M.A.E., G.L., W.B.)
| | - G Lanzino
- From the Department of Neurosurgery (M.A.E., G.L., W.B.)
- Radiology (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- From the Department of Neurosurgery (M.A.E., G.L., W.B.)
- Radiology (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
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9
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Youssef PP, Dornbos Iii D, Peterson J, Sweid A, Zakeri A, Nimjee SM, Jabbour P, Arthur AS. Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms. J Neurointerv Surg 2020; 13:443-446. [PMID: 32719167 DOI: 10.1136/neurintsurg-2020-016405] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Wide-necked bifurcation aneurysms (WNBAs) present unique challenges for endovascular treatment. The Woven EndoBridge (WEB) device is an intrasaccular braided device, recently approved by the FDA for treatment of WNBAs. While treatment of intracranial aneurysms with the WEB device has been shown to yield an adequate occlusion rate of 85% at 1 year, few data have been published for patients with ruptured aneurysms. OBJECTIVE To present a multi-institutional series depicting the safety and efficacy of using the WEB device as the primary treatment modality in ruptured intracranial aneurysms. METHODS A multi-institutional retrospective analysis was conducted, assessing patients presenting with aneurysmal subarachnoid hemorrhage treated with the WEB between January 2014 and April 2020. Baseline demographics, aneurysm characteristics, adverse events, and long-term outcomes (occlusion, re-treatment, functional status) were collected. A descriptive analysis was performed, and variables potentially associated with aneurysm recurrence or re-treatment were assessed. RESULTS Forty-eight patients were included. Anterior communicating artery aneurysms were the most common (35.4%) location for treatment, followed by middle cerebral artery (20.8%) and basilar apex (16.7%). Procedural success was noted in 95.8% of patients, and clinically significant periprocedural adverse events occurred in 12.5%. After a median follow-up of 5.5 months, 54.2% of patients had follow-up angiographic imaging. Complete occlusion was seen in 61.5% of cases with adequate occlusion in 92.3%. Re-treatment was required in only 4.2% of patients during the study period. Tobacco use was significantly higher in patients with aneurysm recurrence (88.9% vs 35.7%; p=0.012). No other characteristics were associated with recurrence/re-treatment. At 30 days, 81.1% were functionally independent (modified Rankin Scale score ≤2). CONCLUSION Treatment of acutely ruptured aneurysms with the WEB device demonstrates both safety and efficacy on par with rates of conventional treatment strategies.
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Affiliation(s)
- Patrick P Youssef
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - David Dornbos Iii
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jeremy Peterson
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Amanda Zakeri
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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10
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Nawka MT, Lohse A, Bester M, Fiehler J, Buhk JH. Residual Flow Inside the Woven EndoBridge Device at Follow-Up: Potential Predictors of the Bicêtre Occlusion Scale Score 1 Phenomenon. AJNR Am J Neuroradiol 2020; 41:1232-1237. [PMID: 32586965 DOI: 10.3174/ajnr.a6605] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) device is an established technique for the treatment of intracranial aneurysms. Occasionally, persistent opacification inside the WEB lumen can be observed at follow-up (previously described as Bicêtre Occlusion Scale Score 1). We evaluated potential risk factors of this phenomenon, hypothesizing that initial deviation of the WEB device from the aneurysm axis, size of the aneurysmal neck surface, or inappropriate WEB sizing correlates with Bicêtre Occlusion Scale Score 1 findings. MATERIALS AND METHODS We systematically reviewed all patients treated with the WEB device between February 2014 and December 2018 in our neurointerventional center. Patients with midterm follow-up DSA available were considered for aneurysm evaluation applying the Bicêtre Occlusion Scale Score. WEB angle deviation from the aneurysm axis, neck widths, and WEB sizes were collected. RESULTS We included 65 patients with 67 intracranial aneurysms. Eleven of 67 (16.4%) intracranial aneurysms showed the Bicêtre Occlusion Scale Score 1 phenomenon at follow-up. Anterior-posterior projections of WEB axis deviation (angles measured in degrees) were significantly different between the Bicêtre Occlusion Scale Score 1 cohort (median ± interquartile range, 17 ± 17) and all other Bicêtre Occlusion Scale Scores (median ± interquartile range, 7 ± 11; P = .023), whereas in lateral projections, no significant difference was observed (median ± interquartile range, 10 ± 10 versus 8 ± 9; P = .169). Neck or aneurysm recurrence, but not the Bicêtre Occlusion Scale Score 1 phenomenon, occurred significantly more often in patients with inappropriate WEB sizing compared with appropriate WEB sizing (median ± interquartile range, 1 ± 1.3 versus 0 ± 0; P < .001/P = .664). CONCLUSIONS The Bicêtre Occlusion Scale Score 1 phenomenon is associated with an initial deviation of the WEB device from the aneurysm axis but does not correlate with aneurysmal neck surface measurements or WEB sizing.
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Affiliation(s)
- M T Nawka
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - A Lohse
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Bester
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J-H Buhk
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Campos JK, Cheaney Ii B, Lien BV, Zarrin DA, Vo CD, Colby GP, Lin LM, Coon AL. Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices. Stroke Vasc Neurol 2020; 5:1-13. [PMID: 32411402 PMCID: PMC7213520 DOI: 10.1136/svn-2020-000347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
Flow diverters and flow disruption technology, alongside nuanced endovascular techniques, have ushered in a new era of treating cerebral aneurysms. Here, we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.
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Affiliation(s)
- Jessica K Campos
- Department of Neurosurgery, University of California Irvine School of Medicine, Orange, California, USA
| | - Barry Cheaney Ii
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Brian V Lien
- Department of Neurosurgery, University of California Irvine School of Medicine, Orange, California, USA
| | - David A Zarrin
- Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chau D Vo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Geoffrey P Colby
- UCLA Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, United States
| | - Alexander L Coon
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, United States
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