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Zur G, Charbonnier G, Fageeh A, Diouf A, Brun-Vergara ML, Lesiuk H, Drake B, Santos M, Mikhael N, Budiansky D, Rhodes E, Fahed R, Mendes Pereira V. Stent-assisted Woven EndoBridge embolization for the treatment of pulsatile tinnitus caused by an ipsilateral high-riding jugular bulb. Interv Neuroradiol 2024:15910199241245156. [PMID: 38576332 DOI: 10.1177/15910199241245156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Pulsatile tinnitus can be caused by a high-riding jugular bulb (HRJB), characterized by the superior position of the jugular bulb in the petrous temporal bone. The anatomical position and morphology of this entity make it challenging for endovascular treatment. We report our experience with two patients successfully treated with a stent-assisted Woven EndoBridge (WEB; Microvention, Tustin, CA, USA) device. MATERIALS AND METHODS We describe two cases of HRJB in patients presenting with disabling pulsatile tinnitus. Temporary balloon occlusion of the jugular bulb prior to the intervention reduced tinnitus intensity. Both patients were subsequently treated under general anesthesia with the WEB device deployed in the HRJB which was held by a stent deployed in the sigmoid sinus. RESULTS Both procedures were successful with good positioning of the WEB device and no procedural complications. Both patients had complete resolution of pulsatile tinnitus immediately after the procedure. Follow-up imaging showed successful occlusion of the venous cavity with a widely patent stent. CONCLUSION Among patients with pulsatile tinnitus caused by an ipsilateral HRJB, a stent-assisted WEB device seems to be a viable endovascular option with angiographic and clinical success.
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Affiliation(s)
- Gil Zur
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Guillaume Charbonnier
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Areej Fageeh
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Ange Diouf
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Lucia Brun-Vergara
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Howard Lesiuk
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Drake
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Marlise Santos
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Mikhael
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Dan Budiansky
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Fahed
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Rodriguez-Erazú F, Cortese J, Mihalea C, Popica A, Chalumeau V, Vasconcellos N, Gallas S, Ikka L, Grimaldi L, Caroff J, Spelle L. Thromboembolic Events With the Woven Endobridge Device: Incidence, Predictive Factors, and Management. Neurosurgery 2024; 94:183-192. [PMID: 37728333 DOI: 10.1227/neu.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Woven EndoBridge (WEB) device has been increasingly used to treat wide-neck aneurysms showing a safe and effective profile, but a relatively high number of thromboembolic events (TEEs) have been reported with such treatment. We aimed to evaluate the incidence and management of TEEs and possible predictive factors related to WEB embolization of ruptured and unruptured intracranial aneurysms. METHODS A single-center database with consecutive aneurysms treated with a WEB device between July 2012 and May 2022 was reviewed for intraoperative and delayed TEEs. Univariate and multivariable analyses were used to determine factors associated with TEEs. RESULTS A total of 266 independent aneurysms were treated with WEB devices in 245 patients (mean age 55.78 ± 11.64 years, 169 (63.5%) females, 80 (30%) ruptured). The overall rate of TEEs is 13% (35/266), including 8.7% intraoperative. Symptomatic TEEs with clinical sequelae at a 3-month follow-up are reported to be 2.6% (7/266) with no TEE-related mortality. Both the replacement of a WEB device during the procedure (adjusted odds ratio = 2.61, 95% CI 1.24-5.49; P = .01) and ruptured aneurysms (adjusted odds ratio = 2.74, 95% CI 1.31-5.7; P = .007) were independent predictors of TEEs. A case-by-case management of intraprocedural TEE is also presented; tirofiban was successfully used in most cases of this cohort. CONCLUSION In this study, we demonstrated that ruptured aneurysms and WEB device replacement during the procedure were independent predictive factors for TEEs. As a result, making the correct choice of WEB is crucial for improving treatment outcomes. Moreover, with proper medical management of TEEs, minimal morbidity and no mortality could be achieved, which reinforces the safety of the technique.
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Affiliation(s)
- Fernanda Rodriguez-Erazú
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Department of Neurological Surgery, University Hospital Dr Manuel Quintela, Montevideo , Uruguay
| | - Jonathan Cortese
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1195, Paris , France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Adrian Popica
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Natalia Vasconcellos
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Sophie Gallas
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Leon Ikka
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-Le-Bretonneux , France
- CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris , France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1176, Paris , France
| | - Laurent Spelle
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1195, Paris , France
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Goertz L, Liebig T, Siebert E, Zopfs D, Pennig L, Schlamann M, Dorn F, Kabbasch C. Oversizing of the Woven EndoBridge for Treatment of Intracranial Aneurysms Improves Angiographic Results (WEBINAR). World Neurosurg 2024; 181:e182-e191. [PMID: 37777172 DOI: 10.1016/j.wneu.2023.09.090] [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: 08/11/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Several studies have demonstrated a high safety and efficacy profile of the Woven EndoBridge (WEB) for endovascular aneurysm treatment. However, contemporary large-scale studies of the WEB are rare. This multicenter study attempts to set a benchmark for state-of-the-art WEB treatment with consistent application of the WEB oversizing technique. METHODS This is a retrospective, multicenter study of aneurysms (dome width 2-10 mm) treated with the WEB between 2015 and 2023. Patient and aneurysm characteristics, complications, and clinical and angiographic outcomes were analyzed. RESULTS The study consisted of 247 patients treated for 251 aneurysms (25.5% ruptured, 5.6% recurrent). WEB implantation was feasible in 98.8%, achieving a mean WEB/dome ratio of 1.2 ± 0.1. The thromboembolic complication rate was 7.2%, which was higher in ruptured versus unruptured aneurysms (hazard ratio: 2.8, 95%CI: 1.0-7.6, P = 0.04), but lower in cases where WEB 17 was used (hazard ratio: 4.0, 95%CI: 1.4-11.2, P = 0.01). Neurological complications occurred in 8 procedures (3.2%), including 3 (1.2%) major, and 5 (2.0%) minor events. Procedural morbidity and mortality were 0.8% and 0%, respectively. Mid-term complete and adequate occlusion rates were 66.3% and 88.4%, respectively. The retreatment rate was 5.2%. Feasibility, complication, and occlusion rates were comparable between typical and atypical aneurysm locations. CONCLUSIONS Oversizing the WEB and using currently available WEB types in this series resulted in slightly better treatment outcomes compared to early WEB studies, confirming the high safety, feasibility, and efficacy of this technique.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - David Zopfs
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital of Bonn, Bonn, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Semeraro V, Palmisano V, Limbucci N, Comelli S, Comelli C, Ganimede MP, Lozupone E, Barone M, Marrazzo A, Paladini A, Della Malva G, Briatico Vangosa A, Laiso A, Renieri L, Capasso F, Gandini R, Di Stasi C, Resta M, Mangiafico S, Burdi N. Woven EndoBridge Device for Unruptured Wide-Neck Bifurcation Aneurysm: A Multicenter 5-Year Follow-up. Neurosurgery 2023:00006123-990000000-00978. [PMID: 38038472 DOI: 10.1227/neu.0000000000002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This multicenter study aimed to assess the safety and efficacy of the Woven EndoBridge (WEB) device for treating unruptured wide-neck intracranial bifurcation aneurysms (WIBAs) with short-, mid-, and long-term follow-ups (FUPs). METHODS Consecutive patients with unruptured WIBAs treated with WEB between December 2014 and January 2018 were included. Patient, aneurysm, and device characteristics were collected and analyzed retrospectively. Morbidity and mortality rates were determined by collecting intraprocedural, periprocedural, and delayed complications. Aneurysm occlusion was assessed at 1, 3, and 5 years using a 3-grade scale: complete occlusion, neck remnant, and residual aneurysm. Complete occlusion and neck remnant were considered as adequate occlusion. Patients who received re-treatment were also evaluated. RESULTS The study included 104 consecutive patients (55.8% female, mean age 58.6 ± 11.8 years). Aneurysm maximum size, neck, and dome-to-neck mean were, respectively, 6.9 ± 2.1 mm, 4.5 ± 1.2 mm, and 1.4 ± 0.3 mm. One-year FUP was collected for 95 patients, and 3- and 5-year FUPs were collected for 83 patients. Adequate occlusion was observed at 1-year FUP in 90.5% (86/95), 91.6% (76/83) was observed at 3-year FUP, and 92.8% (77/83) at 5-year FUP. None of the aneurysms bled after treatment. During FUP, 6/83 patients (7.2%) were re-treated for residual aneurysm. Morbidity and mortality rates closely related to aneurysm occlusion were 0% (0/104). CONCLUSION The WEB device was safe and effective for treating unruptured WIBAs, both in short-term and long-term FUPs.
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Affiliation(s)
- Vittorio Semeraro
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Vitanio Palmisano
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simone Comelli
- Neuroradiology and Vascular Radiology Unit, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", Cagliari, Italy
| | - Chiara Comelli
- Radiology and Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | | | - Michele Barone
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Antonio Marrazzo
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Andrea Paladini
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | | | | | - Antonio Laiso
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Renieri
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesco Capasso
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Roberto Gandini
- Department of Interventional Radiology, University Hospital "Tor Vergata", Rome, Italy
| | - Carmine Di Stasi
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Maurizio Resta
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | | | - Nicola Burdi
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
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Goertz L, Simões Corrêa Galendi J, Kabbasch C, Schlamann M, Pennig L, Froelich MF, Timmer M, Liebig T, Stock S, Mueller D, Große Hokamp N. Cost-effectiveness of WEB Embolization, Coiling and Stent-assisted Coiling for the Treatment of Unruptured Intracranial Aneurysms. Clin Neuroradiol 2023; 33:1075-1086. [PMID: 37368089 PMCID: PMC10654202 DOI: 10.1007/s00062-023-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Information about the cost-effectiveness of a certain treatment is relevant for decision-making and healthcare providers. This study compares the cost-effectiveness of the novel Woven Endobridge (WEB) for intracranial aneurysm treatment with conventional coiling and stent-assisted coiling (SAC) from the perspective of the German Statutory Health Insurance. METHODS A patient-level simulation was constructed to simulate 55-year-old patients with an unruptured middle cerebral artery aneurysm (size: 3-11 mm) considering WEB treatment, coiling or SAC in terms of morbidity, angiographic outcome, retreatment, procedural and rehabilitation costs and rupture rates. Incremental cost-effectiveness ratios (ICERs) were calculated as costs per quality-adjusted life years (QALYs) and costs per year with neurologic morbidity avoided. Uncertainty was explored with deterministic and probabilistic sensitivity analyses. The majority of data were obtained from prospective multi-center studies and meta-analyses of non-randomized studies. RESULTS In the base case, lifetime QALYs were 13.24 for the WEB, 12.92 for SAC and 12.68 for coiling. Lifetime costs were 20,440 € for the WEB, 23,167 € for SAC, and 8200 € for coiling. Compared to coiling, the ICER for the WEB was 21,826 €/QALY, while SAC was absolutely dominated by WEB. Probabilistic sensitivity analysis revealed that at a willingness-to-pay of ≥ 30,000 €/QALY, WEB was the preferred treatment. Deterministic sampling showed that the discount rate, material costs and retreatment rates had the largest impact on the ICERs. CONCLUSION The novel WEB showed at least comparable cost-effectiveness to SAC for treatment of broad-based unruptured aneurysms. Considering all three modalities, coiling had the least costs; however this modality is often not appropriate for the treatment of wide-necked aneurysms.
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Affiliation(s)
- Lukas Goertz
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Julia Simões Corrêa Galendi
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marc Schlamann
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lenhard Pennig
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Marco Timmer
- Faculty of Medicine and University Hospital, Center for Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thomas Liebig
- Faculty of Medicine and University Hospital, Department of Neuroradiology, University of Munich (LMU), Marchioninistraße 15, 81377, Munich, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Dirk Mueller
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nils Große Hokamp
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Abouei Mehrizi MA, Habibi MA, Keykhosravi E, Eazi SM, Minaee P, Mirjani MS. The Safety and Efficacy of eCLIPs for Treatment of Wide-Necked Bifurcation Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 180:213-223.e7. [PMID: 37813336 DOI: 10.1016/j.wneu.2023.10.011] [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: 09/04/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Wide-necked bifurcation aneurysms (WNBAs) are challenging intracranial aneurysms. Several device and treatment approaches have been proposed for the treatment of WNBAs. The endovascular clip system (eCLIPs) is a newly developed endovascular device with flow diverter and flow disruptor features. This study aims to investigate the safety and efficacy of the eCLIPs for treatment of patients with WNBAs. METHODS This is a systematic review and meta-analysis study conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The electronic databases of PubMed, Embase, Scopus, and Web of Science were systematically reviewed from inception to June 19, 2023. The rate of complete and near-complete occlusion, successful device implantation, and serious adverse events were pooled using STATA, version 17. RESULTS A total of 5 studies with 110 patients with WNBAs were systematically investigated. Our findings show that the immediate successful implantation rate of eCLIPs was 0.93 (95% confidence interval [CI], 0.88-0.97). Moreover, the immediate postoperative complete occlusion rate was 0.34 (95% CI, 0.10-0.58), and the immediate postoperative near-complete occlusion rate was 0.35 (95% CI, 0.24-0.45). Also, the near-complete occlusion rate at the latest follow-up was 0.3 (95% CI, 0.16-0.44). The serious adverse event rate was 0.14 (95% CI, 0.05-0.22). Stroke was also reported in 2 studies, with 1 study reporting 1 patient who experienced stroke within the first 24 hours and 1 study reporting no patients with stroke. CONCLUSIONS Our findings document that the eCLIPs is a safe and effective device for treating patients with WNBAs and associated with favorable outcomes.
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Affiliation(s)
| | - Mohammad Amin Habibi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Seyed Mohammad Eazi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | - Poriya Minaee
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
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Javed K, Fortunel A, Holland R, Khatri D, Ahmad S, Haranhalli N, Altschul D. Identifying risk factors for perioperative thromboembolic complications in patients treated with the Woven EndoBridge device. Interv Neuroradiol 2023; 29:561-569. [PMID: 35837721 PMCID: PMC10549708 DOI: 10.1177/15910199221113907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Woven EndoBridge (WEB) is a new endovascular treatment option for wide necked bifurcation aneurysms. Results from the WEB-IT trial showed a 0% risk of thromboembolic complications within 30 days post-op but the rate reported in the literature is as high as 10%. We are exploring potential risk factors associated with immediate thromboembolic complications in patients treated with the WEB device. METHODS Retrospective study of forty-two patients with intracranial aneurysms who were treated with WEB at a single center from 2019-2021. Data was collected on patient demographics, comorbidities, aneurysm characteristics, procedural details, and hospital course. Bivariate analyses were performed to compare patients who experienced a periprocedural ischemic stroke to those who did not. Multiple logistic regression modeling was performed to identify independent risk factors for thromboembolic complications. RESULTS Of the 42 patients that were treated with WEB, 6 suffered an ischemic stroke (AIS). These patients were more likely to have an underlying diagnosis of arrythmias (p value = 0.007). Furthermore, they had a median angle of 32.0° in the true neck view on diagnostic angiogram compared to 19.5° (p value = 0.046). Lastly, they had a longer procedure length of 228 min compared to 178 min (p value = 0.002). Patients with thromboembolic complications had a longer length of stay in the hospital and worse outcomes at three months follow up. On logistic regression modeling, these risk factors did not reach statistical significance. CONCLUSION Risk factors of thromboembolic complications after WEB placement include cardiac arrythmias, acute aneurysmal angle in the true neck view and a longer procedure length.
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Affiliation(s)
- Kainaat Javed
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Adisson Fortunel
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Deepak Khatri
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Samuel Ahmad
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Neil Haranhalli
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
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Zheng H, Zhao Y, Zhou H, Tang Y, Xie Z, Liu CJ. Mid-to-long term safety and efficacy of Woven EndoBridge device for Treatment of intracranial wide neck aneurysms: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 232:107861. [PMID: 37423087 DOI: 10.1016/j.clineuro.2023.107861] [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: 04/08/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND In recent 10 years, Woven EndoBridge(WEB) device has been used as endovascular instrumentation for treating wide neck Bifurcation aneurysms. Its safety and efficacy in the mid-term (6-24 months) and long-term (more than 24 months) follow-up period have yet to be systematically reviewed. PURPOSE To evaluate the WEB device safety and efficacy, relevant literature and publications were extensively reviewed, and a meta-analysis was conducted. DATA RESOURCE All relevant literature/publications were achieved from Pubmed, Cochrane, Embase, and Web of Science databases. RESULTS 767 patients that were studied in 13 literature were included. The focus of this review was placed on the clinical and anatomic outcomes. Complete occlusion was achieved in 67.3% (95% CI, 59.0-75.5%) and 69.3% (95% CI, 55.7-82.8%) of the cases at mid- and long-term follow-up. The rate of adequate occlusion was 86.6% (95% CI, 83.0-90.2%) and 90.1% (95% CI, 85.5-94.4%) for the mid and long-term, respectively. 51 patients (8.8%; 95% CI,5.6-11.9%) and 18 (8.1%; 95% CI,0.8-15.5%) received retreatments during mid- and long-term follow-up, respectively. 410 patients from 427 (94.3%; 95% CI, 89.7-98.9%) showed favorable clinical outcomes. The all-cause mortality rate was 3.5% (95% CI, 1.4-5.6%), where only a few cases were related to the WEB implantation. The WEB device deployment was associated with an overall clinical complication rate of 4.1% (95% CI, 2.7-6.6%), 3 hemorrhagic (1.2%; 95% CI, 0.2-2.6%), and 30 thromboembolic (4.0%; 95% CI, 4.0- 6.0%) complications. CONCLUSIONS The findings reveal the satisfactory safety and effectiveness of the WEB device for the Treatment of wide-neck aneurysms during mid-to-long-term follow-up, indicating the high potential of the WEB device for wide application.
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Affiliation(s)
- Hui Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 404100, China
| | - Yutong Zhao
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 404100, China
| | - Hai Zhou
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 404100, China
| | - Yuguang Tang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 404100, China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 404100, China.
| | - Cheng Jiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, Anhui, 246000, China
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Morioka J, Nakahara I, Matsumoto S, Hasebe A, Tanabe J, Suyama K, Watanabe S, Suyama Y, Kuwahara K. Persistent contrast-filling in the woven endobridge device three months after its implantation for cerebral aneurysm: Incidence, predictive factors, and outcome. Clin Neurol Neurosurg 2023; 231:107837. [PMID: 37356199 DOI: 10.1016/j.clineuro.2023.107837] [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: 01/30/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The Woven EndoBridge (WEB) was developed to treat wide-neck bifurcation intracranial aneurysms. Occasionally, persistent contrast-filling has been observed in the WEB after treatment. The purpose of our study was to investigate its incidence, predictive factors, and clinical impact. METHODS All patients treated with the WEB between January 2021 and September 2021 at our institute were reviewed. Age, gender, antiplatelet therapy, and angioarchitecture were compared between the persistent-filling group and the no-filling group at the three-month follow-up angiography. RESULTS We included 20 patients with 20 unruptured aneurysms. Ten of the 20 intracranial aneurysms (50 %) showed contrast-filling in the WEB after three months. Two of the 10 had contrast not only inside, but around the device. Statistically significant differences were observed between the persistent-filling group and the no-filling group in neck size (median: 4.5 mm vs. 3.8 mm), deviation of the aneurysm axis from the inlet flow line where the orifice of the bifurcated arteries overlaps (mean: 15.1° vs. 33.0°), and postoperative dual antiplatelet therapy (DAPT) for at least a month (90 % vs. 20 %). One case had additional coil embolization six months after the WEB implantation. Including this case, one year after the treatment or the re-treatment, the filling in the device had disappeared in nine of 10 cases. No bleeding was observed during the mean follow-up period of 24 months. CONCLUSION Persistent contrast-filling was associated with postoperative DAPT for at least a month, a wide neck, and less deviation of the aneurysm axis from the inlet flow line. If the contrast-filling is only within the WEB and not between the aneurysmal wall and the WEB, we are not concerned. To further assess the clinical impact of this phenomenon, long-term follow-up will be needed.
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Affiliation(s)
- Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan.
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Akiko Hasebe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jun Tanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Kenichiro Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Yoshio Suyama
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Kiyonori Kuwahara
- Department of Neurosurgery, Nishichita General Hospital, Aichi, Japan
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10
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Alpay K, Lindgren A, Rautio R, Parkkola R. The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months. Neuroradiol J 2023; 36:206-212. [PMID: 36028945 PMCID: PMC10034693 DOI: 10.1177/19714009221122216] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To identify factors influencing short- and mid-term radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB). METHODS A total of 112 patients were treated for IAs with the WEB in at our institution between 2013 and 2020. Patients with 6- and/or 24-months follow-up data were included in the study. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification (RR). RR 1 and RR 2 were considered as adequate outcomes, while RR 3 inadequate. RESULTS Data were available for 91 patients (56 females, 62%) at 6 months and 62 of those patients (39 females, 58%) at 24 months. The adequate occlusion (RR 1/RR 2) rate was 89% (n = 81/91) at the 6-months follow-up and 91% (n = 56/62) at the 24-months follow-up. The treatment-related morbidity rate was 4% (n = 4/91), and mortality rate was 1% (n = 1/91). The predictor for inadequate occlusion at the 6-months follow-up was the lobular shape of an aneurysm (p = .01). The aneurysm's height (p = .02), maximal diameter (p = .001), width (p = .002), aspect ratio (p = .03), dome-to-neck ratio (p = .04), and lobular shape (p= .03) were predictive factors for inadequate occlusion at 24 months. All the thrombosed aneurysms (n = 3) showed unfavorable radiological outcomes and required re-treatment within 24 months. None of the patient-related factors were significant. CONCLUSIONS The WEB provides favorable occlusion rates and low complications for both ruptured and unruptured wide-necked IAs. Unfavorable radiological outcomes after WEB treatment may be related to aneurysm morphology and size.
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Affiliation(s)
- Kemal Alpay
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Antti Lindgren
- Department of Clinical Radiology, 60650Kuopio University Hospital, Kuopio, Finland
| | - Riitta Rautio
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
- 60652Turku University, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
- 60652Turku University, Turku, Finland
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11
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Celik E, Goertz L, Ozpeynirci Y, Schlamann M, Dorn F, Lehnen N, Siebert E, Liebig T, Kabbasch C. Comparative assessment of woven endobridge embolization and standard coil occlusion for the treatment of ruptured basilar tip aneurysms. Neuroradiology 2023; 65:765-773. [PMID: 36460785 DOI: 10.1007/s00234-022-03096-4] [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: 07/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Endovascular coil occlusion represents the standard treatment for basilar tip aneurysms. Recently, this role has been rivalled by intrasaccular flow disruptors across numerous centres. We retrospectively compared WEB embolization and coiling for the treatment of ruptured basilar tip aneurysms. METHODS Patients treated with WEB or coiling at four neurovascular centres were reviewed. Procedure-related complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS The study included 23 patients treated with the WEB (aneurysm size: 6.6 ± 1.9 mm) and 56 by coiling (aneurysm size: 6.7 ± 2.5 mm). Stent-assistance was more often necessary with coiling than with WEB embolization (32% vs. 4%, p = 0.009). A modified Rankin scale score ≤ 2 at discharge had 21 (37.5%) patients in the coiling group and 12 (52.2%) in the WEB group (p = 0.235). Immediate complete and adequate occlusion rates were 52% for the WEB and 87% for coiling. At short-term follow-up, these rates were 87% for the WEB and 72% for coiling, respectively. There was no delayed aneurysm re-bleeding during follow-up. CONCLUSION Both coiling and WEB seem to prevent rebleeding in ruptured BTA aneurysms. WEB embolization required less frequently stent-support than coiling, potentially advantageous for SAH patients to avoid anti-platelet therapy in the light of concomitant procedures like ventricular drainage.
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Affiliation(s)
- Erkan Celik
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
| | - Lukas Goertz
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Yigit Ozpeynirci
- Department of Neuroradiology, Ludwig's Maximilian University Munich, Munich, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Nils Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig's Maximilian University Munich, Munich, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
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12
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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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13
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Rodriguez-Calienes A, Vivanco-Suarez J, Galecio-Castillo M, Zevallos CB, Farooqui M, Malaga M, Moran-Mariños C, Fanning NF, Algin O, Samaniego EA, Pabon B, Mouchtouris N, Altschul DJ, Jabbour P, Ortega-Gutierrez S. Use of the Woven EndoBridge Device for Sidewall Aneurysms: Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2023; 44:165-170. [PMID: 36635056 PMCID: PMC9891330 DOI: 10.3174/ajnr.a7766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Woven EndoBridge device was originally approved to treat intracranial wide-neck saccular bifurcation aneurysms. Recent studies have suggested its use for the treatment of sidewall intracranial aneurysms with variable success. PURPOSE Our aim was to evaluate the safety and efficacy of the Woven EndoBridge device for sidewall aneurysms using a meta-analysis of the literature. DATA SOURCES We performed a systematic review of all studies including patients treated with the Woven EndoBridge device for sidewall aneurysms from inception until May 2022 on Scopus, EMBASE, MEDLINE, the Web of Science, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION Ten studies were selected, and 285 patients with 288 sidewall aneurysms were included. DATA ANALYSIS A random-effects meta-analysis of proportions using a generalized linear mixed model was performed as appropriate. Statistical heterogeneity across studies was assessed with I2 statistics. DATA SYNTHESIS The adequate occlusion rate at last follow-up was 89% (95% CI, 81%-94%; I2, = 0%), the composite safety outcome was 8% (95% CI, 3%-17%; I2 = 34%), and the mortality rate was 2% (95% CI, 1%-7%; I2 = 0%). Aneurysm width (OR = 0.5; P = .03) was the only significant predictor of complete occlusion. LIMITATIONS Given the level of evidence, our results should be interpreted cautiously until confirmation from larger prospective studies is obtained. CONCLUSIONS The initial evidence evaluating the use of the Woven EndoBridge device for the treatment of wide-neck sidewall intracranial aneurysms has demonstrated high rates of adequate occlusion with low procedural complications. Our findings favor the consideration of the Woven EndoBridge device as an option for the treatment of sidewall aneurysms.
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Affiliation(s)
- A Rodriguez-Calienes
- From the Departments of Neurology (A.R.-C., J.V.-S., M.G.-C., C.B.Z., M.F., M.M.)
- Neuroscience, Clinical Effectiveness and Public Health Research Group (A.R.-C.), Universidad Científica del Sur, Lima, Peru
| | - J Vivanco-Suarez
- From the Departments of Neurology (A.R.-C., J.V.-S., M.G.-C., C.B.Z., M.F., M.M.)
| | - M Galecio-Castillo
- From the Departments of Neurology (A.R.-C., J.V.-S., M.G.-C., C.B.Z., M.F., M.M.)
| | - C B Zevallos
- From the Departments of Neurology (A.R.-C., J.V.-S., M.G.-C., C.B.Z., M.F., M.M.)
| | - M Farooqui
- From the Departments of Neurology (A.R.-C., J.V.-S., M.G.-C., C.B.Z., M.F., M.M.)
| | - M Malaga
- From the Departments of Neurology (A.R.-C., J.V.-S., M.G.-C., C.B.Z., M.F., M.M.)
| | - C Moran-Mariños
- Unidad de Investigación en Bibliometría (C.M.-M.), Universidad San Ignacio de Loyola, Lima, Peru
| | - N F Fanning
- Department of Neuroradiology (N.F.F.), Cork University Hospital, Cork, Ireland
| | - O Algin
- Department of Radiology (O.A.), Bilkent City Hospital, Ankara, Turkey
- National MR Research Center (O.A.), Bilkent University, Ankara, Turkey
- Radiology Department (O.A.), Medical Faculty, Yıldırım Beyazıt University, Ankara, Turkey
| | - E A Samaniego
- Neurology, Neurosurgery and Radiology (E.A.S., S.O.-G.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - B Pabon
- Department of Neurosurgery (B.P.), AngioTeam, Medellin, Colombia
| | - N Mouchtouris
- Department of Neurological Surgery (N.M., P.J.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - D J Altschul
- Department of Neurological Surgery (D.J.A.), Montefiore Medical Center, Bronx, New York
| | - P Jabbour
- Department of Neurological Surgery (N.M., P.J.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - S Ortega-Gutierrez
- Neurology, Neurosurgery and Radiology (E.A.S., S.O.-G.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
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14
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de Vries J, Aquarius R, Sørensen L, Boogaarts HD, Turowski B, van Zwam WH, Marotta TR, Bartels RHMA. Safety and efficacy of the eCLIPs bifurcation remodelling system for the treatment of wide necked bifurcation aneurysms: 1 year results from the European eCLIPs Safety, Feasibility, and Efficacy Study (EESIS). J Neurointerv Surg 2023; 15:163-171. [PMID: 35393338 DOI: 10.1136/neurintsurg-2021-018460] [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: 11/19/2021] [Accepted: 03/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The eCLIPs bifurcation remodelling system is a non-circumferential implant that bridges the neck from outside of a bifurcation aneurysm. The goal of the multicenter, post-marketing European eCLIPs Safety, FeasIbility, and Efficacy Study (EESIS), was to present the efficacy and safety results of the eCLIPs device after 365 days of follow-up. METHODS All patients were to receive an eCLIPs in conjunction with coils. The study was conducted according to good clinical practices and included independent adjudication of safety and efficacy outcomes. RESULTS Twenty patients were enrolled at four European centers. Mean age was 60 years (range 41-74) and aneurysms were located at the basilar tip (n=19) and carotid tip (n=1). Average aneurysm dome height was 6.0 mm (range 2.0-15.0). Mean neck length was 5.1 mm (range 2.6-8.5). The technical success rate was 90% (18 of 20). No major territorial strokes or deaths occurred between the index procedure and after 365 days of follow-up. Complete occlusion was achieved in 60% of patients (12 of 20 patients) and 67% of patients with an eCLIPs device (12 of 18) after 365 days of follow-up. Adequate occlusion (complete occlusion and neck remnant) was achieved in 80% of patients (16 of 20 patients) and 89% of patients with an eCLIPs device (16 of 18 patients) after 365 days of follow-up. CONCLUSION In this small series, treatment with eCLIPs was feasible, safe, and efficacious, considering the challenging nature of the aneurysms. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02607501.
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Affiliation(s)
- Joost de Vries
- Neurosurgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - René Aquarius
- Neurosurgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Leif Sørensen
- Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bernd Turowski
- Radiology, Universitätsklinikum Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Wim H van Zwam
- Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Thomas R Marotta
- Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
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15
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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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16
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Long-term clinical and angiographic outcome of the Woven EndoBridge (WEB) for endovascular treatment of intracranial aneurysms. Sci Rep 2022; 12:11467. [PMID: 35794159 PMCID: PMC9259699 DOI: 10.1038/s41598-022-14945-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/15/2022] [Indexed: 11/08/2022] Open
Abstract
The Woven EndoBridge (WEB) is a well-established device for endovascular treatment of wide-necked bifurcation aneurysms. The objective was to evaluate the long-term angiographic outcome of the WEB and to identify factors that influence aneurysm occlusion. Patient, aneurysm and procedural characteristics of 213 consecutive patients treated with the WEB at three German tertiary care centers between 2011 and 2020 were retrospectively reviewed. Aneurysm occlusion was determined immediately after the procedure, at mid-term (≤ 12 months) and at long-term (> 12 months) follow-up. Among 182 included aneurysms (mean diameter: 7.0 ± 2.4, mean neck width: 4.3 ± 1.6 mm), 29.7% were ruptured. The novel WEB 17 was used in 41.8%, and 11.0% were treated in combination with coiling and/or stenting. Complete and adequate occlusions were observed in 101/155 (65.2%) and 133/155 (85.8%) at mid-term, respectively, and in 59/94 (62.8%) and 87/94 (92.6%) at long-term follow-up (median: 19 months), respectively. Among 92 patients available for both mid- and long-term follow-up, occlusion was stable in 72.8%, improved in 16.3% and worsened in 10.9%. There were no major recurrences leading to aneurysm remnants between mid- and long-term follow-up. Retreatment was performed in 10/155 (6.5%) during mid-term and in 1/94 (1.0%) during long-term follow-up. The WEB provides durable aneurysm occlusion at the long-term. Nevertheless, follow-up imaging is necessary to identify late recurrences that may occur in around 10%.
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17
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Comparison of angiographic outcomes and complication rates of WEB embolization and coiling for treatment of unruptured basilar tip aneurysms. Sci Rep 2022; 12:10899. [PMID: 35764798 PMCID: PMC9240056 DOI: 10.1038/s41598-022-15113-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/17/2022] [Indexed: 11/08/2022] Open
Abstract
Endovascular coiling represents the standard treatment for basilar tip aneurysms. Some of these aneurysms are not amenable to conventional coiling due to a complex aneurysm geometry, hence, novel devices such as the Woven Endobridge (WEB) have been developed. We retrospectively compared WEB embolization and coiling for the treatment of unruptured basilar tip aneurysms. Patients treated with WEB or coiling at four centers were reviewed. Procedure-related complications, clinical outcome and angiographic results were retrospectively evaluated and compared. Forty patients treated with the WEB and 35 patients treated by coiling were included. Stent-assistance was more often necessary for coiling than for WEB embolization (71% vs 2.5%, p < 0.001). The technical success rates were 100% for both methods. The overall complication rates were not significantly different between groups (WEB: 5%, coil: 11%, p = 0.409). Procedural morbidity rates were 9% in the coiling group and 2.5% in the WEB group (p = 0.334). There was no mortality. Treatment duration was shorter for WEB implantation than for coiling (p = 0.048). At mid-term follow-up, complete occlusion, neck remnants and aneurysm remnants were observed in 89%, 4% and 7% for the WEB, respectively, and in 100%, 0% and 0% for coiling. While complication rates and mid-term angiographic outcome was comparable between the groups, the WEB was associated with a shorter treatment duration and required stent-assistance less frequently. The choice of the treatment modality should be made based on the specific aneurysm characteristics, the individual experience of the neurointerventionalist and patient preference.
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Chung CY, Peterson RB, Howard BM, Zygmont ME. Imaging Intracranial Aneurysms in the Endovascular Era: Surveillance and Posttreatment Follow-up. Radiographics 2022; 42:789-805. [PMID: 35333634 DOI: 10.1148/rg.210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While most intracranial aneurysms (IAs) remain asymptomatic over a patient's lifetime, those that rupture can cause devastating outcomes. The increased usage and quality of neuroimaging has increased detection of unruptured IAs and driven an increase in surveillance and treatment of these lesions. Standard practice is to treat incidentally discovered unruptured IAs that confer high rupture risk as well as ruptured IAs to prevent rehemorrhage. IAs are increasingly treated with coil embolization instead of microsurgical clipping; more recently, flow diversion and intrasaccular flow disruption have further expanded the versatility and utility of endovascular IA treatment. Imaging is increasingly used for posttreatment IA follow-up in the endovascular era. While cerebral angiography remains the standard for IA characterization and treatment planning, advances in CT and CT angiography and MR angiography have improved the diagnostic accuracy of noninvasive imaging for initial diagnosis and surveillance. IA features including size, dome-to-neck ratio, location, and orientation allow rupture risk stratification and determination of optimal treatment strategy and timing. The radiologist should be familiar with the imaging appearance of common IA treatment devices and the expected imaging findings following treatment. In distinction to clipping and coil embolization, flow diversion and intrasaccular flow disruption induce progressive aneurysm obliteration over months to years. Careful assessment of the device; the treated IA; adjacent brain, bone, meninges; and involved extracranial and intracranial vasculature is crucial at posttreatment follow-up imaging to confirm aneurysm obliteration and identify short-term and long-term posttreatment complications. An invited commentary by Chatterjee is available online. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2022.
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Affiliation(s)
- Charlotte Y Chung
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Ryan B Peterson
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Brian M Howard
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Matthew E Zygmont
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
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19
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Cortese J, Caroff J, Chalumeau V, Gallas S, Ikka L, Moret J, Sabuzi F, Popescu SD, Ozanne A, Grimaldi L, Mihalea C, Spelle L. Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up. J Neurointerv Surg 2022; 15:446-451. [PMID: 35428742 DOI: 10.1136/neurintsurg-2022-018780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
Abstract
BackgroundWoven EndoBridge (WEB) devices are becoming a reliable option for the treatment of wide-neck bifurcation aneurysms, but clear predictive factors are still missing to understand the one in five aneurysm remnant rate.ObjectiveTo evaluate occlusion outcomes after WEB treatment to identify potential determinants of aneurysm occlusion.MethodsA single-center database with consecutive aneurysms treated with WEB between July 2012 and October 2021 was reviewed for potential determinants of aneurysm adequate occlusion (defined as a Bicêtre Occlusion Scale Score (BOSS) of 0, 0’, 1 or 2), through univariate and multivariable analysis. Patients without angiographic follow-up were excluded.Results215 of 247 individual aneurysms were included in the final analysis, of which 59 (27%) were ruptured. Mean age of patients was 56 years (range 23–90 years) and 65% were female. Mean angiographic follow-up was at 18 months (range 3–97 months). Adequate and complete occlusion were achieved in 171/215 (79.5%) and 135/215 (62.8%) of cases, respectively. Aneurysm irregular shape (aOR=0.42, 95% CI 0.20 to 0.88; p=0.02), aneurysm height (aOR=0.79, 95% CI 0.66 to 0.94; p<0.01), and WEB shape modification (aOR=0.98, 95% CI 0.97 to 1.00; p=0.02) were all independent predictors of aneurysm recurrence, whereas the WEB oversizing ratio (WEB width/aneurysm mean width) (aOR=16.4, 95% CI 1.4 to 266.7; p=0.04) was an independent predictor of adequate occlusion.ConclusionIn this study we demonstrated that a width oversizing strategy of the WEB device was an independent predictor of aneurysm angiographic occlusion. Conversely, aneurysm height, irregular aneurysm, and WEB shape modification were all independent determinants of angiographic aneurysm remnant. These results may help to select aneurysms suitable for the WEB device and WEB sizing.
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Affiliation(s)
- Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
- INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Federico Sabuzi
- Interventional Radiology Department, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Septimiu Daniel Popescu
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP Paris-Saclay, Université de Versailles Saint-Quentin- en- Yvelines UFR des sciences de la santé Simone Veil, Montigny-Le- Bretonneux, France
- CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
- INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
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20
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Nordmann NJ, Weber MW, Dayoub H. Woven Endobridge (WEB) augmented by Y-stent in a shallow basilar tip aneurysm. J Cerebrovasc Endovasc Neurosurg 2022; 24:176-180. [PMID: 35172073 PMCID: PMC9260456 DOI: 10.7461/jcen.2022.e2021.08.006] [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: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
The Woven Endobridge (WEB) device can be an effective and simple treatment modality for wide-neck bifurcation intracranial aneurysms. We present a case of a shallow basilar tip aneurysm treated with the WEB device that required stabilization with Y-stent through radial access.
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Affiliation(s)
- Nathan J Nordmann
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Matthew W Weber
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Hayan Dayoub
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.,Neurological Surgery, Springfield Clinic, Springfield, Illinois, USA
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21
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Gajera J, Maingard J, Foo M, Ren Y, Lamanna A, Nour D, Hall J, Kurda D, Tan D, Lalloo S, Bañez RMF, Russell J, Slater LA, Chandra RV, Chong W, Jhamb A, Brooks DM, Asadi H. The Woven EndoBridge Device for the Treatment of Intracranial Aneurysms: Initial Clinical Experience within an Australian Population. Neurointervention 2022; 17:28-36. [PMID: 35130672 PMCID: PMC8891585 DOI: 10.5469/neuroint.2021.00430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Advances in endovascular technology have expanded the treatment options for intracranial aneurysms. Intrasaccular flow diversion is a relatively new technique that aims to disrupt blood inflow at the neck of the aneurysm, hence promoting intrasaccular thrombosis. The Woven EndoBridge device (WEB; MicroVention, Aliso Viejo, CA, USA) is an US Food and Drug Administration approved intrasaccular flow diverter for wide-necked aneurysms. We report the early interim clinical and radiological outcomes of patients with both ruptured and unruptured intracranial aneurysms (IAs) treated using the WEB device in an Australian population. Materials and Methods A retrospective analysis was done of patients with ruptured or unruptured IAs who received treatment with WEB across 5 Australian neuroendovascular referral centers between May 2017 and November 2020. Angiographic occlusion was assessed with time-of-flight magnetic resonance angiography. Complications were recorded and clinical outcomes were assessed using the modified Rankin scale at follow-up. Results In total, 66 aneurysms were treated in 63 patients, with successful deployment of the WEB device in 98.5% (n=65). Eighteen (26.9%) ruptured aneurysms were included. Failure of deployment occurred in a single case. Adjunct coiling and/or stenting was performed in 20.9% (n=14) cases. Sixty-two patients with 65 aneurysms using a WEB device were followed up (mean=9.1 months), and 89.4% of these had complete aneurysm occlusion while 1.5% remained patent. Functional independence was achieved in 93.5% of cases. Conclusion Early results following the use of WEB devices in Australia demonstrate safety and adequate aneurysm occlusion comparable to international literature.
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Affiliation(s)
- Jay Gajera
- Department of Radiology, Royal North Shore Hospital, Sydney, NSW, Australia
- Correspondence to: Jay Gajera, BSc, MD Department of Radiology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia Fax: +61-3-9496-5431 E-mail:
| | - Julian Maingard
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Michelle Foo
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Yifan Ren
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Anthony Lamanna
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Daniel Nour
- Department of Radiology, Interventional Neuroradiology Service, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Jonathan Hall
- Department of Radiology, Interventional Neuroradiology Service, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Dylan Kurda
- Department of Medical Imaging, Interventional Neuroradiology Service, The Canberra Hospital, ACT Health, Canberra, NSW, Australia
| | - David Tan
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Shivendra Lalloo
- Department of Medical Imaging, Interventional Neuroradiology Service, The Canberra Hospital, ACT Health, Canberra, NSW, Australia
| | | | - Jeremy Russell
- Department of Neurosurgery, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Lee-Anne Slater
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - Ronil Vikesh Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - Winston Chong
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - Ashu Jhamb
- Department of Radiology, Interventional Neuroradiology Service, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Hamed Asadi
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
- Department of Medical Imaging, Interventional Neuroradiology Service, The Canberra Hospital, ACT Health, Canberra, NSW, Australia
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, TAS, Australia
- Department of Neurosurgery, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
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22
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Goertz L, Liebig T, Siebert E, Pflaeging M, Forbrig R, Pennig L, Celik E, Abdullayev N, Schlamann M, Dorn F, Kabbasch C. Stent-assisted WEB embolization: aneurysm characteristics, outcome and case report of a WEB delivered through a stent. Acta Neurochir (Wien) 2022; 164:2181-2190. [PMID: 35037115 PMCID: PMC9337996 DOI: 10.1007/s00701-022-05115-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/31/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Woven Endobridge (WEB) embolization has become a well-established endovascular treatment option for wide-necked bifurcation aneurysms. The objective was to analyse cases that required additional stent-implantation. METHODS Images of 178 aneurysms ≤ 11 mm treated by WEB only or by WEB plus stent were retrospectively reviewed, evaluating aneurysm characteristics, procedural specifics, adverse events and angiographic results. Moreover, we report a case of a WEB delivered through a previously implanted stent. RESULTS Additional stent implantation was performed in 15 patients (8.4%). Baseline patient and aneurysm characteristics were comparable between both groups. A single stent was used in 12 cases and 2 stents in Y-configuration in 3. Thromboembolic complications occurred more often with stent assistance (33.3% vs. 8.0%, p = 0.002), while ischemic stroke rates were comparable between both groups (0% vs. 1.8%, p = 1.0). Six-month angiographic follow-up showed complete occlusion, neck remnants and aneurysm remnants in 73.4%, 19.4% and 7.3% after WEB only, respectively, and in 66.7%, 20.0% and 16.7% after WEB plus stent, respectively (p = 0.538). A case report shows that WEB deployment through the struts of a previously implanted standard microstent is feasible, even if a VIA 33 microcatheter is needed. CONCLUSION In the present study, stent-assisted WEB embolization had a comparable safety and efficacy profile compared to treatment by WEB only. However, stent-assisted WEB embolization requires long-term anti-platelet medication, which annihilates the advantages of the WEB as a purely intrasaccular device. CLINICAL TRIAL REGISTRATION NUMBER N/A.
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23
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De Beule T, Boulanger T, Heye S, van Rooij WJ, van Zwam W, Stockx L. The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center. Interv Neuroradiol 2021; 27:594-601. [PMID: 33745363 PMCID: PMC8493345 DOI: 10.1177/15910199211003428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. MATERIALS AND METHODS Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37-80). RESULTS Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3-13 mm).In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01-6.5%) and mortality was 0% (0 of 93, 95%CI 0.0-4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7-13.6%). CONCLUSION WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.
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Affiliation(s)
- Tom De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Sam Heye
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Wim van Zwam
- Department of Radiology, Maastricht Universiteit Medisch Centrum, Maastricht, the Netherlands
| | - Luc Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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24
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Al Saiegh F, Velagapudi L, Khanna O, Sweid A, Mouchtouris N, Baldassari MP, Theofanis T, Tahir R, Schunemann V, Andrews C, Philipp L, Chalouhi N, Tjoumakaris SI, Hasan D, Gooch MR, Herial NA, Rosenwasser RH, Jabbour P. Predictors of aneurysm occlusion following treatment with the WEB device: systematic review and case series. Neurosurg Rev 2021; 45:925-936. [PMID: 34480649 DOI: 10.1007/s10143-021-01638-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
The Woven EndoBridge (WEB) device is becoming increasingly popular for treatment of wide-neck aneurysms. As experience with this device grows, it is important to identify factors associated with occlusion following WEB treatment to guide decision making and screen patients at high risk for recurrence. The aim of this study was to identify factors associated with adequate aneurysm occlusion following WEB device treatment in the neurosurgical literature and in our case series. A systematic review of the present literature was conducted to identify studies related to the prediction of WEB device occlusion. In addition, a retrospective review of our institutional data for patients treated with the WEB device was performed. Demographics, aneurysm characteristics, procedural variables, and 6-month follow-up angiographic outcomes were recorded. Seven articles totaling 450 patients with 456 aneurysms fit our criteria. Factors in the literature associated with inadequate occlusion included larger size, increased neck width, partial intrasaccular thrombosis, irregular shape, and tobacco use. Our retrospective review identified 43 patients with 45 aneurysms. A total of 91.1% of our patients achieved adequate occlusion at a mean follow-up time of 7.32 months. Increasing degree of contrast stasis after WEB placement on the post-deployment angiogram was significantly associated with adequate occlusion on follow-up angiogram (p = 0.005) and with Raymond-Roy classification (p = 0.048), but not with retreatment (p = 0.617). In our systematic review and case series totaling 450 patients with 456 aneurysms, contrast stasis on post-deployment angiogram was identified as a predictor of adequate aneurysm occlusion, while morphological characteristics such as larger size and wide neck negatively impact occlusion.
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Affiliation(s)
- Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lohit Velagapudi
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael P Baldassari
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thana Theofanis
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rizwan Tahir
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Victoria Schunemann
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carrie Andrews
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lucas Philipp
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | | | - David Hasan
- Department of Neurological Surgery, University of Iowa Hospitals, Iowa City, IA, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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25
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Lefevre PH, Schramm P, Kemmling A, Barreau X, Marnat G, Piotin M, Berlis A, Wanke I, Bonafe A, Houdart E. Multi-centric European post-market follow-up study of the Neuroform Atlas Stent System: primary results. J Neurointerv Surg 2021; 14:694-698. [PMID: 34475253 DOI: 10.1136/neurintsurg-2021-017849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few prospective series have described the safety and effectiveness of the Neuroform Atlas Stent System. We aimed to investigate the efficacy and safety of the device in patients treated for unruptured aneurysm. METHODS ATLAS EU PMCF is a consecutive, prospective, multicentric study that included patients with unruptured saccular aneurysm of all sizes. Follow-up visits were scheduled at 3-6 months and 12-16 months with digital subtraction angiography (DSA) or MRI imaging follow-up as per the site standard of care. The primary efficacy endpoint was adequate aneurysm occlusion (Raymond Roy occlusion grade I and II) on 12 month angiography. The primary safety endpoint was any major stroke or ipsilateral stroke or neurological death within 12 months. RESULTS Of the 106 patients consented, 105 were treated with at least one Neuroform Atlas stent. There was a failed implantation attempt in 1 patient, 85 patients received lateral stenting, and 19 patients received Y-stenting. Mean aneurysm neck size was 4.2 mm (range 1.9-33 mm). Adequate occlusion was observed in 95.1% immediately after the procedure and in 98.9% of cases at 1 year DSA follow-up. Overall, 1.0% (1/102; 95% CI 0.0% to 5.3%) of patients experienced a primary safety endpoint of major stroke. Three minor strokes resulted in a modified Rankin Scale score of 2. CONCLUSIONS In this multicentric, prospective study, stent-assisted coiling of medium size unruptured aneurysms with the Neuroform Atlas stent resulted in a favorable rate of satisfactory occlusion. In our findings, the use of the Y-stenting technique was associated with increased rates of procedural complications. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02783339.
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Affiliation(s)
- Pierre-Henri Lefevre
- Neuroradiology department, Gui de Chauliac Hospital Montpellier University Hospital, Montpellier, France
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - André Kemmling
- Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Xavier Barreau
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Bayern, Germany
| | - Isabel Wanke
- Neuroradiology Department, Hirslanden Clinic, Zurich, Switzerland
| | - Alain Bonafe
- Neuroradiology department, Gui de Chauliac Hospital Montpellier University Hospital, Montpellier, France
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26
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Daubé P, Cagnazzo F, Barreau X, Morganti R, Ferreira I, Gariel F, Dargazanli C, Gascou G, Riquelme C, Derraz I, Berge J, Lefevre PH, Costalat V, Marnat G. Influence of operator experience on the technical and clinical results of Woven EndoBridge endovascular treatment for intracranial aneurysms. Clin Neurol Neurosurg 2021; 208:106900. [PMID: 34454205 DOI: 10.1016/j.clineuro.2021.106900] [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: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND & PURPOSE The safety and efficacy of the Woven EndoBridge (WEB) device has been proven in recent multicenter trials. This study investigated whether operator experience influences WEB treatment-related outcomes. MATERIAL AND METHODS This was a retrospective analysis of a prospectively collected multicenter database. The data of all patients who underwent WEB treatment for an intracranial aneurysm from March 2014 to June 2020 in two high-volume centers were pooled. Operator experience was indexed by the number of WEB treatments performed previously. The primary endpoint was the overall complication rate. Secondary endpoints were long-term adequate (Raymond-Roy classification of 1-2.) angiographic occlusion, WEB-related complications, number of WEB not deployed, procedure duration, and radiation exposure (air kerma). RESULTS Among 237 patients (mean age 59.4 +/- 11.5 years) treated with WEB (median aneurysm diameter, 5.8 mm; interquartile range 4.5-7 mm), WEB-related complications occurred in 28 patients (11.8%) and adequate long-term occlusion was achieved for 154 aneurysms (86%). The median number of WEB treatment performed previously per operator was 20 (IQR, 9-41). The overall complication rate, WEB-related complication rate and aneurysm occlusion rate were not significantly correlated with WEB operator experience. There were also no significant correlations between the WEB operator experience and the number of WEB not deployed, procedure duration or radiation exposure. CONCLUSION There was no significant association between the number of WEB treatments previously performed per operator and any technical or clinical results after intracranial aneurysm treatment with WEB. These results imply a relatively short learning curve for this device in high-volume neurovascular centers.
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Affiliation(s)
- P Daubé
- Department of Neuroradiology, CHU Poitiers, Poitiers, France.
| | - F Cagnazzo
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - X Barreau
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
| | - R Morganti
- Section of Statistics, University Hospital of Pisa, Pisa, Italy.
| | - I Ferreira
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - F Gariel
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
| | - C Dargazanli
- Department of Neuroradiology, CHU Montpellier, Montpellier, France; Institut de Génomique Fonctionnelle, Université Montpellier, CNRS, INSERM, Montpellier, France.
| | - G Gascou
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - C Riquelme
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - I Derraz
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - J Berge
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
| | - P H Lefevre
- Department of Neuroradiology, CHU Montpellier, Montpellier, France.
| | - V Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France; Institut de Génomique Fonctionnelle, Université Montpellier, CNRS, INSERM, Montpellier, France.
| | - G Marnat
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France.
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Cortese J, Caroff J, Girot JB, Mihalea C, Da Ros V, Aguiar G, Elawady A, Ikka L, Gallas S, Ozanne A, Chalumeau V, Rouchaud A, Moret J, Spelle L. Impact of A1 Asymmetry on the Woven EndoBridge Device in Anterior Communicating Artery Aneurysms. AJNR Am J Neuroradiol 2021; 42:1479-1485. [PMID: 34117022 DOI: 10.3174/ajnr.a7189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Woven EndoBridge (WEB) devices are increasingly used to treat intracranial aneurysms. A1 asymmetry contributes to anterior communicating artery aneurysm formation and to treatment instability after coiling. We sought to evaluate whether A1 asymmetry had an impact on angiographic outcome in anterior communicating artery aneurysms treated with the WEB. MATERIALS AND METHODS Anterior communicating artery aneurysms treated between July 2012 and July 2020 with the WEB from an institutional review board-approved database were reviewed. A1 asymmetry was categorized as the following: absence of the A1 segment on 1 side (unilateral A1) versus bilateral A1. Univariate and multivariable analyses assessed independent predictors of adequate (WEB Occlusion Scale A, B, and C) and complete occlusion (WEB Occlusion Scale A and B). RESULTS Forty-eight individual aneurysms (47 patients) were included in the final analysis, of which 16 (33%) were acutely ruptured. The mean size was 6.5 (SD, 2.2) mm. Adequate and complete occlusion was achieved in 33 (69%) and 30 (63%) cases, respectively. Unilateral A1 was associated with significantly higher rates of adequate (92% versus 60% for bilateral A1; P = .03) and complete occlusion (92% versus 50% for bilateral A1; P < .01). Multivariable logistic regression confirmed unilateral A1 as an independent predictor of both adequate (OR = 10.6; 95% CI, 1.6-220.7; P = .04) and complete occlusion (OR = 9.5, 95% CI, 1.5-190.2; P = .04. A sensitivity analysis comparing unilateral "functional" A1 with bilateral "functional" A1 showed similar results. WEB shape modification was not influenced by the unilateral A1 configuration (P = .70). CONCLUSIONS Anterior communicating artery aneurysms with a unilateral A1 configuration treated with WEB devices are associated with better angiographic outcome than those with bilateral A1. This finding supports the hypothesis that WEB devices are resistant to unilateral flow in the aneurysm as opposed to coils.
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Affiliation(s)
- J Cortese
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J Caroff
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J-B Girot
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Department of Radiology (J.-B.G.), Angers University Hospital, Angers, France
| | - C Mihalea
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Da Ros
- Department of Biomedicine (V.D.R.), Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - G Aguiar
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Elawady
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Ikka
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - S Gallas
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Ozanne
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Rouchaud
- Department of Interventional Neuroradiology (A.R.), Limoges University Hospital, Limoges, France.,University of Limoges (A.R.), XLIM UMR CNRS 7252, Limoges, France
| | - J Moret
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Spelle
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
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Zaitoun MM, Malky IE, Winklhofer S, Valavanis A, Baltsavias G. Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review. Interv Neuroradiol 2021; 28:169-176. [PMID: 34053314 DOI: 10.1177/15910199211021718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature. METHODS Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome. RESULTS The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero.Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence. CONCLUSION Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.
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Affiliation(s)
- Mohamed Ma Zaitoun
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.,Diagnostic and Interventional Radiology Department, Faculty of Human Medicine, Zagazig University, Sharkia, Egypt
| | - Islam El Malky
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.,Department of Neurology, Interventional Neurovascular Unit, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Anton Valavanis
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Gerasimos Baltsavias
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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Goertz L, Liebig T, Siebert E, Pennig L, Laukamp KR, Celik E, Timmer M, Brinker G, Schlamann M, Goldbrunner R, Dorn F, Krischek B, Kabbasch C. Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms: A Propensity Score Analysis. Neurosurgery 2021; 88:779-784. [PMID: 33372215 DOI: 10.1093/neuros/nyaa539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Intrasaccular flow-disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms. OBJECTIVE To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment. METHODS A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion. RESULTS The technical success rates were 83% for WEB and 100% for clipping. Procedure-related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P < .01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01). CONCLUSION Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in ≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient's preferences.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Erkan Celik
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marco Timmer
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Boris Krischek
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Department of Neurosurgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Peterson C, Cord BJ. Recurrent and Residual Aneurysms After Woven EndoBridge (WEB) Therapy: What's Next? Cureus 2021; 13:e14404. [PMID: 33981516 PMCID: PMC8109841 DOI: 10.7759/cureus.14404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 01/23/2023] Open
Abstract
The prevalence of recurrent and residual aneurysms following Woven EndoBridge (WEB) treatment is not insignificant. The goal of this systematic review was to evaluate retreatment methods for such aneurysms and their outcomes. PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Original studies reporting on aneurysms that were retreated after WEB were included. Sixteen studies (n = 901 aneurysms), of which three were prospective, reported on retreated aneurysms following initial WEB treatment. Of those 901 aneurysms, on average 18.7 ± 11.5% were recurrent or residual at the last follow-up and 10.7 ± 11% required some form of retreatment. When compared to WEB-IT (WEB Intra-saccular Therapy) data, retreated aneurysms were more likely to be large in size (p < 0.0001) and more likely to have been initially treated with the WEB dual-layer configuration. The mean age of those with retreated aneurysms was 58 ± 5.7 years old, and the mean size of aneurysm dome was 11.1 ± 5.5 millimeters. Majority (34.1%) of the aneurysms were located at the basilar apex. Retreatment modalities included coiling (20%), stent-assisted coiling (38.7%), additional WEB device (13.3%), flow diversion (16%), and clipping (12%). Majority of retreated cases had favorable outcomes, with 96.4 ± 13.4% of the cases demonstrating technical success and 90.5 ± 18.2% having adequate occlusion at the last follow-up. Our systematic review suggests that retreatment of recurrent and residual aneurysms after initial WEB treatment is feasible. Future prospective studies would be helpful in validating these results.
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Affiliation(s)
| | - Branden J Cord
- Neurological Surgery, University of California Davis, Sacramento, USA
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31
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Moore KA, Goyal N, Arthur AS. The Woven EndoBridge embolization device for the treatment of intracranial wide-necked bifurcation aneurysms. Future Cardiol 2021; 17:953-961. [PMID: 33559501 DOI: 10.2217/fca-2020-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Wide-necked bifurcation aneurysms are common when evaluating both ruptured and unruptured intracranial aneurysms and can pose unique challenges. The Woven EndoBridge device (recently approved in the US) is specifically designed for the treatment of these aneurysms. This article serves to introduce the device to a wider audience with a thorough review of the literature, device design, indications, pre-operative evaluation, procedural usage and potential pitfalls.
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Affiliation(s)
- Kenneth A Moore
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Nitin Goyal
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,Semmes-Murphey Clinic, Memphis, TN 38120, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,Semmes-Murphey Clinic, Memphis, TN 38120, USA
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32
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Shah KA, White TG, Teron I, Link T, Dehdashti AR, Katz JM, Woo HH. Volume-based sizing of the Woven EndoBridge (WEB) device: A preliminary assessment of a novel method for device size selection. Interv Neuroradiol 2021; 27:473-480. [PMID: 33478310 DOI: 10.1177/1591019920987685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Accurate sizing of the Woven EndoBridge (WEB) device is of critical importance as it determines procedural safety and successful occlusion of wide neck bifurcation aneurysms. The aim of this study was to assess the ability of aneurysm volume to assist in accurate WEB size selection. METHODS All patients with an intracranial aneurysm treated with the WEB SL or WEB SLS device between March 2019 and October 2019 were identified for this retrospective study. Aneurysm volumes were calculated with auto-segmentation using a three-dimensional volume rendering program on an independent Syngo workstation (Siemens Healthineers AG). Pearson correlation coefficients were calculated for aneurysm auto-segmented volumes and WEB volumes, as well as for aneurysm height × width and WEB height × width. Follow-up angiographic outcomes were collected at 6-9 months post-procedure. RESULTS Twenty-nine aneurysms were evaluated by 3D rotational angiography. The correlation coefficient with WEB size was larger for auto-segmented aneurysm volumes (r = 0.979) compared to height × width measurements (r = 0.867). Using Fisher r-to-z transformations, we found the difference between the two correlations to be statistically significant (p = 0.0007). Follow-up angiography available in 13 subjects demonstrated an 85% complete aneurysm occlusion rate. CONCLUSION Aneurysm volumes are highly correlated with WEB volumes, with auto-segmentation volumes displaying statistically significant difference against conventional height by width measurements. These results suggest that volumetric measurements of aneurysm size provide a useful adjuvant measure to assist in appropriate size selection of the WEB device.
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Affiliation(s)
- Kevin A Shah
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Timothy G White
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Ina Teron
- Department of Neurosurgery, Southside Hospital, Northwell Health, Bay Shore, USA
| | - Thomas Link
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
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Brunozzi D, Alaraj A. Commentary: Treatment of Carotid Ophthalmic Aneurysm With Woven EndoBridge (WEB SL): 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E426-E427. [PMID: 32615584 DOI: 10.1093/ons/opaa183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
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Pranata R, Yonas E, Vania R, Sidipratomo P, July J. Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm-A systematic review and meta-analysis. Interv Neuroradiol 2020; 27:60-67. [PMID: 32635777 DOI: 10.1177/1591019920940521] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. METHOD We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. RESULTS There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%-94%) and 91% (95% CI, 85%-96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%-56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%-72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%-37%) of aneurysms immediately after coiling, and 25% (17-33) after six-month follow-up. Complications occur in 5% (95% CI, 1%-8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. CONCLUSIONS PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Prijo Sidipratomo
- Department of Radiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Julius July
- Department of Neurosurgery, Medical Faculty, Pelita Harapan University, Tangerang, Indonesia.,Neuroscience Centre Siloam Hospital, Tangerang, Indonesia
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35
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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: 4] [Impact Index Per Article: 1.0] [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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36
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Fujimoto M, Lylyk I, Bleise C, Albiña P, Chudyk J, Lylyk P. Long-Term Outcomes of the WEB Device for Treatment of Wide-Neck Bifurcation Aneurysms. AJNR Am J Neuroradiol 2020; 41:1031-1036. [PMID: 32467180 DOI: 10.3174/ajnr.a6548] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/30/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Treatment of wide-neck bifurcation aneurysms using endovascular therapy is still challenging even with the development of treatment devices. The purpose of this investigation was to assess the safety and efficacy of treatment with a Woven EndoBridge (WEB) device for wide-neck bifurcation aneurysms. MATERIALS AND METHODS All patients treated with a WEB device at our institution between May 2009 and November 2016 were retrospectively evaluated. Clinical and imaging evaluation, aneurysm occlusion status, and modified Rankin scale score were analyzed 1 day after treatment and in the short- (<6 months), mid- (<24 months), and long-term (>24 months) follow-up periods. RESULTS Forty-one cases of wide-neck aneurysms were analyzed in this study. Overall, 78.8% of the aneurysms had complete occlusion in the last follow-up, and 19.5% required retreatment with additional endovascular devices. A good clinical outcome (modified Rankin scale: 0-2) was obtained in 95.1% of the patients, and the overall treatment-related morbidity and mortality rates were 2.4% and 0.0%, respectively. The mean follow-up time was 15.3 ± 13.5 months. CONCLUSIONS The results obtained in this study suggest that treatment of wide-neck bifurcation aneurysms with a WEB device is feasible with an acceptable safety and efficacy rate.
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Affiliation(s)
- M Fujimoto
- From the Department of Neurosurgery (M.F.), Shin-Yurigaoka General Hospital, Kawasaki, Japan .,Clinica Sagrada Familia (M.F., I.L., C.B., J.C., P.L.), ENERI, Buenos Aires, Argentina
| | - I Lylyk
- Clinica Sagrada Familia (M.F., I.L., C.B., J.C., P.L.), ENERI, Buenos Aires, Argentina
| | - C Bleise
- Clinica Sagrada Familia (M.F., I.L., C.B., J.C., P.L.), ENERI, Buenos Aires, Argentina
| | - P Albiña
- Department of Neurosurgery (P.A.), Hospital Barros Luco Trudeau, University of Santiago, Santiago, Chile
| | - J Chudyk
- Clinica Sagrada Familia (M.F., I.L., C.B., J.C., P.L.), ENERI, Buenos Aires, Argentina
| | - P Lylyk
- Clinica Sagrada Familia (M.F., I.L., C.B., J.C., P.L.), ENERI, Buenos Aires, Argentina
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Simgen A, Yilmaz U, Dietrich P, Tomori T, Mühl-Benninghaus R, Laschke MW, Menger MD, Reith W, Kettner M. Rescue of migrated Woven Endobridge devices using a stent-retriever-technique in a porcine model. Interv Neuroradiol 2020; 26:772-778. [PMID: 32340514 DOI: 10.1177/1591019920920984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The Woven Endobridge device (WEB) has become widely applied for the treatment of intracranial aneurysms. Complications are rare, however, especially dislocations and migrations can potentially increase poor clinical outcome. The aim of this study was to assess the feasibility and effectiveness of rescuing migrated Woven Endobridges using different stent retrievers. METHODS In a porcine model, Woven Endobridges of different sizes (SLS 4, SLS 7, SL 5 × 3, SL 4 × 3) were placed into the axillary arteries. By means of two different stent retrievers (Solitaire Platinum and 3D Revascularization Device), a total of 20 rescue maneuvers were performed. For this purpose, the retrievers were deployed distally of the migrated Woven Endobridges. After retracting the stent retrievers partially, the Woven Endobridges were trapped within the microcatheter. Rescue rates, time, attempts and complications were assessed. RESULTS Successful rescue of the migrated Woven Endobridges was observed in all cases (100%). Rescue was slightly faster (177.8 ± 72.8 s vs. 223.4 ± 104.1 s) with fewer attempts (1.5 ± 0.8 vs. 1.8 ± 0.9) when using the 3D Revascularization Device compared to the Solitaire Platinum. However, there were no significant differences (p = 0.327; p = 0.554). Migration of the Woven Endobridges during rescue was seen with both stent retrievers in a comparable frequency (p = 0.642). Further complications, such as entrapment of the stent-retriever-WovenEndobridge-complex at the intermediate catheter, vasospasm, perforation or dissection, were not observed. CONCLUSIONS Rescue of migrated Woven Endobridges using stent retrievers is a feasible and effective method. Rescue rates, times and attempts with the Solitaire Platinum and 3D Revascularization Device are comparable with each other.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
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Different Rescue Approaches of Migrated Woven Endobridge (WEB) Devices: an Animal Study. Clin Neuroradiol 2020; 31:431-438. [PMID: 32166403 PMCID: PMC8211610 DOI: 10.1007/s00062-020-00893-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022]
Abstract
Purpose Treatment of wide-necked intracranial aneurysms using the Woven Endobridge (WEB) device has become broadly accepted. Feared complications with the potential of increased poor clinical outcome include dislocations and migration of the device. This study was carried out to determine the effectiveness of a variety of different strategies to rescue migrated WEB devices. Methods In a porcine model, WEB devices of different sizes (SL [single layer] 3.5 × 2mm and SL 4.0 × 3 mm, SL 8 × 5 mm and SLS 8 mm [single layer spherical]) were placed into both the subclavian and axillary arteries. A total of 32 rescue maneuvers (8 per rescue device) were performed. Small WEBs were rescued using reperfusion catheters (RC) (SOFIA Plus and JET 7), larger WEBs were rescued using dedicated rescue devices (Microsnare and Alligator). Rescue rates, times, attempts and complications were assessed. Results Rescue attempts of migrated WEBs were successful in all cases (100%). Rescue time (p = 0.421) and attempts (p = 0.619) of small WEBs using RCs were comparable without significant differences. Aspiration alone was not successful for larger WEBs. Rescue of larger WEBs was slightly faster (122.75 ± 41.15 s vs. 137.50 ± 54.46 s) with fewer attempts (1 vs. 1.37) when using the Microsnare compared to the Alligator device. Complications such as entrapment of the WEB in the RCs, vasospasm, perforation, or dissection were not observed. Conclusion Rescue of migrated WEB devices is a feasible and effective method and 100% successful rescue rates and appropriate rescue times can be achieved for small WEBs using RCs and for larger WEBs using dedicated rescue devices (Microsnare and Alligator).
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Iosif C. Neurovascular devices for the treatment of intracranial aneurysms: emerging and future technologies. Expert Rev Med Devices 2020; 17:173-188. [PMID: 32141395 DOI: 10.1080/17434440.2020.1733409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Despite numerous advances in the endovascular treatment of intracranial aneurysms (IAs), treatment in cases of wide-neck, complex configurations or branching locations remains challenging. Apart from the paradigm shift introduced by flow diverters, several other devices have seen the light or are under development in order to address these challenges.Areas covered: We performed a review of the novel implantable endovascular devices which have been introduced for the treatment of IAs, from 1 January 2014 to 1 September 2019, excluding classic flow diverter and intracranial stent designs.Expert opinion: Alternative designs have been proposed for the treatment of IAs at branching positions, which do not jail the side branches, with or without flow diversion effect, most of which with good initial outcomes. Endosaccular devices have also been proposed, some of which with lower initial total occlusion rates. Alternative materials such as biopolymers have also been proposed and are under bench research. Despite the challenges in the exploitation of some of the new devices, most of them seem to provide solutions to some current technical shortcomings. The exploitation of the biological phenomena and the physical properties of the devices will allow us to expand the therapeutic armamentarium for more complex IA cases.
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Affiliation(s)
- Christina Iosif
- School of Medicine, European University of Cyprus, Nicosia, Cyprus.,Department of Interventional Neuroradiology, Henry Dunant Hospital, Athens, Greece.,Department of Interventional Neuroradiology, Iaso Hospital, Athens, Greece
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