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Forestier G, Piotin M, Chau Y, Derelle AL, Brunel H, Aggour M, Saleme S, Levrier O, Pierot L, Barreau X, Boubagra K, Janot K, Barbier C, Clarençon F, Chabert E, Spelle L, Arteaga C, Consoli A, Machi P, Blanc R, Rodesch G, Cortese J, Sourour N, Herbreteau D, Heck O, Soize S, Marnat G, Rouchaud A, Anxionnat R, Sedat J, Mounayer C. Safety and effectiveness of the LVIS and LVIS Jr devices for the treatment of intracranial aneurysms: Final results of the LEPI multicenter cohort study. J Neuroradiol 2024; 51:242-248. [PMID: 37858720 DOI: 10.1016/j.neurad.2023.10.007] [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: 07/12/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The Low profile visualized intraluminal support (LVIS)/LVIS Jr is a self-expanding braiding stent for the treatment of intracranial aneurysm. This study is to determine the safety and effectiveness of the LVIS/LVIS Jr for the treatment of intracranial aneurysms in a real-world setting. METHODS This prospective, observational, multicenter study enrolled patients with unruptured, ruptured and recanalized intracranial aneurysms treated with the LVIS stents, between February 2018 to December 2019. Primary endpoint was the cumulative morbidity and mortality rate (CMMR) assessed at 12 months follow-up (FU). RESULTS A total of 130 patients were included (62.3 % women, mean age 55.9 ± 11.4) on an intention-to-treat basis. Four patients (3.1 %) had 2 target aneurysms; 134 total aneurysms were treated. The aneurysms were mainly located on the middle cerebral artery (41/134; 30.6 %) and the anterior communicating artery (31/134; 23.1 %). The CMMR at 1 year linked to the procedure and/or device was 4.6 % (6/130). The overall mortality was 1.5 % (2/130), none of these deaths adjudged as being linked to the procedure and/or device. All aneurysms (134/134, 100 %) were successfully treated with LVIS stent and/or other devices. At a mean FU of 16.8 months post-procedure, complete/nearly complete occlusion was achieved in 112 aneurysms (92.6 %), and only 3 patients (2.5 %) required aneurysm retreatment. CONCLUSION This study provides evidence that the LVIS/LVIS Jr devices are safe and effective in the treatment of complex intracranial aneurysms, with very high rates of adequate occlusion at FU. These angiographic results are stable over time with an acceptable complication rate. TRIAL REGISTRATION ClinicalTrial.gov under NCT03553771.
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Affiliation(s)
- Géraud Forestier
- Neuroradiology Department, University Hospital of Limoges, Dupuytren, Limoges, France.
| | - Michel Piotin
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France; Laboratory for Vascular Translational Science UMRS 1148, INSERM, Paris, France
| | - Yves Chau
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, France
| | - Anne-Laure Derelle
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Hervé Brunel
- Department of Neuroradiology, APHM, Marseille, France
| | - Mohammed Aggour
- Department of Neuroradiology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Suzana Saleme
- Neuroradiology Department, University Hospital of Limoges, Dupuytren, Limoges, France
| | - Olivier Levrier
- Department of Interventional Neuroradiology, Polyclinique Clairval, Marseille, France
| | - Laurent Pierot
- Department of Interventional Neuroradiology, University Hospital of Reims, Reims, France
| | - Xavier Barreau
- Department of Interventional Neuroradiology, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Kamel Boubagra
- Department of Interventional Neuroradiology, University Hospital of Grenoble, Grenoble, France
| | - Kévin Janot
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France
| | - Charlotte Barbier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Caen, Caen, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France; GRC BioFast, Sorbonne University, Paris VI, France
| | - Emmanuel Chabert
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Clermont-Ferrrand, Clermont-Ferrand, France
| | - Laurent Spelle
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University-Hospital, Le Kremlin-Bicetre, France
| | | | - Arturo Consoli
- Interventional and Diagnostic Neuroradiology, Foch Hospital, University of Versailles Saint-Quentin-des-Yvelines, France
| | - Paolo Machi
- Diagnostic and Interventional Neuroradiology department, Geneva University Hospitals, Geneva, Switzerland
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, FHU NeuroVasc, Adolphe de Rothschild Foundation Hospital, Paris, France; Laboratory for Vascular Translational Science UMRS 1148, INSERM, Paris, France
| | - Georges Rodesch
- Interventional and Diagnostic Neuroradiology, Foch Hospital, University of Versailles Saint-Quentin-des-Yvelines, France
| | - Jonathan Cortese
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University-Hospital, Le Kremlin-Bicetre, France; Faculty of Medicine, Paris-Saclay University, INSERM U1195, Le Kremlin-Bicetre, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Denis Herbreteau
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France
| | - Olivier Heck
- Department of Interventional Neuroradiology, University Hospital of Grenoble, Grenoble, France
| | - Sébastien Soize
- Department of Interventional Neuroradiology, University Hospital of Reims, Reims, France
| | - Gaultier Marnat
- Department of Interventional Neuroradiology, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Aymeric Rouchaud
- Neuroradiology Department, University Hospital of Limoges, Dupuytren, Limoges, France; CNRS, XLIM, UMR 7252, Limoges 87000, France
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Jacques Sedat
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, France
| | - Charbel Mounayer
- Neuroradiology Department, University Hospital of Limoges, Dupuytren, Limoges, France; CNRS, XLIM, UMR 7252, Limoges 87000, France
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Zhang G, Zhang R, Wei Y, Chen R, Zhang X, Xue G, Lv N, Duan G, Wang C, Yu Y, Dai D, Zhao R, Li Q, Xu Y, Huang Q, Yang P, Zuo Q, Liu J. Comparison of staged-stent and stent-assisted coiling technique for ruptured saccular wide-necked intracranial aneurysms: Safety and efficacy based on a propensity score-matched cohort study. Front Neurol 2023; 14:1101859. [PMID: 36756245 PMCID: PMC9899883 DOI: 10.3389/fneur.2023.1101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
Background Application of stent-assisted coiling and FD in acute phase of ruptured wide-necked aneurysms is relatively contraindicated due to the potential risk of ischemic and hemorrhagic complications. Scheduled stenting after initial coiling has emerged as an alternative paradigm for ruptured wide-necked aneurysms. The objective of this study is to evaluate the safety and efficacy of a strategy of staged stent-assisted coiling in acutely ruptured saccular wide-necked intracranial aneurysms compared with conventional early stent-assisted coiling strategy via propensity score matching in a high-volume center. Methods A retrospective review of patients with acutely ruptured saccular wide-necked intracranial aneurysms who underwent staged stent-assisted coiling or conventional stent-assisted coiling from November 2014 to November 2019 was performed. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Results A total of 69 patients with staged stent-assisted coiling and 138 patients with conventional stent-assisted coiling were enrolled after 1:2 propensity score matching. The median interval time between previous coiling and later stenting was 4.0 weeks (range 3.5-7.5 weeks). No rebleeding occurred during the intervals. The rate of immediate complete occlusion was lower with initial coiling before scheduled stenting than with conventional stent-assisted coiling (21.7 vs. 60.9%), whereas comparable results were observed at follow-up (82.5 vs. 72.9%; p = 0.357). The clinical follow-up outcomes, overall procedure-related complications and procedure-related mortality between the two groups demonstrated no significant differences (P = 0.232, P = 0.089, P = 0.537, respectively). Multivariate analysis showed that modified Fisher grades (OR = 2.120, P = 0.041) were independent predictors for overall procedure-related complications and no significant predictors for hemorrhagic and ischemic complications. Conclusions Staged stent-assisted coiling is a safe and effective treatment strategy for acutely ruptured saccular wide-necked intracranial aneurysms, with comparable complete occlusion rates, recurrence rates at follow-up and overall procedure-related complication rates compared with conventional stent-assisted coiling strategy. Staged stent-assisted coiling could be an alternative treatment option for selected ruptured intracranial aneurysms in the future.
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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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Sahnoun M, Soize S, Manceau PF, Gelmini C, Pierot L. Intracranial aneurysm treatment with WEB and adjunctive stent: preliminary evaluation in a single-center series. J Neurointerv Surg 2021; 14:164-168. [PMID: 33785641 PMCID: PMC8785053 DOI: 10.1136/neurintsurg-2021-017379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/04/2022]
Abstract
Background Intrasaccular flow disruption with WEB is a safe and efficacious technique that has significantly changed endovascular management of wide-neck bifurcation aneurysms (WNBAs). Use of stent in combination with WEB is occasionally required. We analyzed the frequency of use, indications, safety, and efficacy of the WEB–stent combination. Methods All aneurysms treated with WEB and stent were extracted from a prospectively maintained database. Patient and aneurysm characteristics, complications, and anatomical results were independently analyzed by a physician independent of the procedures. Results From June 2011 to January 2020, 152 patients with 157 aneurysms were treated with WEB. Of these, 17/152 patients (11.2%) with 19/157 aneurysms (12.1%) were treated with WEB device and stent. Indications were very wide neck with a branch emerging from the neck in 1/19 (5.2%) aneurysms and WEB protrusion in 18/19 (94.7%). At 1 month, no morbimortality was reported. At 6 months, anatomical results were complete aneurysm occlusion in 15/17 aneurysms (88.2%), neck remnant in 1/17 (5.9%), and aneurysm remnant in 1/17 (5.9%). At 12 months, there was complete aneurysm occlusion in 13/14 aneurysms (92.9%) and neck remnant in 1/14 (7.1%). Conclusions Combining WEB and stent is a therapeutic strategy to manage WNBA. In our series, this combination was used in 11.2% of patients treated with WEB, resulting in no morbidity or mortality with a high efficacy at 6 and 12 months (complete aneurysm occlusion in 88.2% and 92.9%, respectively).
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Affiliation(s)
- Maher Sahnoun
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, Reims, France
| | - Sébastien Soize
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, Reims, France
| | | | - Christophe Gelmini
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, Reims, France
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, Reims, France
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Booth TC, Parra-Farinas C, deSouza RM, Kandasamy N, Bhattacharya J, Rangi P, Downer J. Woven Endobridge (WEB) Device as a Retreatment Strategy After Unsuccessful Surgical Clipping. World Neurosurg 2020; 139:111-120. [PMID: 32179191 PMCID: PMC7611019 DOI: 10.1016/j.wneu.2020.02.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical clipping of intracranial aneurysms is typically robust and durable. However, residual aneurysmal components may be seen after clipping. Furthermore, there may be occasional aneurysmal recurrence. These factors are both clinically relevant because subarachnoid hemorrhage after clipping is a rare but important event. The rationale for any treatment is to substantially decrease the future risk of hemorrhage. Small series have shown coiling as a retreatment strategy after unsuccessful clipping, but none has explored the feasibility of Woven Endobridge (WEB) implantation. CASE DESCRIPTION We examined the feasibility of WEB implantation as second-line treatment for wide-necked residual aneurysms after unsuccessful clipping. We also recorded the safety and efficacy in this small series of 6 patients. To determine safety, we measured the modified Rankin Scale score before and after the procedure, and at 2 later time points (mean follow-up, 5 months and 15 months). To determine efficacy, we obtained radiographic aneurysm occlusion outcomes (including WEB Occlusion Scale) at these 2 time points. Four middle cerebral artery and 2 anterior communicating artery complex aneurysms were treated with WEB implantation, showing feasibility in 6/6 cases (100%). Follow-up at 15 months showed no change from preprocedural modified Rankin Scale score and there were no other complications. There was adequate occlusion in 5/6 cases (83%). CONCLUSIONS WEB implantation provided a feasible option in this challenging retreatment scenario. This is a small series and prospective data are required to make outcome inferences for this population. Nonetheless, we observed no complications and high adequate occlusion rates.
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Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | | | - Ruth-Mary deSouza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Naga Kandasamy
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jo Bhattacharya
- Department of Neuroradiology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Prem Rangi
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jonathan Downer
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
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Nguyen HA, Soize S, Manceau PF, Vudang L, Pierot L. Persistent Blood Flow inside the Woven EndoBridge Device More Than 6 Months after Intracranial Aneurysm Treatment: Frequency, Mechanisms, and Management-A Retrospective Single-Center Study. AJNR Am J Neuroradiol 2020; 41:1225-1231. [PMID: 32527839 DOI: 10.3174/ajnr.a6593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Due to its high safety and great efficacy, flow disruption with the Woven EndoBridge (WEB) device is increasingly used to treat intracranial aneurysms. We recently identified patients with intracranial aneurysm treated with the WEB who presented with residual blood flow inside the device ("contrast-in-WEB" phenomenon) more than 6 months posttreatment. This series reports the frequency and underlying mechanisms and discusses management of this phenomenon. MATERIALS AND METHODS All patients presenting with the contrast-in-WEB phenomenon in the prospectively collected data base of patients with aneurysm treated with the WEB were retrospectively collected and analyzed. RESULTS From June 2011 to February 2019, one hundred twenty-seven patients with 133 aneurysms were treated with the WEB and had DSA follow-up at 6 months or later. Eight patients (6.3%) presented with the phenomenon. All aneurysms were wide-neck bifurcation aneurysms, including 7 unruptured and 1 ruptured aneurysm located at the MCA (5 aneurysms), anterior communicating artery (2 aneurysms), and basilar artery (1 aneurysm). All except 1 patient received dual-antiplatelet therapy preprocedure. All except 1 patient received dual-antiplatelet therapy postoperatively for at least 1 month. The most likely mechanism of the phenomenon is the absence of intradevice thrombosis related to perioperative dual-antiplatelet medication. The phenomenon is also likely associated with a low risk of bleeding except when there is residual blood flow against the aneurysm wall or in the dome. CONCLUSIONS Contrast-in-WEB is a relatively rare phenomenon possibly induced by dual-antiplatelet therapy continued post-WEB procedure. In most cases, no additional treatment is required.
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Affiliation(s)
- H A Nguyen
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - S Soize
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - P-F Manceau
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - L Vudang
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
| | - L Pierot
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France.
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