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Teranishi K, Ikemura R, Arai S, Mitome-Mishima Y, Kitamura T, Kondo A, Oishi H. Endovascular Treatment of Bifurcation Aneurysms with the Woven EndoBridge: Product Features and Selected Results of Off-Label Use. JOURNAL OF NEUROENDOVASCULAR THERAPY 2024; 18:65-74. [PMID: 38559453 PMCID: PMC10973567 DOI: 10.5797/jnet.ra.2023-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024]
Abstract
Treatment for wide-neck bifurcation cerebral aneurysms (WNBAs) is widely performed by endovascular treatment as well as open surgical clipping. However, due to factors such as the shape and size of the aneurysms, as well as the anatomical features of surrounding branch vessels, there are some cases in which simple coiling or conventional adjunctive techniques, such as balloon-assisted or neck bridge stent-assisted coiling, are not sufficient to achieve a satisfactory cure. Against this backdrop, the device known as the Woven EndoBridge (WEB) (MicroVention, Aliso Viejo, CA, USA) was developed and can be deployed directly into the aneurysm for treatment. Over a decade has passed since its development, and it is now used in many countries worldwide. This review provides insights into the evolution of the WEB device from its development to the date of this writing, highlighting the unique features of the device and its treatment indications. Additionally, it discusses the posttreatment course, perspectives on recurrence and retreatment, imaging assessments, and potential off-label use based on numerous studies primarily conducted in Europe and the USA.
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Affiliation(s)
- Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryogo Ikemura
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Sho Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Takayuki Kitamura
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neuroendovascular Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Kashkoush A, El-Abtah ME, Srivatsa S, Desai A, Davison M, Achey R, Mahapatra A, Patterson T, Moore N, Bain M. Comparative effectiveness of stent-assisted coiling and Woven EndoBridge embolization for the treatment of unruptured wide-neck bifurcation intracranial aneurysms. J Neurosurg 2023; 138:1487-1493. [PMID: 36334292 DOI: 10.3171/2022.10.jns221138] [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: 05/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs. METHODS Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices. RESULTS Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202-834] days vs 228 [177-494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8-3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630. CONCLUSIONS Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.
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Affiliation(s)
- Ahmed Kashkoush
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | | | - Shaarada Srivatsa
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Ansh Desai
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mark Davison
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Rebecca Achey
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Ashutosh Mahapatra
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Thomas Patterson
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Nina Moore
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Mark Bain
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
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Chen CJ, Dabhi N, Snyder MH, Ironside N, Abecassis IJ, Kellogg RT, Park MS, Ding D. Intrasaccular flow disruption for brain aneurysms: a systematic review of long-term outcomes. J Neurosurg 2022; 137:360-372. [PMID: 34952523 DOI: 10.3171/2021.9.jns211706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The long-term safety and efficacy of intrasaccular flow disruption (IFD) for the treatment of brain aneurysms remain unclear. With accumulating experience and increasing use of IFD devices, recent studies have provided additional data regarding their outcomes. This review summarizes the long-term outcomes of IFD-treated brain aneurysms. METHODS A systematic literature review was performed on May 23, 2021, in PubMed, Web of Science, and Ovid MEDLINE for aneurysm treatment outcomes with IFD devices. Procedural details, including use of adjunctive devices and complications, were collected. The quality of studies was assessed using the Downs and Black checklist. Angiographic outcomes were classified as complete occlusion, residual neck, and residual aneurysm. Other outcomes included need for retreatment, permanent neurological deficit, and mortality. Pooled analyses were performed. RESULTS The final analysis comprised 1217 patients with 1249 aneurysms from 22 studies. The mean aneurysm diameter and neck width were 6.9 and 4.5 mm, respectively, and 27.6% of aneurysms were ruptured. The complete occlusion rates at 12 months and final follow-up (pooled mean duration 15.7 months) were 50.1% and 58.2%, respectively. Adjunctive devices were used in 6.4% of cases. The rates of hemorrhage, symptomatic infarction, permanent neurological deficit, and mortality were 1.2%, 2.8%, 1.0%, and 2.6%, respectively. CONCLUSIONS IFD is a very safe treatment for appropriately selected brain aneurysms with low complication and neurological deterioration rates. However, complete occlusion is achieved in only half of IFD-treated aneurysms at 1 year with a modest increase beyond this time point. As the majority of the studies were single arm, the pooled data are subject to selection and reporting biases. Future device developments, increased operator experience, and direct comparisons with alternative endovascular strategies and surgical clipping may clarify the role of IFD in aneurysm management.
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Affiliation(s)
- Ching-Jen Chen
- 1Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nisha Dabhi
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - M Harrison Snyder
- 3Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts; and
| | - Natasha Ironside
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Isaac Josh Abecassis
- 4Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Ryan T Kellogg
- 1Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Min S Park
- 1Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dale Ding
- 4Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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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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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Hostetter J, Miller TR, Gandhi D. Imaging for Treated Aneurysms (Including Clipping, Coiling, Stents, Flow Diverters). Neuroimaging Clin N Am 2021; 31:251-263. [PMID: 33902878 DOI: 10.1016/j.nic.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intracranial aneurysms are common in the adult population and carry a risk of rupture leading to catastrophic subarachnoid hemorrhage. Treatment of aneurysms has evolved significantly, with the introduction of new techniques and devices for minimally invasive and endovascular approaches. Follow-up imaging after aneurysm treatment is standard of care to monitor for recurrence or other complications, and the preferred imaging modality and schedule for follow-up are areas of active research. The modality and follow-up schedule should be tailored to treatment technique, aneurysm characteristics, and patient factors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA.
| | - Timothy R Miller
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
| | - Dheeraj Gandhi
- Neurology and Neurosurgery, Department of Radiology, Interventional Neuroradiology, CMIT Center, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
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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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Zhang SM, Liu LX, Ren PW, Xie XD, Miao J. Effectiveness, Safety and Risk Factors of Woven EndoBridge Device in the Treatment of Wide-Neck Intracranial Aneurysms: Systematic Review and Meta-Analysis. World Neurosurg 2020; 136:e1-e23. [DOI: 10.1016/j.wneu.2019.08.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022]
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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 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] [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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10
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Jiao S, Gong L, Wu Z, Zhu L, Hu J, Tang B, Yao S. Assessment of the value of 3D-DSA combined with neurointerventional thrombolysis in the treatment of senile cerebrovascular occlusion. Exp Ther Med 2019; 19:891-896. [PMID: 32010249 PMCID: PMC6966151 DOI: 10.3892/etm.2019.8274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/11/2019] [Indexed: 01/29/2023] Open
Abstract
Assessment of the value of three-dimensional digital subtraction angiography (3D-DSA) combined with neurointerventional thrombolysis in the treatment of senile cerebrovascular occlusion was investigated. A total of 129 patients with senile cerebrovascular occlusion admitted to the Affiliated Hospital of Zunyi Medical University from August 2015 to September 2017 were collected. Among them, 69 patients who underwent neurointerventional catheter thrombolysis under 3D-DSA were included in the study group, and 60 patients treated with neurointerventional thrombolysis were the control group. The levels of inflammatory cytokines IL-6, IL-1β and IL-8 in the two groups were measured by enzyme linked immunosorbent assay (ELISA) before treatment (T0), 7 days (7d) after treatment (T1) and 14 days (14d) after treatment (T2). The score of the National Institute of Health Stroke Scale and the clinical efficacy of patients in the two groups were compared before and after treatment, and Barthel index (BI) was used for investigation before and after treatment. The recurrence rate of disease in the two groups within 1 year was recorded. At T1, IL-6, IL-1β and IL-8 in the study group were significantly lower than those in the control group (P<0.05). The NIHSS score in the study group was lower than that in the control group after treatment (P<0.05). The BI score in the study group was significantly higher than that in the control group after treatment (P<0.05). After the prognostic follow-up, the disease recurrence rate of the study group was significantly lower than that of the control group (P<0.05). In conclusion, 3D-DSA combined with neurointerventional thrombolysis can significantly reduce the expression of inflammatory cytokines and improve the quality of life in patients with cerebrovascular occlusion, which has a high clinical value.
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Affiliation(s)
- Song Jiao
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Ling Gong
- Clinical Skill Room, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Zhongbo Wu
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Linrui Zhu
- Tuberculosis Ward, Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Jinjian Hu
- Department of Neurology, People's Hospital of Xixiu District, Anshun, Anshun 561000, P.R. China
| | - Bo Tang
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Shengtao Yao
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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Ahmed SU, Mocco J, Zhang X, Kelly M, Doshi A, Nael K, De Leacy R. MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 2019; 11:1009-1014. [PMID: 31048457 DOI: 10.1136/neurintsurg-2019-014936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. METHODS Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. RESULTS The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. CONCLUSION MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.
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Affiliation(s)
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kambiz Nael
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ozpeynirci Y, Braun M, Schmitz B. CT Angiography in Occlusion Assessment of Intracranial Aneurysms Treated with the WEB Device. J Neuroimaging 2019; 29:481-486. [DOI: 10.1111/jon.12622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Michael Braun
- Section of NeuroradiologyUlm University Gunzburg Germany
| | - Bernd Schmitz
- Section of NeuroradiologyUlm University Gunzburg Germany
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13
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van Rooij S, Peluso JP, Sluzewski M, Kortman HG, Boukrab I, van Rooij WJ. Mid-term 3T MRA follow-up of intracranial aneurysms treated with the Woven EndoBridge. Interv Neuroradiol 2018; 24:601-607. [PMID: 30001648 DOI: 10.1177/1591019918788346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Angiography is the standard follow-up modality for treated aneurysms with the Woven EndoBridge (WEB), and magnetic resonance angiography (MRA) is useful for extended follow-up. We present the results of WEB-treated aneurysms with angiographic follow-up at three months and at least 18 months' 3T MRA follow-up. MATERIALS AND METHODS Included were 52 patients with 53 aneurysms treated with the WEB between February 2015 and July 2016. There were 29 women and 23 men with a mean age of 60 years (median 62, range 23-76). Mean aneurysm size was 6.2 mm (median 6, range 3-16 mm). RESULTS 3T MRA follow-up was mean 19.6 months (median 18, range 18-36 months). One patient had an aneurysm remnant at three-month angiography that was additionally coiled and with stable complete occlusion at 18 months' 3T MRA follow-up. At three-month follow-up angiography, 44 aneurysms were completely occluded and eight had a neck remnant. At latest 3T MRA, stable complete occlusion was present in 43 aneurysms and stable neck remnant in eight. One posterior cerebral artery (PCA) dissection aneurysm was stable at three and six months but was enlarged and reopened at 18 months, confirmed with angiography. Focal signal loss by the proximal marker of the WEB was apparent in four patients without compromising diagnostic evaluation. CONCLUSION WEB-treated aneurysms with adequate occlusion at three-month angiography remained stable during serial 3T MRA follow-up of 18-36 months. One PCA aneurysm reopened during the 6- to 18-month interval. Once the WEB-treated aneurysm is adequately occluded in the short term, later reopening is uncommon.
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Affiliation(s)
- Sbt van Rooij
- 1 Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - J P Peluso
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - M Sluzewski
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - H G Kortman
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - I Boukrab
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - W J van Rooij
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
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Raoult H, Eugène F, Le Bras A, Mineur G, Carsin-Nicol B, Ferré JC, Gauvrit JY. CT angiography for one-year follow-up of intracranial aneurysms treated with the WEB device: Utility in evaluating aneurysm occlusion and WEB compression at one year. J Neuroradiol 2018. [PMID: 29524499 DOI: 10.1016/j.neurad.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The WEB is an innovative flow disruption device for cerebral aneurysm embolization with rapidly expanding indications. Our purpose was to evaluate the diagnostic performance of computed tomography angiography (CTA) at 1-year follow-up of aneurysms treated with the WEB. MATERIALS AND METHODS Between April 2014 and May 2016, the study prospectively included patients treated with the WEB at our institution, and followed up within 24hours by CTA and at 1year by CTA, time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). The diagnostic quality of imaging data was assessed based on the confidence index, artifacts, and WEB shape depiction. The imaging diagnostic performance was assessed using 3 criteria at 1year: aneurysm occlusion status and worsening, and WEB shape compression. Interobserver and intermodality agreement was determined by calculating κ values. RESULTS The study ultimately included 16 patients (9 women, mean age 53±7.6years). CTA quality confidence was scored as 2/2, artifacts 0.4/2 and WEB shape depiction 1.9/2, superior to TOF MRA for the latter two criteria. Aneurysm occlusion was adequate in 93.7% of patients, with CTA showing excellent interobserver reproducibility and agreement with DSA on a 4-grade scale (κ=1.00), while TOF MRA yielded good reproducibility (κ=0.76) and agreement with DSA (κ=0.69). CTA also identified aneurysm occlusion worsening (43.7%) and WEB compression (81.2%) in excellent agreement with DSA (κ=0.85 and 1.00). CONCLUSIONS CTA is a reproducible and reliable technique for the follow-up of aneurysms treated with the WEB device.
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Affiliation(s)
- Hélène Raoult
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - François Eugène
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Anthony Le Bras
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Géraldine Mineur
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Béatrice Carsin-Nicol
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Jean-Christophe Ferré
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Jean-Yves Gauvrit
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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15
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Nawka MT, Sedlacik J, Frölich A, Bester M, Fiehler J, Buhk JH. Multiparametric MRI of intracranial aneurysms treated with the Woven EndoBridge (WEB): a case of Faraday's cage? J Neurointerv Surg 2018; 10:988-994. [PMID: 29440326 DOI: 10.1136/neurintsurg-2017-013625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate multiparametric MRI including non-contrast and contrast-enhanced morphological and angiographic techniques for intracranial aneurysms treated with the single-layer Woven EndoBridge (WEB) embolization system applying simultaneous digital subtraction angiography (DSA) as the reference of standard. MATERIALS AND METHODS We retrospectively identified all patients with incidental and acute ruptured intracranial aneurysms treated with a WEB device (WEB SL and WEB SLS) between March 2014 and June 2016 in our neurovascular center with early (within 7 days) postinterventional multiparametric MRI as well as mid-term (5-8 months) follow-up MRI and DSA available. Occlusion rates were recorded both in DSA and MR angiography (MRA). In MRI, signal intensities within the WEB as well as in the occluded dome distal to the WEB, if present, were measured by region-of-interest (ROI) analysis. RESULTS Twenty-five patients fulfilled the inclusion criteria. Rates of complete/adequate occlusion at mid-term follow-up were 84% with both MRA and DSA. A strong signal loss within the WEB was observed in all MR sequences at initial and follow-up examinations. ROI analysis did not reveal significant differences in non-contrast (P=0.946) and contrast-enhanced imaging (P=0.377). A T1-hyperintense thrombus in the non-WEB-carrying dome was a frequent observation. CONCLUSIONS Signal intensity measurements in multiparametric MRI suggest that neither contrast-enhanced MRA nor morphological sequences are capable of revealing reliable information on the WEB lumen, presumably due to radio frequency shielding. MRI is therefore not suitable for confirming complete thrombus formation within the WEB.
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Affiliation(s)
- Marie Teresa Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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16
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Frölich AM, Nawka MT, Ernst M, Frischmuth I, Fiehler J, Buhk JH. Intra-aneurysmal flow disruption after implantation of the Medina® Embolization Device depends on aneurysm neck coverage. PLoS One 2018; 13:e0191975. [PMID: 29408857 PMCID: PMC5800678 DOI: 10.1371/journal.pone.0191975] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/15/2018] [Indexed: 11/21/2022] Open
Abstract
Background and purpose Flow disruption achieved by braided intrasaccular implants is a novel treatment strategy for cerebrovascular aneurysms. We hypothesized that the degree of intra-aneurysmal flow disruption can be quantified in vitro and is influenced by device position across the aneurysm neck. We tested this hypothesis using the Medina® Embolization Device (MED). Methods Ten different patient-specific elastic vascular models were manufactured. Models were connected to a pulsatile flow circuit, filled with a blood-mimicking fluid and treated by two operators using a single MED. Intra-aneurysmal flow velocity was measured using conventional and high-frequency digital subtraction angiography (HF-DSA) before and after each deployment. Aneurysm neck coverage by the implanted devices was assessed with flat detector computed tomography on a three-point Likert scale. Results A total of 80 individual MED deployments were performed by the two operators. The mean intra-aneurysmal flow velocity reduction after MED implantation was 33.6% (27.5–39.7%). No significant differences in neck coverage (p = 0.99) or flow disruption (p = 0.84) were observed between operators. The degree of flow disruption significantly correlated with neck coverage (ρ = 0.42, 95% CI: 0.21–0.59, p = 0.002) as well as with neck area (ρ = -0,35, 95% CI: -0.54 –-0.13, p = 0.024). On multiple regression analysis, both neck coverage and total neck area were independent predictors of flow disruption. Conclusions The degree of intra-aneurysmal flow disruption after MED implantation can be quantified in vitro and varies considerably between different aneurysms and different device configurations. Optimal device coverage across the aneurysm neck improves flow disruption and may thus contribute to aneurysm occlusion.
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Affiliation(s)
- Andreas Maximilian Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Marie Teresa Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabell Frischmuth
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lv X, Zhang Y, Jiang W. Systematic Review of Woven EndoBridge for Wide-Necked Bifurcation Aneurysms: Complications, Adequate Occlusion Rate, Morbidity, and Mortality. World Neurosurg 2018; 110:20-25. [PMID: 29107726 DOI: 10.1016/j.wneu.2017.10.113] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the Woven EndoBridge (WEB [Sequent Medical, Aliso Viejo, California, USA]) is a highly innovative technique for the endovascular treatment of wide-necked bifurcation aneurysms (WNBAs), there are no studies available comparing this technique with surgical results or other endovascular results of stent-assisted coiling or balloon-assisted coiling for WNBAs. The purpose of this study was to assess complications, complete occlusion rate, and morbidity and mortality of the WEB in WNBA treatment. METHODS Published literature citing embolization results for WNBAs using the WEB was reviewed. A systematic review was performed to evaluate the complications, complete occlusion rate, and morbidity and mortality. RESULTS We identified 19 studies, including 935 patients. The most frequent aneurysm locations were the bifurcation of the middle cerebral artery (MCA) (42.8%), the anterior communicating artery (23%), and the basilar bifurcation (20.8%). The technical success rate of the WEB was 97% (95% confidence interval [CI], 96%-98%). The thromboembolic complication rate was 8% (95% CI, 6%-11%). The thromboembolic complication rate was 10% (95% CI, 7%-13%) in cases before 2013, which was higher than in cases after 2013 (6%; 95% CI, 4%-9%; P = 0.045). MCA bifurcation aneurysm has a higher thromboembolic complication rate than posterior circulation aneurysm. The overall bleeding complication rate of the WEB was 2% (95% CI, 1%-3%). The adequate occlusion rate was 81% (95% CI, 76%-85%). Morbidity during follow-up was 3% (95% CI, 1%-4%) (I2 = 30.4%), and mortality was 2% (95% CI, 1%-3%). CONCLUSIONS Adequate aneurysm occlusion was found in 81% of WEB cases with low morbidity and mortality.
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Affiliation(s)
- Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China; New Era Stroke Care and Research Institute, The PLA Rocket Force General Hospital, Beijing, China
| | - Yupeng Zhang
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weijian Jiang
- New Era Stroke Care and Research Institute, The PLA Rocket Force General Hospital, Beijing, China.
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Shang S, Ye J, Luo X, Qu J, Zhen Y, Wu J. Follow-up assessment of coiled intracranial aneurysms using zTE MRA as compared with TOF MRA: a preliminary image quality study. Eur Radiol 2017; 27:4271-4280. [PMID: 28382536 DOI: 10.1007/s00330-017-4794-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To prospectively assess coiled intracranial aneurysms using a novel non-contrast enhanced zero echo time (zTE) MR angiography (MRA) method, and compare its image quality with time-of-flight (TOF) MRA, using digital subtraction angiography (DSA) as reference. METHODS Twenty-five patients (10 males and 15 females; age 53.96 ± 12.46 years) were enrolled in this monocentric study. MRA sequences were performed 24 h before DSA. Susceptibility artefact intensity and flow signal within the parent artery were carried out using a 4-point scale. Occlusion status was assessed using the 3-grade Montreal scale. RESULTS Scores of zTE were higher than TOF for both susceptibility artefact intensity (3.42 ± 0.64, 2.92 ± 0.63, P = 0.01) and flow signal (3.66 ± 0.95, 3.24 ± 1.24, P = 0.01). DSA revealed 17 complete occlusions, five residual neck aneurysms and two residual aneurysms. Inter-observer agreement was excellent (weighted κ: 0.89) for zTE and good (weighted κ: 0.68) for TOF. Intermodality agreement was excellent for zTE (weighted κ: 0.95) and good for TOF (weighted κ: 0.80). Correlations of both MRA sequences with DSA were high (zTE, Spearman's ρ: 0.91; TOF, Spearman's ρ: 0.81). CONCLUSIONS zTE MRA showed promising results for follow-up assessment of coiled intracranial aneurysms and was superior to TOF MRA for visualizing the parent artery and evaluating occlusion status. KEY POINTS • Various MRA sequences were applied for follow-up assessment of coiled intracranial aneurysms. • zTE MRA was less sensitive to susceptibility artefacts and haemodynamics. • In this monocentric study, zTE MRA was equivalent to DSA. • zTE MRA maybe an alternative to TOF MRA for follow-up assessment.
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Affiliation(s)
- Song'an Shang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jianxun Qu
- MR Enhanced Application, GE Healthcare, Beijing, 100176, China
| | - Yong Zhen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jingtao Wu
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China.
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The Woven Endobridge Device for Treatment of Intracranial Aneurysms: A Systematic Review. World Neurosurg 2016; 98:809-817.e1. [PMID: 27856383 DOI: 10.1016/j.wneu.2016.11.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Woven Endobridge (WEB) device is an innovative endovascular device for treatment of intracranial aneurysms, especially bifurcation and wide-neck aneurysms. Although not approved by the U.S. Food and Drug Administration, it has been available in Europe since 2011. The aim of this review is to evaluate the outcomes of WEB device use for intracranial aneurysm treatment. METHODS A systematic review was conducted with MEDLINE search engines PubMed and Embase from 2011. The search strategy provided 6229 articles, and 19 articles were included. RESULTS A total of 19 papers were identified describing the use of WEB devices in 687 patients with 718 aneurysms. The 2 largest prospective multicenter studies (WEBCAST and the French Observatory Trial) reported successful treatment, defined as complete closure or a neck remnant, in 85% and 79% of aneurysms, respectively. The use of a WEB device in combination with coiling or stenting was described with varying results in multiple small series. Outcomes of WEB device use in ruptured aneurysms in 2 studies showed 94% and 80% adequate treatment. Thromboembolic events were described in 71 patients (10.3% of all patients) and infarctions in 8 patients (1.2% of all patients). CONCLUSIONS Despite initial promising results, the WEB device should be used with caution given its potentially large learning curve and because it has primarily been investigated only in wide-neck and bifurcation aneurysms. In addition, currently available prospective studies have short follow-up, and the device has not been directly compared with other treatment modalities.
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20
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Timsit C, Soize S, Benaissa A, Portefaix C, Gauvrit JY, Pierot L. Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device. AJNR Am J Neuroradiol 2016; 37:1684-9. [PMID: 27102311 DOI: 10.3174/ajnr.a4791] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging follow-up at 3T of intracranial aneurysms treated with the WEB Device has not been evaluated yet. Our aim was to assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system. MATERIALS AND METHODS From June 2011 to December 2014, patients treated with the WEB in our institution, then followed for ≥6 months after treatment by MRA at 3T (3D-TOF-MRA and contrast-enhanced MRA) and DSA within 48 hours were included. Aneurysm occlusion was assessed with a simplified 2-grade scale (adequate occlusion [total occlusion + neck remnant] versus aneurysm remnant). Interobserver and intermodality agreement was evaluated by calculating the linear weighted κ. MRA test characteristics and predictive values were calculated from a 2 × 2 contingency table, by using DSA data as the standard of reference. RESULTS Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (κ = 0.71) and contrast-enhanced-MRA (κ = 0.65) compared with moderate with 3D-TOF-MRA (κ = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (κ = 0.36) and 3D-TOF-MRA (κ = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%). CONCLUSIONS Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up.
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Affiliation(s)
- C Timsit
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - S Soize
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - A Benaissa
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - C Portefaix
- CReSTIC SIC EA3804 (C.P.), Université de Champagne-Ardenne, Reims, France
| | - J-Y Gauvrit
- Department of Neuroradiology (J.-Y.G.), Hôpital Pontchaillou, Rennes, France Unité VISAGES U746 INSERM-INRIA (J.-Y.G.), IRISA UMR CNRS 6074, University of Rennes, Rennes, France
| | - L Pierot
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
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