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Nasra M, Pavlin-Premrl D, Protto S, Khabaza A, Gan C, Siasat P, Jhamb A, Smith P, Moore J, Russell J, Ren Y, Slater LA, Chandra RV, Chong W, Shaygi B, Brooks M, Maingard J, Asadi H. The Clinical and Radiological Outcomes of the Multimodal Use of the Woven EndoBridge Device: A Large Multicenter Study. World Neurosurg 2024; 188:e168-e176. [PMID: 38763461 DOI: 10.1016/j.wneu.2024.05.076] [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: 01/17/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The Woven EndoBridge (WEB) is a device used for intrasaccular flow diversion, designed for the elimination of wide-necked bifurcation aneurysms from the circulation. In this study, we aim to assess the safety and efficacy of the WEB and its uses in treating aneurysms of different morphologies and locations. METHODS In a retrospective analysis, we compiled a comprehensive dataset from patients treated with the WEB device across three major Australian neurovascular centers from May 2017 to September 2023. The case series encompassed a spectrum of aneurysm types, including wide-necked bifurcation, sidewall, and irregularly shaped aneurysms, as well as cases previously managed with alternative therapeutic strategies. This study additionally encompasses cases where aneurysms were managed using the WEB device in combination with supplementary endovascular devices. RESULTS The study included 169 aneurysms in 161 patients. The rate of satisfactory aneurysm occlusion was 85.6%, with 86.7% of patients maintaining good functional status at their most recent follow-up. The procedure exhibited a low mortality rate of 0.6% and a thromboembolic complication rate of 7.1% (n = 12/161). There were no instances of postoperative re-rupture and the procedure-related hemorrhage rate was low (1.2%, n = 2/169), aligning with the literature regarding the safety and efficacy of the WEB device. CONCLUSIONS Our multicenter trial reinforces the WEB device's role as an effective and safe modality for intracranial aneurysm management, supporting its expanded application beyond wide-necked bifurcation aneurysms. Further prospective studies are required to delineate its evolving role fully.
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Affiliation(s)
- Mohamed Nasra
- Department of Medicine, Northern Health, Melbourne, Victoria, Australia.
| | - Davor Pavlin-Premrl
- Department of Neurology, Austin Health, Melbourne Victoria, Australia; Department of Interventional Neuroradiology, Austin Health, Melbourne, Victoria, Australia; Department of Interventional Neuroradiology, St Vincent's Health, Fitzroy, Victoria, Australia
| | - Sara Protto
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
| | - Ali Khabaza
- Department of Interventional Neuroradiology, Austin Health, Melbourne, Victoria, Australia; Department of Interventional Neuroradiology, St Vincent's Health, Fitzroy, Victoria, Australia; Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
| | - Calvin Gan
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
| | - Paul Siasat
- Department of Surgery, St. Vincent's Health, Fitzroy, Victoria, Australia
| | - Ashu Jhamb
- Department of Radiology, St Vincent's Health, Fitzroy, Victoria, Australia
| | - Paul Smith
- Department of Neurosurgery, St Vincent's Health, Fitzroy, Australia; Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Justin Moore
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia
| | - Jeremy Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Yifan Ren
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Lee-Anne Slater
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
| | - Ronil V Chandra
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
| | - Winston Chong
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
| | - Behnam Shaygi
- Department of Interventional Radiology, London North West University Healthcare NHS Trust, London, UK
| | - Mark Brooks
- Department of Interventional Neuroradiology, Austin Health, Melbourne, Victoria, Australia; Department of Interventional Neuroradiology, St Vincent's Health, Fitzroy, Victoria, Australia
| | - Julian Maingard
- Department of Interventional Neuroradiology, Austin Health, Melbourne, Victoria, Australia; Department of Interventional Neuroradiology, St Vincent's Health, Fitzroy, Victoria, Australia; School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hamed Asadi
- Department of Interventional Neuroradiology, Austin Health, Melbourne, Victoria, Australia; Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia; School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
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Korte J, Gaidzik F, Larsen N, Schütz E, Damm T, Wodarg F, Hövener JB, Jansen O, Janiga G, Berg P, Pravdivtseva MS. In vitro and in silico assessment of flow modulation after deploying the Contour Neurovascular System in intracranial aneurysm models. J Neurointerv Surg 2024; 16:815-823. [PMID: 37852752 DOI: 10.1136/jnis-2023-020403] [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: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The novel Contour Neurovascular System (Contour) has been reported to be efficient and safe for the treatment of intracranial, wide-necked bifurcation aneurysms. Flow in the aneurysm and posterior cerebral arteries (PCAs) after Contour deployment has not been analyzed in detail yet. However, this information is crucial for predicting aneurysm treatment outcomes. METHODS Time-resolved three-dimensional velocity maps in 14 combinations of patient-based basilar tip aneurysm models with and without Contour devices (sizes between 5 and 14 mm) were analyzed using four-dimensionsal (4D) flow MRI and numerical/image-based flow simulations. A complex virtual processing pipeline was developed to mimic the experimental shape and position of the Contour together with the simulations. RESULTS On average, the Contour significantly reduced intra-aneurysmal flow velocity by 67% (mean w/ = 0.03m/s; mean w/o = 0.12m/s; p-value=0.002), and the time-averaged wall shear stress by more than 87% (mean w/ = 0.17Pa; mean w/o = 1.35Pa; p-value=0.002), as observed by numerical simulations. Furthermore, a significant reduction in flow (P<0.01) was confirmed by the neck inflow rate, kinetic energy, and inflow concentration index after Contour deployment. Notably, device size has a stronger effect on reducing flow than device positioning. However, positioning affected flow in the PCAs, while being robust in effectively reducing flow. CONCLUSIONS This study showed the high efficacy of the Contour device in reducing flow within aneurysms regardless of the exact position. However, we observed an effect on the flow in PCAs, which needs to be investigated further.
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Affiliation(s)
- Jana Korte
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Franziska Gaidzik
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Erik Schütz
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Timo Damm
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Gábor Janiga
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Healthcare Telematics and Medical Engineering, University of Magdeburg, Magdeburg, Germany
| | - Mariya S Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
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Spelle L, Costalat V, Caroff J, Wodarg F, Fischer S, Herbreteau D, Möhlenbruch MA, Januel AC, Papagiannaki C, Klisch J, Numminen J, Rautio R, Berlis A, Mihalea C, Chalumeau V, Downer J, Cortese J, Ikka L, Gallas S, Bester M, Liebig T, Velasco S, Grimaldi L, Byrne J, Szikora I, Pierot L, Cognard C. CLinical EValuation of WEB 17 device in intracranial aneuRysms (CLEVER): 1-year effectiveness results for ruptured and unruptured aneurysms. J Neurointerv Surg 2024:jnis-2024-021918. [PMID: 38991733 DOI: 10.1136/jnis-2024-021918] [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: 04/26/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is designed to treat wide-necked bifurcation aneurysms. The WEB 17 is the latest iteration and can be delivered through a 0.017″ microcatheter. The CLEVER study demonstrated that WEB 17 is safe and effective for providing protection against bleeding or rebleeding at 1 month and 1 year. OBJECTIVE To evaluate angiographic stability at 1 year. METHODS The CLEVER study was a prospective multicenter study conducted in 17 European centers, involved 163 subjects, comprising 60 ruptured and 103 unruptured aneurysms. Independent assessment of 1-year follow-up imaging was incorporated into the study design. RESULTS Aneurysm diameters ranged from 2.0 to 9.2 mm, with 95.7% being broad-based (dome-to-neck ratio <2). Follow-up imaging at 1 year was completed for 146 out of 163 subjects (89.6%) and evaluated by an independent core laboratory. The primary efficacy endpoint of adequate occlusion without re-treatment at 1 year was achieved for 120 (82.2%) of all subjects. At 1 year, the adequate occlusion rate was 86.5% for ruptured aneurysms (73.1% complete occlusion) and 82.4% for unruptured aneurysms (57.1% complete occlusion). The overall re-treatment rate at 1 year was 2.6% (4/152), with 3.1% (3/97) for unruptured aneurysms and 1.8% (1/55) for ruptured aneurysms CONCLUSION: Delivery of the WEB 17 via 0.017 inch catheters represents a significant evolution of the WEB design. The results of CLEVER presented here demonstrate that it maintains the same efficacy as previous generations of WEB.
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Affiliation(s)
- Laurent Spelle
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Jildaz Caroff
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Fritz Wodarg
- Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Germany
| | | | - Markus A Möhlenbruch
- Department of Neuroradiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Pierre Paul Riquet Hospital, Toulouse, France
| | | | - Joachim Klisch
- Department of Neuroradiology, HELIOS Klinikum, Erfurt, Germany
| | - Jussi Numminen
- Department of Neuroradiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Riitta Rautio
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Ansgar Berlis
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Cristian Mihalea
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Jonathan Downer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Jonathan Cortese
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Leon Ikka
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Sophie Gallas
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig-Maximilian University Hospital, Munchen, Germany
| | | | - Lamiae Grimaldi
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
- Clinical research unit, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - James Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
| | - Istvan Szikora
- Department of Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Laurent Pierot
- Department of Neuroradiology, Maison Blanche Hospital, Reims-Champagne-Ardenne University, Reims, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Pierre Paul Riquet Hospital, Toulouse, France
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Liebig T, Gal G, O Kelly C, Wodarg F, Killer-Oberpfalzer M, Ozpeynirci Y, Bester M, Tsogkas I, Psychogios MN, Jansen O, Fiehler J. Neqstent coil-assisted flow diverter (NQS) for the treatment of bifurcation aneurysms: the coil-assisted flow diversion safety and performance study (CAFI). J Neurointerv Surg 2024; 16:721-725. [PMID: 37419693 PMCID: PMC11228220 DOI: 10.1136/jnis-2022-020056] [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: 01/15/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BackgroundThe Neqstent coil-assisted flow diverter (NQS) is a neck bridging device to facilitate coil occlusion of intracranial aneurysms. CAFI is a prospective, single-arm, multicenter study on the safety and performance of the NQS adjunctive therapy device together with platinum coils for treatment of unruptured intracranial aneurysms. METHODS Thirty-eight patients were enrolled. Primary endpoints were occlusion at 6 months for efficacy, and any major stroke or non-accidental death up to 30 days or major disabling stroke within 6 months for safety. Secondary endpoints were re-treatment rate, procedure time, and procedure/device-related adverse events. Procedural and follow-up imaging was reviewed by an independent core laboratory. Adverse events were reviewed and adjudicated by a clinical events committee. RESULTS The NQS was successfully implanted in 36/38 aneurysms, 2/38 in the intention-to-treat group did not receive a NQS and were excluded from follow-up after 30 days. In the per protocol group (PP), 33/36 patients were available for angiographic follow-up. Device related adverse events were recorded in 4/38 (10.5%) patients, one hemorrhagic and three thromboembolic. In the PP group, immediate post-treatment adequate occlusion (RR1 and RR2) was seen in 9/36 (25%) and progressed to 28/36 (77.8%) at 6 months. Complete occlusion (RR1) was achieved in 29/36 (80.6%) at the last available angiogram (3/36 were post procedure). The mean procedure time was 129 min (50-300 min, median 120 min). CONCLUSION The NQS in conjunction with coils appears to be effective in the treatment of intracranial wide-neck bifurcation aneurysms, but its safety remains to be proved in larger series. TRIAL REGISTRATION NUMBER NCT04187573.
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Affiliation(s)
- Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilian University, Muenchen, Germany
| | - Gyula Gal
- Department of Radiology, Odense Universitetshospital, Odense, Denmark
| | - Cian O Kelly
- Department of Surgery (Neurosurgery), University of Alberta, Edmonton, Alberta, Canada
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitaetsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | | | - Yigit Ozpeynirci
- Department of Neuroradiology, Ludwig Maximilian University, Muenchen, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ioannis Tsogkas
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | | | - Olav Jansen
- Department of Radiology and Neuroradiology, Universitaetsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Spitz L, Korte J, Gaidzik F, Larsen N, Preim B, Saalfeld S. Assessment of intracranial aneurysm neck deformation after contour deployment. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03189-w. [PMID: 38819700 DOI: 10.1007/s11548-024-03189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The contour neurovascular system (CNS) is a novel device to treat intracranial wide-necked bifurcation aneurysms, with few studies assessing its long-term effects. Particularly its impact on aneurysm morphology has not been explored yet. We present a preliminary study to explore this impact for the first time, focusing on the neck curve and ostium of the aneurysm. METHODS We investigated seven aneurysms treated with the CNS to assess ostium deformation after CNS deployment by comparing models extracted from in vivo medical pre-treatment and follow-up scans via morphological analysis. Time between pre- and follow-up scans was ten months on average. Size and shape indices like area, neck diameter, ellipticity index, undulation index, and more were assessed. RESULTS Ostium size was reduced after treatment. On average, ostium area was reduced at a rate of - 0.58 (± 4.88) mm2 per year, from 15.52 (± 3.51) mm2 to 13.30 (± 2.27) mm2, and ostium width from 5.01 (± 0.54) mm to 4.49 (± 0.45) mm, with an average reduction of - 0.59 (± 0.87) mm. This shrinking positively correlated with time passing. Shape deformation was low, though notably mean ellipticity index was reduced by 0.06 (± 0.15) on average, indicating ostia were less elongated after treatment. CONCLUSION We interpret the shrinking of the ostium as part of the healing process. Shape changes were found to be small enough to conclude no shape deformation of the ostium from CNS deployment, but the analysis of more cases with more parameters and information is necessary.
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Affiliation(s)
- Lena Spitz
- Department of Simulation and Graphics, Otto-von-Guericke University, Universtitaetsplatz 2, 39106, Magdeburg, Sachsen-Anhalt, Germany.
- Research campus STIMULATE, Magdeburg, Germany.
| | - Jana Korte
- Research campus STIMULATE, Magdeburg, Germany
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Germany
| | - Franziska Gaidzik
- Research campus STIMULATE, Magdeburg, Germany
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Universtitaetsplatz 2, 39106, Magdeburg, Sachsen-Anhalt, Germany
- Research campus STIMULATE, Magdeburg, Germany
| | - Sylvia Saalfeld
- Research campus STIMULATE, Magdeburg, Germany
- Computational Medicine Group, Technical University Ilmenau, Ilmenau, Germany
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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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Santana LS, Yoshikawa MH, Ramos MB, Figueiredo EG, Telles JPM. Neuropsychological outcomes in patients with ruptured anterior communicating artery aneurysms treated by clipping versus coiling: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:196. [PMID: 38676753 DOI: 10.1007/s10143-024-02418-9] [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: 12/28/2023] [Revised: 02/14/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
Ruptured anterior communicating artery (ACoA) aneurysms are frequently associated with neuropsychological deficits. This review aims to compare neuropsychological outcomes between surgical and endovascular approaches to ACoA. We systematically searched PubMed, Embase, and Web of Science for studies comparing the endovascular and surgical approaches to ruptured ACoA aneurysms. Outcomes of interest were the cognitive function, covered by memory, attention, intelligence, executive, and language domains, as well as motor and visual functions. Nine studies, comprising 524 patients were included. Endovascularly-treated patients showed better memory than those treated surgically (Standardized Mean Difference (SMD) = -2; 95% CI: -3.40 to -0.61; p < 0.01). Surgically clipped patients had poorer motor ability than those with coiling embolization (p = 0.01). Executive function (SMD = -0.20; 95% CI: -0.47 to 0.88; p = 0.55), language (SMD = -0.33; 95% CI: -0.95 to 0.30; p = 0.30), visuospatial function (SMD = -1.12; 95% CI: -2.79 to 0.56; p = 0.19), attention (SMD = -0.94; 95% CI: -2.79to 0.91; p = 0.32), intelligence (SMD = -0.25; 95% CI: -0.73 to 0.22; p = 0.30), and self-reported cognitive status (SMD = -0.51; 95% CI: -1.38 to 0.35; p = 0.25) revealed parity between groups. Patients with ACoA treated endovascularly had superior memory and motor abilities. Other cognitive domains, including executive function, language, visuospatial function, attention, intelligence and self-reported cognitive status revealed no statistically significant differences between the two approaches. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42023461283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461283.
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Affiliation(s)
| | | | - Miguel Bertelli Ramos
- Department of Neurosurgery, Instituto de Assistência Médica Ao Servidor Público Estadual, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Mascitelli JR. Management of wide-neck aneurysms in 2024: how does one make the best treatment decision when there are so many good options? J Neurointerv Surg 2024; 16:433-434. [PMID: 38653525 DOI: 10.1136/jnis-2024-021732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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9
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Gunkan A, Onal Y, Ramazanoglu L, Fouad ME, Kahraman AN, Derin Cicek E, Demirhindi H, Velioglu M. Stent plus balloon-assisted coiling with low-profile braided stents in the treatment of complex wide-necked intracranial bifurcation aneurysms. Neuroradiol J 2024:19714009241247462. [PMID: 38622821 DOI: 10.1177/19714009241247462] [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: 04/17/2024] Open
Abstract
INTRODUCTION Wide-necked bifurcation aneurysms pose significant challenges for endovascular treatment. A recent innovation, the stent plus balloon-assisted coiling technique, combines a stent and a balloon to address these aneurysms effectively. PURPOSE To evaluate the safety and efficacy of the stent plus balloon-assisted coiling for the treatment of wide-necked bifurcation aneurysms. METHODS We conducted a retrospective review of our endovascular database to identify patients who were treated with this technique and had a satisfactory angiographic follow-up of at least 24 months. Technical success, initial clinical and angiographic outcomes, procedural complications, and follow-up results were analyzed. Angiographic and clinical outcomes were assessed using Modified Raymond-Roy Classification and Modified Rankin Scale, respectively. RESULTS Our study included 37 aneurysms in 36 patients (26 females) with a mean age of 56.6 years. Mean aneurysm and neck sizes were 7.3 ± 3.5 mm and 3.7 ± 1.0 mm, respectively. Technical success reached 97.2%, with an immediate occlusion rate of 65.7%. At a mean follow-up of 36.5 ± 9.7 months, final angiographic follow-up showed a 91.9% complete occlusion rate. Three aneurysms did not achieve complete occlusion; however, none required retreatment. Complications developed in 32.4% of the procedures. Mortality and morbidity rates were 5.4% and 2.7%, respectively. A good clinical outcome was observed in 91.9% of patients. CONCLUSION Our results showed that stent plus balloon-assisted coiling technique allows good angiographic outcomes for wide-necked bifurcation aneurysms. However, overall complication rate is high. Subgroup analysis indicated promising safety and efficacy for MCA bifurcation aneurysms, suggesting this technique could be a valuable option for select aneurysms.
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Affiliation(s)
- Ahmet Gunkan
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Yilmaz Onal
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Leyla Ramazanoglu
- Department of Neurology, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Mohamed Em Fouad
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Germany
| | - Ahmet Nedim Kahraman
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Esin Derin Cicek
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Turkey
| | - Hakan Demirhindi
- Faculty of Medicine, Department of Public Health, Cukurova University, Turkey
| | - Murat Velioglu
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Turkey
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10
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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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11
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Heiferman DM, Goyal N, Inoa V, Nickele CM, Arthur AS. A new era in the treatment of wide necked bifurcation aneurysms: Intrasaccular flow disruption. Interv Neuroradiol 2024; 30:31-36. [PMID: 35469513 PMCID: PMC10956467 DOI: 10.1177/15910199221094390] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/26/2022] [Indexed: 11/15/2022] Open
Abstract
Wide-necked bifurcation aneurysms (WNBAs) are challenging lesions to treat via both open surgical and endovascular techniques. Presently, there are 3 intrasaccular devices available to address many of the limitations of prior techniques, all of which are at different phases of approval for human use around the world. These devices include the Woven EndoBridge (WEB®) made by MicroVention, the Artisse™ Embolization Device made by Medtronic, and the Contour Neurovascular System™ made by Cerus Endovascular. Although heterogenous in design, these devices rely on the principle of using fine mesh overlying the aneurysm neck to slow blood inflow, promoting stagnation and thrombosis that ultimately leads to healing across the neck and exclusion from the circulation. While our understanding improves as long-term occlusion rates from these devices continue to be studied, the safety profiles and short-term success rates demonstrated in recent studies provide optimism for these innovative intrasaccular devices for the treatment of WNBAs. In this paper, we review these 3 intra-saccular flow disruption devices for use in WNBAs and summarize recent literature and studies of their effectiveness and safety.
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Affiliation(s)
- Daniel M. Heiferman
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Nitin Goyal
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Violiza Inoa
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Christopher M. Nickele
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Adam S. Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
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12
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Haryu S, Sakata H, Matsumoto Y, Niizuma K, Endo H. Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique. JOURNAL OF NEUROENDOVASCULAR THERAPY 2024; 18:75-83. [PMID: 38559450 PMCID: PMC10973563 DOI: 10.5797/jnet.ra.2023-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/11/2023] [Indexed: 04/04/2024]
Abstract
Wide-neck bifurcation aneurysms (WNBAs) are sometimes challenging to treat. During endovascular treatment, it is important to prevent coil deviation and preserve normal vessels. Adjunctive balloon- and stent-assisted techniques have been developed. A meta-analysis of endovascular treatments of WNBAs revealed that only 40% of patients had complete occlusion. Recently, novel devices have been developed to expand the range of treatment options. Flow-diverter stents and intra-aneurysmal flow disruption devices do not require coils; however, coil embolization remains the standard procedure used by many neurointerventionists. This review describes the recent trends in adjunctive techniques for supporting coil embolization for WNBAs. We referred to literature on balloon-assisted techniques, stent-assisted techniques, Y-stenting, PulseRider, Barrel stents, Comaneci temporary stents, pCONUS, and eCLIPs. These reports showed that adequate embolization rates were generally greater than 80%, and the complete occlusion rate was as high as 94.6%. All devices had a relatively high occlusion rate; however, it may be inaccurate to simply compare each device because of the heterogeneity of the studies. It is important to select the best treatment for each individual case by considering not only literature-based efficacy and safety but also patient background, aneurysm characteristics, and operator experience.
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Affiliation(s)
- Shinya Haryu
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Sakata
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Yasushi Matsumoto
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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13
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Spelle L, Costalat V, Caroff J, Wodarg F, Fischer S, Herbreteau D, Möhlenbruch MA, Januel AC, Papagiannaki C, Klisch J, Numminen J, Rautio R, Berlis A, Mihalea C, Chalumeau V, Downer J, Cortese J, Ikka L, Gallas S, Bester M, Liebig T, Velasco S, Grimaldi L, Byrne J, Szikora I, Pierot L, Cognard C. CLinical EValuation of WEB 17 device in intracranial aneuRysms (CLEVER): procedural, 30-day and 1-year safety results for ruptured and unruptured aneurysms. J Neurointerv Surg 2023:jnis-2023-020866. [PMID: 37914392 DOI: 10.1136/jnis-2023-020866] [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: 07/28/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Intrasaccular flow disruption is an endovascular approach for the treatment of wide-neck aneurysms and, more specifically, wide-neck bifurcation aneurysms, which are challenging to treat with previously developed technologies. The Woven EndoBridge (WEB) device has demonstrated its efficacy and safety, for both unruptured and ruptured aneurysms. METHODS The CLEVER study was an observational, multicenter, prospective study conducted in 17 European investigational sites using the WEB 17 device, for the treatment of ruptured and unruptured aneurysms. The study objective was to provide safety and efficacy data on the WEB 17 device in the treatment of wide-neck bifurcation aneurysms. Imaging results were assessed independently by a Corelab and adverse events adjudicated by a Clinical Event Adjudicator. This analysis reports procedural results and safety at 30 days and 12 months. RESULTS A total of 163 patients (mean age 58.1 years; 68.1% women) with 103 unruptured aneurysms and 60 ruptured aneurysms were enrolled. Most aneurysms were located on the anterior communicating artery (ACom) (37.4%) or the middle cerebral artery (MCA) bifurcation (30.1%). Aneurysm widths ranged from 2.0-9.2 mm, and the mean sac width was 5.0 mm. The WEB procedure was successfully completed in 163 patients (100%). At the 12-month follow-up, major stroke events occurred in 3 of 163 patients (1.8%), and no device-related mortality was observed. CONCLUSION Endovascular treatment of ruptured and unruptured wide-neck bifurcation aneurysms using WEB 17 is safe, with a low complication rate and no device-related mortality. In particular, none of the ruptured aneurysms bled again up to 1 year of follow-up. TRIAL REGISTRATION NUMBER NCT03844334.
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Affiliation(s)
- Laurent Spelle
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Vincent Costalat
- Interventional Neuroradiology, Gui de Chauliac University hospital, Montpellier, France
| | - Jildaz Caroff
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Sebastian Fischer
- Neuroradiology, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Nordrhein-Westfalen, Germany
| | - Denis Herbreteau
- Inreventional Neuroradiology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Markus A Möhlenbruch
- Neuroradiology, UniversitätsKlinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Anne-Christine Januel
- Diagnostic and Therapeutic Neuroradiology, Hospital Pierre Paul Riquet, Toulouse, Occitanie, France
| | | | - Joachim Klisch
- Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Thüringen, Germany
| | - Jussi Numminen
- Interventional Neuroradiology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | | | - Ansgar Berlis
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Cristian Mihalea
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Jonathan Downer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Jonathan Cortese
- Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- UMR CNRS no 7252, XLIM, Limoges, Aquitaine, France
| | - Léon Ikka
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Sophie Gallas
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | | | - Lamiae Grimaldi
- Clinical Research Unit Bicetre hospital, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - James Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Istvan Szikora
- Interventional Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Budapest, Hungary
| | - Laurent Pierot
- Department of Interventional Neuroradiology, CHU de Reims, Reims, Grand Est, France
- Champagne University Hospital Group, Reims, Grand Est, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, Occitanie, France
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Shibuya K, Hasegawa H, Suzuki T, Fujiwara H, Shibuma S, Shida K, Oishi M. Usefulness of Y-shaped PulseRider-assisted coil embolization for basilar artery tip aneurysm with a misaligned axis: A case report. Surg Neurol Int 2023; 14:300. [PMID: 37680930 PMCID: PMC10481857 DOI: 10.25259/sni_449_2023] [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: 05/27/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Background Endovascular treatment of wide-necked bifurcation aneurysms remains challenging. Although the advent of PulseRider and Web has expanded treatment options, aneurysms with a large deviation from the parent artery axis remains difficult to treat. We present the case of a wide-necked bifurcation aneurysm that was misaligned with the angle between the long axis of the parent artery and the aneurysm and was successfully treated with Y-shaped PulseRider-assisted coil embolization. Case Description A 64-year-old woman presented with an unruptured basilar tip aneurysm. Cerebral angiography showed a wide-necked aneurysm measuring 8.1 mm × 6.1 mm, neck 5.7 mm. The aneurysm was strongly tilted to the right and posterior relative to the basilar artery, and the bilateral posterior cerebral artery (PCA) and superior cerebellar artery (SCA) diverged from the aneurysm body. PulseRider-assisted coil embolization was performed. A Y-shaped PulseRider was selected to be placed in a hybrid fashion with the right arch in the aneurysm and the left arch in the branch. Adequate coil embolization with preservation of the bilateral PCA and SCA was possible, and cerebral angiography immediately after the treatment showed slight dome filling. Cerebral angiography 6 months after the procedure showed that the embolic status had improved to complete occlusion. Conclusion For wide-neck bifurcation aneurysms with a misaligned axis, a Y-shaped PulseRider used in a hybrid fashion, in which the leaflet on the side with the tilted axis is placed in the aneurysm, allows the PulseRider to be deployed more closely to the aneurysm, thereby enabling good coil embolization.
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Affiliation(s)
- Kohei Shibuya
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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15
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Kashkoush A, El-Abtah ME, Petitt JC, Glauser G, Winkelman R, Achey RL, Davison M, Abdulrazzak MA, Hussain SM, Toth G, Bain M, Moore N. Flow diversion for the treatment of intracranial bifurcation aneurysms: a systematic review and meta-analysis. J Neurointerv Surg 2023:jnis-2023-020582. [PMID: 37541838 DOI: 10.1136/jnis-2023-020582] [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: 05/12/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Flow diversion (FD: flow diversion, flow diverter) is an endovascular treatment for many intracranial aneurysm types; however, limited reports have explored the use of FDs in bifurcation aneurysm management. We analyzed the safety and efficacy of FD for the management of intracranial bifurcation aneurysms. METHODS A systematic review identified original research articles that used FD for treating intracranial bifurcation aneurysms. Articles with >4 patients that reported outcomes on the use of FDs for the management of bifurcation aneurysms along the anterior communicating artery (AComA), internal carotid artery terminus (ICAt), basilar apex (BA), or middle cerebral artery bifurcation (MCAb) were included. Meta-analysis was performed using a random effects model. RESULTS 19 studies were included with 522 patients harboring 534 bifurcation aneurysms (mean size 9 mm, 78% unruptured). Complete aneurysmal occlusion rate was 68% (95% CI 58.7% to 76.1%, I2=67%) at mean angiographic follow-up of 16 months. Subgroup analysis of FD as a standalone treatment estimated a complete occlusion rate of 69% (95% CI 50% to 83%, I2=38%). The total complication rate was 22% (95% CI 16.7% to 28.6%, I2=51%), largely due to an ischemic complication rate of 16% (95% CI 10.8% to 21.9%, I2=55%). The etiologies of ischemic complications were largely due to jailed artery hypoperfusion (47%) and in-stent thrombosis (38%). 7% of patients suffered permanent symptomatic complications (95% CI 4.5% to 9.8%, I2=6%). CONCLUSION FD treatment of bifurcation aneurysms has a modest efficacy and relatively unfavorable safety profile. Proceduralists may consider reserving FD as a treatment option if no other surgical or endovascular therapy is deemed feasible.
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Affiliation(s)
- Ahmed Kashkoush
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jordan C Petitt
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gregory Glauser
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Winkelman
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca L Achey
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Davison
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammad A Abdulrazzak
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shazam M Hussain
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gabor Toth
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nina Moore
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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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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Tanabe J, Nakahara I, Ishihara T, Matsumoto S, Morioka J, Hasebe A, Watanabe S, Suyama K. Decision-making tree for optimal Woven EndoBridge device sizing with ideal Woven EndoBridge-aneurysm volume (iWAVe) ratio. J Clin Neurosci 2023; 114:55-61. [PMID: 37307716 DOI: 10.1016/j.jocn.2023.06.003] [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: 03/22/2023] [Revised: 05/13/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Optimal size selection is important for successful Woven EndoBridge (WEB) treatment. Conventional recommendations for WEB sizing based on aneurysm width and height sometimes require device exchange. We aimed to design a novel volume-based parameter, the ideal WEB-aneurysm volume (iWAVe) ratio, for optimal WEB sizing. METHODS Consecutive patients who underwent WEB treatment for wide-neck bifurcation aneurysms between January 2021 and May 2022 were retrospectively reviewed. Aneurysm volume was automatically calculated using software. We measured the aneurysm volume based on the expected position of the device within the aneurysm. The WAVe ratio was defined as the ratio of the aneurysm volume to WEB volume. We dichotomized aneurysms treated with a successful sizing or unsuccessful sizing for WEB (successful group and unsuccessful group, respectively). RESULTS Thirty-five patients were eligible for study enrollment. Ten patients (28.6%) needed to exchange the WEB on the first attempt and required another WEB on the second attempt resulting in deployment success. Hence, 35 aneurysms were in the successful group and 10 were in the unsuccessful group. The median WAVe ratio was 1.0 (range 0.76-1.31) in the successful group and 1.27 (0.58-1.89) in the unsuccessful group. Using logistic regression, iWAVe ratio was from 0.90-1.16 to secure a >80% probability of success by the 95% lower confidence limit. The sensitivity and specificity of the iWAVe ratio for optimal size selection on the first attempt were 0.60 and 1.00, respectively. CONCLUSION Decision-making based on aneurysm width and the iWAVe ratio could promote optimal WEB sizing.
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Affiliation(s)
- Jun Tanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Gifu, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Akiko Hasebe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kenichiro Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, 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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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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20
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Yeomans J, Gatt S, Habeeb Mohamed E, Crossley R, Keston P, Minks D, Dobbs N, Mortimer A, Downer J, Sastry A. pCONUS 2 and pCONUS 2-HPC in the treatment of wide-necked intracranial aneurysms: Multicentre UK experience. Interv Neuroradiol 2023:15910199221150467. [PMID: 36617807 DOI: 10.1177/15910199221150467] [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: 01/10/2023] Open
Abstract
BACKGROUND/PURPOSE pCONUS 2 and pCONUS 2-HPC are neck-bridging devices that provide coiling support in the endovascular treatment of wide-necked intracranial aneurysms. To date, limited multicentre data has been published. This study provides the first pooled data from multiple UK centres regarding outcomes for these devices covering the periprocedural period to 6-month follow-up. MATERIALS/METHODS This retrospective, single-arm study assessed 65 patients treated over 3 years from the time of procedure to 6 months post-procedure across four UK centres. Data collected included patient demographics, aneurysm characteristics and antiplatelet regimens. Outcome measures were angiographic results and procedure-related complications from the immediate periprocedural period to 6-month follow-up. RESULTS Fifty-four unruptured (83.1%) and 11 ruptured (16.9%) aneurysms were treated. Fifty-five aneurysms were located in the anterior circulation (87.7%). There were four device-related intraprocedural complications: three cases of asymptomatic, temporary thrombus formation and one mortality associated with branch vessel occlusion and aneurysm re-bleeding in a ruptured case. There were no post-procedural device-related complications. Satisfactory occlusion was achieved in 58/65 procedures (89.2%) at time of treatment and in 44/60 (73.3%) at 6 months. Satisfactory occlusion correlated with aneurysm size and coiling packing density. Retreatment was required for five unruptured cases (7.7%) and was straightforward with the device in situ. CONCLUSION pCONUS 2 and pCONUS 2-HPC have good short-term safety profiles. The use of pCONUS 2-HPC in the acute treatment of ruptured aneurysms with postprocedural SAPT is feasible. The devices have an intraprocedural complication rate of 4/65 (6.2%) across multiple UK centres, including a single death (1.5%).
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Affiliation(s)
- James Yeomans
- Radiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Simon Gatt
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - Ezaz Habeeb Mohamed
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - Robert Crossley
- 159003Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Peter Keston
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - David Minks
- 105563Radiology Department, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, England, UK
| | - Nicholas Dobbs
- 159003Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Alexander Mortimer
- 159003Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Jonathan Downer
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - Anand Sastry
- Radiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
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21
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Pravdivtseva MS, Pravdivtsev AN, Peters S, Hensler J, Larsen N, Hövener JB, Jansen O, Wodarg F. The effect of the size of the new contour neurovascular device for altering intraaneurysmal flow. Interv Neuroradiol 2023:15910199221145985. [PMID: 36594503 DOI: 10.1177/15910199221145985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a novel intrasaccular device (contour neurovascular system, contour) was introduced to treat intracranial aneurysms. Contour is placed at thе aneurysm neck and reduces the intraaneurysmal blood inflow. Contour comes in a range of sizes to target different aneurysms. The efficiency of altering flow with contour and the effect of device size have not yet been investigated. Therefore, we studied the effect of the device size with patient-based aneurysm models using 2D digital subtraction angiography (DSA). METHODS Three patient-based aneurysm models with necks ranging from 2.7 to 9.7 mm were produced, providing standardized testing conditions. Contours with diameters of 5, 11, and 14 mm were implanted into the models, four of each size. 2D DSA images were acquired before and after implanting contour (15 frames/s, manual contrast injection). After injecting angiographic contrast agent, the DSA signal was recorded over time to calculate the contrast washout time (WOT), which is a measure of flow diversion efficiency. RESULTS All contour devices caused contrast agent stasis and increased WOT in aneurysm sac (p-value = 0.0005). The median relative WOT was largest for 5-mm contour (6.6 ± 3.2) and similar for 11-mm contour (3.4 ± 2.6) and 14-mm contour (3.2 ± 3.8). The implantation procedure might affect WOT values even for contours of the same size; the overall relative WOT ranged between 1.5 and 10.89. CONCLUSION The 5-mm contour showed the longest WOT value in our study, while no apparent difference between 11-mm contour and 14-mm contour was found.
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Affiliation(s)
- Mariya S Pravdivtseva
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), 54186University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Andrey N Pravdivtsev
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), 54186University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Sönke Peters
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), 54186University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
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22
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Hecker C, Broussalis E, Griessenauer CJ, Killer-Oberpfalzer M. A mini-review of intrasaccular flow diverters. J Neurointerv Surg 2023; 15:70-74. [PMID: 35580985 DOI: 10.1136/neurintsurg-2021-018426] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/08/2022] [Indexed: 12/16/2022]
Abstract
Treatment of wide-necked complex intracranial aneurysms continues to challenge neurointerventionalists. Intrasaccular flow diverters have expanded the armamentarium considerably and are now used extensively. While five types of devices have already obtained the CE mark for use within Europe, only the Woven EndoBridge (WEB) device is approved by the US Food and Drug Administration. Other intrasaccular devices are the Luna/Artisse Aneurysm Embolization System (Medtronic), the Medina Embolic Device (Medtronic), the Contour Neurovascular System (Cerus), and the Neqstent Coil Assisted Flow Diverter (Cerus). This mini review will provide a compact overview of these devices and a summary of the current literature.
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Affiliation(s)
- Constantin Hecker
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria .,Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Erasmia Broussalis
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph J Griessenauer
- Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
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Liu C, Guo K, Wu X, Wu L, Cai Y, Hu X, Fang B. Utility of low-profile visualized intraluminal support (LVIS™) stent for treatment of acutely ruptured bifurcation aneurysms: A single-center study. Front Neurol 2023; 14:1050369. [PMID: 37034062 PMCID: PMC10073472 DOI: 10.3389/fneur.2023.1050369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Objective Stent-assisted coiling has been increasingly used in the treatment of intracranial aneurysms. However, its application in ruptured bifurcation aneurysms remains controversial and challenging. This study aimed to present the safety and feasibility of low-profile visualized intraluminal support (LVIS™, LVIS, and LVIS Jr.) stent for acutely ruptured bifurcation aneurysms. Methods A total of 41 patients with acutely ruptured intracranial aneurysms arising at the bifurcation were treated with LVIS™ stent-assisted coiling in our hospital between January 2017 and December 2021. The clinical data and angiographic results of the patients were analyzed. Results Among these patients, all stents were successfully implanted. According to the immediate angiographic results, 29 aneurysms (70.7%) were completely occluded. Intraoperative thrombosis and hemorrhage occurred in two and one cases, respectively. No post-operative thrombosis or rebleeding events were observed. The clinical follow-up of all patients revealed that 38 (92.7%) cases had favorable outcomes (modified Rankin scale: 0-2). The angiographic results available for the 36 patients during the follow-up period revealed complete occlusion was achieved in 30 patients (83.3%) and residual neck in six patients. Conclusion The LVIS™ stent-assistant coiling is a safe and feasible option for acutely ruptured bifurcation aneurysms. Further studies with a prospective design, a larger sample size, and long-term follow-up are needed to validate these findings.
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Affiliation(s)
- Changya Liu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kaikai Guo
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinxin Wu
- Shanghai Skin Disease Hospital, Skin Disease Hospital of Tongji University, Shanghai, China
| | - Linguangjin Wu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yike Cai
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Xuebin Hu
| | - BangJiang Fang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Emergency and Critical Care Institute of Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: BangJiang Fang
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24
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Alpay K, Nania A, Raj R, Numminen J, Parkkola R, Rautio R, Downer J. Long term WEB results - still going strong at 5 years? Interv Neuroradiol 2022:15910199221139542. [PMID: 36397733 DOI: 10.1177/15910199221139542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE The aim of our multi-center study is to examine 5-year radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB). METHODS All patients treated with WEB between January 2013 and December 2016 were included. Patient and aneurysm characteristic data was collected from the electronic patient record. Aneurysm occlusion was assessed using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. Complete occlusion and neck remnant were considered as adequate occlusion, whereas aneurysm remnant was assessed as an inadequate occlusion. RESULTS A total of 66 patients (72.7% female) with 66 IAs (n = 25 acutely ruptured) were treated with WEB. The mean age of patients was 55.6 years (range: 36-71 years). The mean width of the aneurysm neck was 4.5 mm (range: 2-9 mm). 5-year imaging follow-up data was not available for 16.6% patients (n = 11). During the follow up period, 14.5% of IAs (n = 8/55) required retreatment within 24 months of initial treatment with the WEB. A total of 55 IAs were analyzed for 5-year radiological outcome. Of these, including IAs required retreatment, 47.3% of IAs (n = 26/55) were occluded completely, 36.4% (n = 20/55) had neck remnant and 16.3% (n = 9/55) had recanalized. 83.7% of IAs were occluded adequately. None of the IAs rebled after initial treatment with WEB. CONCLUSION WEB can provide acceptable adequate occlusion rates at 5 years. Furthermore, recanalization appears to be unlikely after the first two years post-treatment. The results of large studies are needed to confirm these promising long term radiological outcomes.
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Affiliation(s)
- Kemal Alpay
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Alberto Nania
- Department of Clinical Neurosciences, 3124University of Edinburgh, Edinburgh, UK
| | - Rahul Raj
- Department of Neurosurgery, 3836Helsinki University Hospital and University of Helsinki, Finland
| | - Jussi Numminen
- Department of Radiology, 3836Helsinki University Hospital, Helsinki, Finland
| | - Riitta Parkkola
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Riitta Rautio
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Jonathan Downer
- Department of Clinical Neurosciences, 3124University of Edinburgh, Edinburgh, UK
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Webb M, Riina H, Mascitelli J. Wide-Neck and Bifurcation Aneurysms. Neurosurg Clin N Am 2022; 33:359-369. [DOI: 10.1016/j.nec.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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26
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Mascitelli JR, Mocco J, Hardigan T, Hendricks BK, Yoon JS, Yaeger KA, Kellner CP, De Leacy RA, Fifi JT, Bederson JB, Albuquerque FC, Ducruet AF, Birnbaum LA, Caron JLR, Rodriguez P, Lawton MT. Endovascular therapy versus microsurgical clipping of unruptured wide-neck aneurysms: a prospective multicenter study with propensity score analysis. J Neurosurg 2022; 137:352-359. [PMID: 34952522 DOI: 10.3171/2021.10.jns211942] [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: 08/10/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Numerous techniques have been developed to treat wide-neck aneurysms (WNAs), each with different safety and efficacy profiles. Few studies have compared endovascular therapy (EVT) with microsurgery (MS). The authors' objective was to perform a prospective multicenter study of a WNA registry using rigorous outcome assessments and to compare EVT and MS using propensity score analysis (PSA). METHODS Unruptured, saccular, not previously treated WNAs were included. WNA was defined as an aneurysm with a neck width ≥ 4 mm or a dome-to-neck ratio (DTNR) < 2. The primary outcome was modified Rankin Scale (mRS) score at 1 year after treatment (good outcome was defined as mRS score 0-2), as assessed by blinded research nurses and compared with PSA. Angiographic outcome was assessed using the Raymond scale with core laboratory review (adequate occlusion was defined as Raymond scale score 1-2). RESULTS The analysis included 224 unruptured aneurysms in the EVT cohort (n = 140) and MS cohort (n = 84). There were no differences in baseline demographic characteristics, such as proportion of patients with good baseline mRS score (94.3% of the EVT cohort vs 94.0% of the MS cohort, p = 0.941). WNA inclusion criteria were similar between cohorts, with the most common being both neck width ≥ 4 mm and DTNR < 2 (50.7% of the EVT cohort vs 50.0% of the MS cohort, p = 0.228). More paraclinoid (32.1% vs 9.5%) and basilar tip (7.1% vs 3.6%) aneurysms were treated with EVT, whereas more middle cerebral artery (13.6% vs 42.9%) and pericallosal (1.4% vs 4.8%) aneurysms were treated with MS (p < 0.001). EVT aneurysms were slightly larger (p = 0.040), and MS aneurysms had a slightly lower mean DTNR (1.4 for the EVT cohort vs 1.3 for the MS cohort, p = 0.010). Within the EVT cohort, 9.3% of patients underwent stand-alone coiling, 17.1% balloon-assisted coiling, 34.3% stent-assisted coiling, 37.1% flow diversion, and 2.1% PulseRider-assisted coiling. Neurological morbidity secondary to a procedural complication was more common in the MS cohort (10.3% vs 1.4%, p = 0.003). One-year mRS scores were assessed for 218 patients (97.3%), and no significantly increased risk of poor clinical outcome was found for the MS cohort (OR 2.17, 95% CI 0.84-5.60, p = 0.110). In an unadjusted direct comparison, more patients in the EVT cohort achieved a good clinical outcome at 1 year (93.4% vs 84.1%, p = 0.048). Final adequate angiographic outcome was superior in the MS cohort (97.6% of the MS cohort vs 86.5% of the EVT cohort, p = 0.007). CONCLUSIONS Although the treatments for unruptured WNA had similar clinical outcomes according to PSA, there were fewer complications and superior clinical outcome in the EVT cohort and superior angiographic outcomes in the MS cohort according to the unadjusted analysis. These results may be considered when selecting treatment modalities for patients with unruptured WNAs.
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Affiliation(s)
- Justin R Mascitelli
- 1Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas
| | - J Mocco
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Trevor Hardigan
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Benjamin K Hendricks
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - James S Yoon
- 4Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kurt A Yaeger
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Christopher P Kellner
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Reade A De Leacy
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Johanna T Fifi
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Joshua B Bederson
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Felipe C Albuquerque
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Andrew F Ducruet
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Lee A Birnbaum
- 1Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas
| | - Jean Louis R Caron
- 1Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas
| | - Pavel Rodriguez
- 1Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas
| | - Michael T Lawton
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Adeeb N, Dibas M, Diestro JDB, Cuellar-Saenz HH, Sweid A, Kandregula S, Lay SV, Guenego A, Renieri L, Sundararajan SH, Saliou G, Aslan A, Möhlenbruch M, Vranic JE, Regenhardt RW, Savardekar A, Mamilly A, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Parra Farinas C, Tutino VM, Inoue Y, Mirshahi S, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Sporns P, Brehm A, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Stapleton CJ, Siddiqui A, Ducruet AF, Albuquerque FC, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB, Dmytriw AA. Multicenter Study for the Treatment of Sidewall versus Bifurcation Intracranial Aneurysms with Use of Woven EndoBridge (WEB). Radiology 2022; 304:372-382. [DOI: 10.1148/radiol.212006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Spelle L, Herbreteau D, Caroff J, Barreau X, Ferré JC, Fiehler J, Januel AC, Costalat V, Liebig T, Bourcier R, Möhlenbruch MA, Berkefeld J, Weber W, Mihalea C, Ikka L, Ozanne A, Cognard C, Narata AP, Bibi RE, Gauvrit JY, Raoult H, Velasco S, Buhk JH, Chalumeau V, Bester M, Desal H, du Mesnil de Rochemont R, Bohner G, Fischer S, Gallas S, Biondi A, Grimaldi L, Moret J, Byrne J, Pierot L. CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): 12-month angiographic results of a multicenter study. J Neurointerv Surg 2022:neurintsurg-2022-018749. [PMID: 35882550 DOI: 10.1136/neurintsurg-2022-018749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS) study has shown that the endovascular treatment of ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) is safe and effective and provides protection against rebleeding at 1 month and 1 year. The 12-month angiographic follow-up is an important endpoint of the study. METHODS The CLARYS study is a prospective multicenter study conducted in 13 European centers. The study enrolled 60 patients with 60 ruptured aneurysms of the anterior and posterior circulation. The study was conducted with an independent assessment of safety outcomes and imaging. RESULTS Sixty patients with 60 ruptured bifurcation aneurysms to be treated with the WEB were included. Fifty-three aneurysms (88.3%) had a broad base with a dome to neck ratio <2 (mean 1.6). Of these, 46 patients were evaluated by an independent core laboratory with follow-up imaging performed at 12 months or before eventual retreatment. At 1 year, 19/46 aneurysms (41.3%) were completely occluded (Raymond-Roy grade I), 21/46 (45.7%) had a residual neck and 6/46 (13.0%) had residual aneurysm filling. Adequate occlusion was reported in 40/46 (87%) aneurysms. Six patients underwent target aneurysm retreatment. CONCLUSIONS The CLARYS study has previously shown that the use of the WEB in the endovascular treatment of ruptured bifurcation aneurysms provides effective protection against rebleeding with a good safety profile. The angiographic occlusion rates at 1 year reported here are comparable to those already seen in previous multicenter studies which primarily included unruptured aneurysms.
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Affiliation(s)
- Laurent Spelle
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France .,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilians University, Munich Faculty of Medicine, Munchen, Germany
| | - Romain Bourcier
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | - Markus A Möhlenbruch
- Department of Neuroradiology, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Joachim Berkefeld
- Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Werner Weber
- Department of Neuroradiology, Ruhr-Universitat Bochum Medizinische Fakultat, Bochum, Germany
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Léon Ikka
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Augustin Ozanne
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Richard Edwige Bibi
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jean-Yves Gauvrit
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Hélène Raoult
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Stéphane Velasco
- Department of Radiology, Regional University Hospital, Poitiers, France
| | - Jan-Hendrik Buhk
- Department of Neuroradiology, Asklepios Hospital Group, Hamburg, Germany
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hubert Desal
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Georg Bohner
- Neuroradiology, Charite Universitatsmedizin, Berlin, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, Ruhr-Universitat Bochum Medizinische Fakultat, Bochum, Germany
| | - Sophie Gallas
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Jean Minjoz University Hospital, Besancon, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,CESP Anti-Infective Evasion and Pharmacoepidemiology Team, Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-Le-Bretonneux, France
| | - Jacques Moret
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicetre University Hospital, Le Kremlin-Bicetre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - James Byrne
- Department of Neuroradiology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, Reims, France.,Champagne-Ardenne University, Reims, France
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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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30
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Mascitelli JR, Lawton MT, Hendricks BK, Hardigan TA, Yoon JS, Yaeger KA, Kellner CP, De Leacy RA, Fifi JT, Bederson JB, Albuquerque FC, Ducruet AF, Birnbaum LA, Caron JLR, Rodriguez P, Mocco J. Endovascular Therapy Versus Microsurgical Clipping of Ruptured Wide Neck Aneurysms (EVERRUN Registry): a multicenter, prospective propensity score analysis. J Neurosurg 2022; 137:87-94. [PMID: 34740187 DOI: 10.3171/2021.7.jns211323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Randomized controlled trials have demonstrated the superiority of endovascular therapy (EVT) compared to microsurgery (MS) for ruptured aneurysms suitable for treatment or when therapy is broadly offered to all presenting aneurysms; however, wide neck aneurysms (WNAs) are a challenging subset that require more advanced techniques and warrant further investigation. Herein, the authors sought to investigate a prospective, multicenter WNA registry using rigorous outcome assessments and compare EVT and MS using propensity score analysis (PSA). METHODS Untreated, ruptured, saccular WNAs were included in the analysis. A WNA was defined as having a neck ≥ 4 mm or a dome/neck ratio (DNR) < 2. The primary outcome was the modified Rankin Scale (mRS) score at 1 year posttreatment, as assessed by blinded research nurses (good outcome: mRS scores 0-2) and compared using PSA. RESULTS The analysis included 87 ruptured aneurysms: 55 in the EVT cohort and 32 in the MS cohort. Demographics were similar in the two cohorts, including Hunt and Hess grade (p = 0.144) and modified Fisher grade (p = 0.475). WNA type inclusion criteria were similar in the two cohorts, with the most common type having a DNR < 2 (EVT 60.0% vs MS 62.5%). More anterior communicating artery aneurysms (27.3% vs 18.8%) and posterior circulation aneurysms (18.2% vs 0.0%) were treated with EVT, whereas more middle cerebral artery aneurysms were treated with MS (34.4% vs 18.2%, p = 0.025). Within the EVT cohort, 43.6% underwent stand-alone coiling, 50.9% balloon-assisted coiling, 3.6% stent-assisted coiling, and 1.8% flow diversion. The 1-year mRS score was assessed in 81 patients (93.1%), and the primary outcome demonstrated no increased risk for a poor outcome with MS compared to EVT (OR 0.43, 95% CI 0.13-1.45, p = 0.177). The durability of MS was higher, as evidenced by retreatment rates of 12.7% and 0% for EVT and MS, respectively (p = 0.04). CONCLUSIONS EVT and MS had similar clinical outcomes at 1 year following ruptured WNA treatment. Because of their challenging anatomy, WNAs may represent a population in which EVT's previously demonstrated superiority for ruptured aneurysm treatment is less relevant. Further investigation into the treatment of ruptured WNAs is warranted.
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Affiliation(s)
- Justin R Mascitelli
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - Michael T Lawton
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Trevor A Hardigan
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - James S Yoon
- 4Yale School of Medicine, New Haven, Connecticut
| | - Kurt A Yaeger
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Christopher P Kellner
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Reade A De Leacy
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Johanna T Fifi
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Joshua B Bederson
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | | | - Andrew F Ducruet
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Lee A Birnbaum
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - Jean Louis R Caron
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - Pavel Rodriguez
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - J Mocco
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
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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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Mouchtouris N, Hasan D, Samaniego EA, Saiegh FA, Sweid A, Abbas R, Naamani KE, Tahir R, Zanaty M, Khanna O, Chalouhi N, Tjoumakaris S, Gooch MR, Rosenwasser R, Jabbour P. The Woven EndoBridge (WEB) device: feasibility, techniques, and outcomes after FDA approval. J Neurosurg 2022; 136:1266-1272. [PMID: 34624864 DOI: 10.3171/2021.5.jns21889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wide-neck bifurcation cerebral aneurysms have historically required either clip ligation or stent- or balloon-assisted coil embolization. This predicament led to the development of the Woven EndoBridge (WEB) aneurysm embolization system, a self-expanding mesh device that achieves intrasaccular flow disruption and does not require antithrombotic medications. The authors report their operative experience and 6-month follow-up occlusion outcomes with the first 115 aneurysms they treated via WEB embolization. METHODS The authors reviewed the first 115 cerebral aneurysms they treated by WEB embolization after FDA approval of the WEB embolization device (from February 2019 to January 2021). Data were collected on patient demographics and clinical presentation, aneurysm characteristics, procedural details, postembolization angiographic contrast stasis, and functional outcomes. RESULTS A total of 110 patients and 115 aneurysms were included in our study (34 ruptured and 81 unruptured aneurysms). WEB embolization was successful in 106 (92.2%) aneurysms, with a complication occurring in 6 (5.5%) patients. Contrast clearance was seen in the arterial phase in 14 (12.2%) aneurysms, in the capillary phase in 16 (13.9%), in the venous phase in 63 (54.8%), and no contrast was seen in 13 (11.3%) of the aneurysms studied. Follow-up angiography was performed on 60 (52.6%) of the aneurysms, with complete occlusion in 38 (63.3%), neck remnant in 14 (23.3%), and aneurysmal remnant in 8 (13.3%). Six (5.5%) patients required re-treatment for persistent aneurysmal residual on follow-up angiography. CONCLUSIONS The WEB device has been successfully used for the treatment of both unruptured and ruptured wide-neck bifurcation aneurysms by achieving intrasaccular flow diversion. Here, the authors have shared their experience with its unique technical considerations and device size selection, as well as critically reviewed complications and aneurysm occlusion rates.
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Affiliation(s)
- Nikolaos Mouchtouris
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | | | - Edgar A Samaniego
- Departments of2Neurological Surgery and
- 3Neurology, University of Iowa, Iowa City, Iowa
| | - Fadi Al Saiegh
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Ahmad Sweid
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Rawad Abbas
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Kareem El Naamani
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Rizwan Tahir
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | | | - Omaditya Khanna
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Nohra Chalouhi
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Stavropoula Tjoumakaris
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - M Reid Gooch
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Robert Rosenwasser
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Pascal Jabbour
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
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Srinivasan VM, Farhadi DS, Shlobin NA, Cole TS, Graffeo CS, Lawton MT. Clinical Trials of Microsurgery for Cerebral Aneurysms: Past and Future. World Neurosurg 2022; 161:354-366. [PMID: 35505555 DOI: 10.1016/j.wneu.2021.11.087] [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: 08/30/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND New findings and research regarding the microsurgical treatment of intracerebral aneurysms (IAs) continue to advance even in the era of endovascular therapies. Research in the past 2 decades has continued to revolve around the question of whether open surgery or endovascular treatment is preferable. The answer remains both complex and in flux. OBJECTIVE This review focuses on microsurgery, reflects on the research decisions of previous landmark studies, and proposes future study designs that may further our understanding of IAs and how best to treat them. RESULTS The future of IA research may include a combination of pragmatic trials, artificial intelligence integrated tools, and mining of large data sets, in addition to the publication of high-quality single-center studies. CONCLUSIONS The future will likely emphasize testing innovative techniques, looking at granular patient data, and considering every patient encounter as a potential source of knowledge, creating a system in which data are updated daily because each patient interaction contributes to answering important research questions.
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Affiliation(s)
- Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dara S Farhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nathan A Shlobin
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Cavasin N, Gava UA, Magrini S, Cagliari E. Treatment of a ruptured fetal-type posterior communicating aneurysm with a combined approach using the new contour neurovascular system. BMJ Case Rep 2022; 15:e248065. [PMID: 35440434 PMCID: PMC9020296 DOI: 10.1136/bcr-2021-248065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
Fetal-type posterior communicating artery (FPCom) aneurysms are associated with higher rates of recurrence after endovascular treatment than aneurysms at other locations. We report the case of a patient with a subarachnoid haemorrhage and ruptured right-sided FPCom aneurysm. The patient underwent acute endovascular treatment with application of a novel combined approach-partial coiling to protect the dome and occlusion of the neck with a new flow-disrupter, endosaccular device, Contour (Cerus Endovascular)-as a stable, single-step treatment to prevent rebleeding in the acute stage and long-term potential recurrences.
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Chacón-Quesada T, Mielke D, Rohde V, Hernández-Durán S. Microsurgical clipping vs Woven EndoBridge (WEB) device for the management of unruptured wide-neck bifurcation aneurysms. Neurosurg Rev 2022; 45:2717-2722. [PMID: 35403981 PMCID: PMC9349077 DOI: 10.1007/s10143-022-01781-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
The Woven EndoBridge device (WEB) was introduced in 2010 to treat wide-neck bifurcation aneurysms (WNBAs). Three landmark studies have been conducted to assess its safety and efficacy: WEBCAST, WEBCAST 2, and French Observatory Study. However, these studies have not compared its safety and efficacy to other treatment modalities. In this study, we compare WEB versus microsurgical clipping in the management of unruptured WNBA. We conducted a retrospective study of unruptured WNBA meeting the morphological criteria to be amenable for WEB treatment operated on at our institution. Surgical morbidity, mortality, and occlusion rates were assessed. We compared our results to those reported in the cumulative population of the three WEB landmark studies at 1 year. A total of 84 patients with 89 WNBA were included. The most common aneurysm location was the middle cerebral artery bifurcation (n = 67/89, 75%). No operative mortality was observed. Morbidity comprised small-vessel vasospasm (n = 1/89, 1%) resulting in hemiparesis vs. 3% morbidity for WEB (p = .324). All but one (n = 1/89, 1%) WNBA were completely occluded vs WEB occlusion rate of 53% at 1 year, statistically significantly worse (p < .001). In our analysis, we were not able to show superiority of WEB in terms of procedural morbidity in comparison to microsurgical clipping, defined as worsening in mRS. Microsurgical clipping achieves statistically significantly higher rates of complete aneurysm occlusion, thus posing the question of whether the WEB should be presented as a viable, comparable alternative to patients amenable to surgical treatment.
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Affiliation(s)
- Tatiana Chacón-Quesada
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Silvia Hernández-Durán
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Nania A, Gatt S, Banerjee R, Syed MB, Tiefenbach J, Dobbs N, Du Plessis J, Keston P, Downer J. WEB vs coiling in ruptured aneurysms: A propensity score matched comparison of safety and efficacy. Interv Neuroradiol 2022:15910199221092241. [PMID: 35379037 PMCID: PMC10399506 DOI: 10.1177/15910199221092241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aim to compare the safety and efficacy of WEB with coiling for acutely ruptured aneurysms.METHODS: All consecutive ruptured aneurysms with width suitable for WEB (2-10 mm) treated over 5 years (1/1/2015 to 31/12/2019) were included. We recorded WFNS, Fisher grade, patient demographics and aneurysm characteristics (size, location, D/W and aspect ratio, lobulation). Primary endpoints were mRS status at 3 months, aneurysm occlusion on latest available imaging follow-up, retreatment rate and procedural complications. We applied propensity score matching using aneurysm morphology (size, D/N ratio, ASPECT ratio and lobulation) to optimise matching for WEB versus coil comparison and minimise the effects of confounding. RESULT A total of 493 patients were identified, 97 treated with the WEB device. 1:1 propensity score matching was used to establish a matched group of 97 patients treated with coiling. The WEB arm showed 3% procedural complication rate, with no haemorrhagic complications and use of adjunctive device in 4%. Satisfactory occlusion on follow-up (mean 14 months) was 79%, with 19% retreatment rate. The coil arm had 8% complication rate, with use of an adjunctive device in 52% of cases (balloon 44%, stent 8%). Satisfactory occlusion on follow-up (mean 22 months) was 90%, with 8% retreatment rate. CONCLUSION Treatment of ruptured wide-necked bifurcation aneurysms with WEB has a lower complication rate than coiling with high rate of satisfactory occlusion. However, there was a higher retreatment rate when compared with patients treated with coiling. An adjunct device (balloon or stent), was used in over 50% of aneurysms in the coiling group.
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Affiliation(s)
- Alberto Nania
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK
| | - Simon Gatt
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK
| | - Rohan Banerjee
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK
| | - Maaz Bj Syed
- 3124University of Edinburgh, 9-16 Chambers Street, Edinburgh EH8 9AG, Edinburgh, UK
| | - Jakov Tiefenbach
- 3124University of Edinburgh, 9-16 Chambers Street, Edinburgh EH8 9AG, Edinburgh, UK
| | - Nicholas Dobbs
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK
| | - Johannes Du Plessis
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK
| | - Peter Keston
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK
| | - Johnathan Downer
- 3129NHS Lothian, Department of Clinical Neuroscience, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Edinburgh, UK.,3124University of Edinburgh, 9-16 Chambers Street, Edinburgh EH8 9AG, Edinburgh, UK
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Liebig T, Killer-Oberpfalzer M, Gal G, Schramm P, Berlis A, Dorn F, Jansen O, Fiehler J, Wodarg F. The Safety and Effectiveness of the Contour Neurovascular System (Contour) for the Treatment of Bifurcation Aneurysms: The CERUS Study. Neurosurgery 2022; 90:270-277. [PMID: 35113830 DOI: 10.1227/neu.0000000000001783] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Contour is a novel intra-aneurysmal flow disrupting device to treat intracranial aneurysms. OBJECTIVE To evaluate the safety and effectiveness of the Contour device for treatment of nonruptured intracranial bifurcation aneurysms through a prospective, multicenter, single-arm study. METHODS Thirty-four patients were enrolled. Primary end points were successful occlusion at 6 mo for efficacy and any major stroke or nonaccidental death up to 30 d or major disabling stroke within 6 mo for safety. Secondary end points were occlusion at 12 mo, retreatment rate, procedure time, and procedure-related/device-related adverse events. Procedural and follow-up imaging was reviewed by an independent core laboratory. Adverse events were reviewed and adjudicated by a clinical events committee. RESULTS In total, 32 of 34 aneurysms were successfully implanted and, 2 of 34 in the intention-to-treat (ITT) group did not receive the Contour and were excluded from follow-up after 30 d. In addition, 2 of 32 were lost to angiographic follow-up and regarded as treatment failure. The primary safety end point was met in 2 patients in the ITT group. In the perprotocol (PP) group, complete occlusion was seen in 14 of 32 (44%) at 6 mo and 22 of 32 (69%) at 12 mo. Adequate occlusion (Raymond-Roy [RR] 1 and 2) was reached in 84% at a last available follow-up. One patient from the ITT group and 1 from the PP group received additional treatment during follow-up. CONCLUSION The Contour seems to be both safe and effective in the treatment of intracranial bifurcation aneurysms.
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Affiliation(s)
- Thomas Liebig
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Monika Killer-Oberpfalzer
- Department of Neurology/Institute of Neurointervention, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gyula Gal
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Peter Schramm
- Department of Neuroradiology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ansgar Berlis
- Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Franziska Dorn
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
- Department of Neuroradiology, University of Bonn, Bonn, Germany
| | - Olav Jansen
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fritz Wodarg
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
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38
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Fatania K, Patankar DT. Comprehensive review of the recent advances in devices for endovascular treatment of complex brain aneurysms. Br J Radiol 2022; 95:20210538. [PMID: 34609898 PMCID: PMC8722252 DOI: 10.1259/bjr.20210538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The International Subarachnoid Aneurysm Trial (ISAT) showed superiority for endovascular treatment of ruptured aneurysms and technology has since moved on rapidly. Many approaches and technology now exist for the endovascular management of ruptured and unruptured intracranial aneurysms, which reflects their varied nature - there is no one-size-fits-all technique. We aim to provide an overview of the various classes of device and the major developments over the past decade. Coiling is the oldest of the technology and continues to demonstrate high levels of occlusion and acceptable risks, making it the default treatment choice, particularly in the acutely ruptured aneurysm setting. Advances on coiling include the use of adjuncts such as balloons, stents and fully retrievable temporary neck-bridging devices, which have facilitated the treatment of more complex aneurysms. Flow divertors have also revolutionised complex aneurysm treatment with small added risk in acute aneurysm treatment and seek to remodel the aneurysm-vessel interface without accessing the aneurysm sac. The latest development and most promising avenue appears to be intrasaccular flow disrupting devices like WEB, Contour and Neqstent that provide excellent opportunities to treat wide neck complex aneurysm with minimal mortality and morbidity and good occlusion rates and may in future replace a significant number of stent-assisted coiling too.
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Affiliation(s)
- Kavi Fatania
- Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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39
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Guenego A, Mine B, Bonnet T, Elens S, Vazquez Suarez J, Jodaitis L, Ligot N, Naeije G, Lubicz B. Long-term follow-up of the pCONus device for the treatment of wide-neck bifurcation aneurysms. Interv Neuroradiol 2021; 28:455-462. [PMID: 34516326 PMCID: PMC9326855 DOI: 10.1177/15910199211040279] [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: 11/15/2022] Open
Abstract
PURPOSE Wide-neck bifurcation aneurysms remain challenging for the neurointerventionist and/or neurosurgeon despite many recent advances. The pCONus (Phenox, Bochum, Germany) is an emerging device for endovascular neck protection, we report the first long-term results of this device. METHODS We performed a retrospective analysis of all consecutive intracranial wide-neck bifurcation aneurysms treated with the pCONus. Patients' characteristics were reviewed, procedural complications, angiographic (Roy-Raymond scale) and clinical outcomes were documented. RESULTS Between January 2016 and September 2019, 43 patients (74% female, median age 56 [49-66] years) with 43 wide-neck bifurcation aneurysms (mean width of 6.8 ± 2.1 mm, dome/neck ratio of 1.3 ± 0.2 and neck of 5.2 ± 1.3 mm) were included. A procedural angiographic complication was reported in five patients (12%), no patient presented a post-operative neurological deficit or long-term complication, mortality rate was 0%. At last follow-up (median of 46.5 months [38.3-51.7]), an adequate occlusion (complete and neck remnant) was observed in 37/43 patients (86%) and an aneurysm remnant in 6/43 (14%). Four patients (9%) needed retreatment. No in-stent stenosis or branch occlusion was depicted. CONCLUSION pCONus device provides a safe and efficient alternative for endovascular wide-neck bifurcation aneurysms management, with long-term stability.
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Affiliation(s)
- Adrien Guenego
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Belgium
| | - Stephanie Elens
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Belgium
| | - Juan Vazquez Suarez
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Belgium
| | - Lise Jodaitis
- Department of Neurology, 70496Erasme University Hospital, Belgium
| | - Noémie Ligot
- Department of Neurology, 70496Erasme University Hospital, Belgium
| | - Gilles Naeije
- Department of Neurology, 70496Erasme University Hospital, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Belgium
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40
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Spelle L, Herbreteau D, Caroff J, Barreau X, Ferré JC, Fiehler J, Januel AC, Costalat V, Liebig T, Bourcier R, Möhlenbruch M, Berkefeld J, Weber W, Mihalea C, Ikka L, Ozanne A, Cognard C, Narata AP, Bibi RE, Gauvrit JY, Raoult H, Velasco S, Buhk JH, Chalumeau V, Bester M, Desal H, du Mesnil de Rochemont R, Bohner G, Fischer S, Biondi A, Grimaldi L, Moret J, Byrne J, Pierot L. CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): results of 1-month and 1-year assessment of rebleeding protection and clinical safety in a multicenter study. J Neurointerv Surg 2021; 14:807-814. [PMID: 34493578 PMCID: PMC9304095 DOI: 10.1136/neurintsurg-2021-017416] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022]
Abstract
Background The primary goal of the CLARYS study is to assess the protection against rebleeding when treating ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) device. Methods The CLARYS study is a prospective, multicenter study conducted in 13 European centers. Patients with ruptured bifurcation aneurysms were consecutively included between February 2016 and September 2017. The primary endpoint was defined as the rebleeding rate of the target aneurysm treated with the WEB within 30 days postprocedure. Secondary endpoints included periprocedural and postprocedural adverse events, total procedure and fluoroscopy times, and modified Rankin Scale score at 1 month and 1 year. Results Sixty patients with 60 ruptured bifurcation aneurysms to be treated with the WEB were included. A WEB device was successfully implanted in 93.3%. The rebleeding rate at 1 month and 1 year was 0%. The mean fluoroscopy time was 27.0 min. Twenty-three periprocedural complications were observed in 18 patients and resolved without sequelae in 16 patients. Two of these complications were attributed to the procedure and/or the use of the WEB, leading to a procedure/device-related intraoperative complication rate of 3.3%. Overall mortality at 1 month and 1 year was 1.7% and 3.8%, respectively and overall morbidity at 1 month and 1 year was 15% and 9.6%, respectively. WEB-related 1-month and 1-year morbidity and mortality was 0%. Conclusions The interim results of CLARYS show that the endovascular treatment of ruptured bifurcation aneurysms with the WEB is safe and effective and, in particular, provides effective protection against rebleeding. It may induce profound change in the endovascular management of ruptured bifurcation aneurysms.
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Affiliation(s)
- Laurent Spelle
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France .,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, Pellegrin University Hospital, Bordeaux, France
| | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Vincent Costalat
- Department of Neuroradiology, University Hospital Gui de Chauliac, Montpellier, France
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital, Munchen, Germany
| | - Romain Bourcier
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Joachim Berkefeld
- Institut für Neuroradiologie, Universitätsklinikum, Frankfurt am Main, Germany.,Goethe-Universität, Frankfurt am Main, Germany
| | - Werner Weber
- Department of Neuroradiology, University Hospital of the Ruhr, Bochum, Germany
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Léon Ikka
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Augustin Ozanne
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Richard Edwige Bibi
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Jean-Yves Gauvrit
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Hélène Raoult
- Department of Neuroradiology, Regional University Hospital, Rennes, France
| | - Stéphane Velasco
- Department of Radiology, Regional University Hospital, Poitiers, France
| | - Jan-Hendrik Buhk
- Department of Neuroradiology, Asklepios Hospital Group, Hamburg, Germany
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hubert Desal
- Department of Neuroradiology, Regional University Hospital, Nantes, France
| | | | - Georg Bohner
- Department of Neuroradiology, Charité Universitatsmedizin, Berlin, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, University Hospital of the Ruhr, Bochum, Germany
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapy, Jean-Minjoz University Hospital, Besancon, France
| | - Lamiae Grimaldi
- Assistance Publique - Hopitaux de Paris, Paris, France.,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
| | - Jacques Moret
- NEURI Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France.,Assistance Publique - Hopitaux de Paris, Paris, France
| | - James Byrne
- Department of Neuroradiology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, Reims, France.,Reims Champagne-Ardenne University, Reims, France
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Mokin M, Hirsch JA, Fiorella D, Jadhav AP. Lies, damned lies, and TICI. J Neurointerv Surg 2021; 13:769-770. [PMID: 34389630 DOI: 10.1136/neurintsurg-2021-018072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
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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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43
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Siddiqui FM, Pandey AS. Commentary: Post-Market American Experience With Woven EndoBridge Device: Adjudicated Multicenter Case Series. Neurosurgery 2021; 89:E112-E113. [PMID: 34133743 DOI: 10.1093/neuros/nyab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fazeel M Siddiqui
- Department of Neurology, Metro Health, University of Michigan, Wyoming, Michigan, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Sattur MG, Al Kasab S, Porto GB, Spiotta AM. Endovascular Treatment of Basilar Bifurcation Aneurysms With PulseRider-Assisted Coiling: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E109-E110. [PMID: 33861344 DOI: 10.1093/ons/opab102] [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: 10/02/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
Wide-necked bifurcation aneurysms pose technical and anatomical challenges to endovascular treatment, which make the simpler assisted (balloon or single stent) coiling techniques less effective.1 Consequently, unique endovascular solutions to treat such aneurysms have been devised.2,3 One such device is PulseRider (Cerenovus, New Brunswick, New Jersey), which is designed to provide neck support for a coil mass while protecting the bifurcation.3 The device comprises a body or stem that is deployed in the parent artery and a saddle component that sits at the aneurysm neck to keep the coil mass away from the bifurcation. There are several technical nuances involved in successful use of the device during positioning, deployment, and detachment.3 We present a surgical video detailing the steps of PulseRider-assisted coiling of unruptured basilar bifurcation (or basilar apex) aneurysms. The first case highlights index treatment at diagnosis and the second showcases treatment of a recurrent basilar apex aneurysm. Both patients provided informed consent to the procedure. We also briefly discuss the rationale for treating basilar apex aneurysms.4,5.
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Affiliation(s)
- Mithun G Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme B Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Rai AT, Turner RC, Brotman RG, Boo S. Comparison of operating room variables, radiation exposure and implant costs for WEB versus stent assisted coiling for treatment of wide neck bifurcation aneurysms. Interv Neuroradiol 2021; 27:465-472. [PMID: 33076746 PMCID: PMC8392778 DOI: 10.1177/1591019920965392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The WEB device offers another option for treating wide neck bifurcation aneurysms (WNBA). The objective was to compare procedure variables, radiation and implant cost between WEB and stent assisted coiling (SAC) for WNBA. METHODS A retrospective comparison of similarly sized WNBA treated with SAC or WEB over 5-years was performed. The operating room (arrival-departure), anesthesia (intubation-extubation), procedure duration (puncture-closure), fluoroscopy time and radiation dose(m-Gy) were recorded from the patients' charts. Implant cost per case of all implants (stents, coils, WEB) that were opened whether deployed or not was captured including any coils used in the WEB cases. The implant cost represented the true cost incurred by the institution. RESULTS There were 46 WEB and 41 SAC cases with no significant difference in aneurysm size. There were more MCA and ACOMM (p = 0.005) and more ruptured aneurysms (p = 0.02) in the WEB group. Regarding procedure variables (hours:minutes): Operating room time WEB 2:31 (±0:37) versus SAC 3:41 (±0:50) (p < 0.0001); anesthesia duration WEB 2:05 (±0:31) versus SAC 3:13 (±0:51) (p < 0.0001) and procedure duration WEB 1:16 (±0:29) versus SAC 2:09 (±0:46) (p < 0.0001). Regarding radiation: Fluoroscopy time WEB 0:34 (±0:18) versus SAC 1:06 (±0:35) (p < 0.0001) and radiation dose WEB 2392(±1086)m-Gy versus SAC 3442 (±1528)m-Gy (p = 0.0007). The implant cost was $17,028(±$5,527) for the WEB versus $23,813 (±$7,456) for the SAC group (p < 0.0001). CONCLUSION The WEB group had significantly shorter operating room, procedure and anesthesia duration compared to the SAC group. The radiation dose and fluoroscopy time was lower for the WEB group. The total implant cost per case was significantly lower for the WEB versus the SAC group.
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Affiliation(s)
- Ansaar T Rai
- Interventional Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Ryan C Turner
- Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ryan G Brotman
- Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - SoHyun Boo
- Interventional Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, School of Medicine, Morgantown, WV, USA
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Monteiro A, Lazar AL, Waqas M, Rai HH, Baig AA, Cortez GM, Dossani RH, Cappuzzo JM, Levy EI, Siddiqui AH. Treatment of ruptured intracranial aneurysms with the Woven EndoBridge device: a systematic review. J Neurointerv Surg 2021; 14:366-370. [PMID: 34266907 DOI: 10.1136/neurintsurg-2021-017613] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/28/2021] [Indexed: 11/04/2022]
Abstract
The Woven EndoBridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the aneurysm's parent vessel lumen obviates the need for potent antiplatelet therapy, making this device appealing for acutely ruptured aneurysms not amenable to clipping or coiling. To assess the literature regarding WEB treatment of these aneurysms, we performed a comprehensive systematic search of PubMed, MEDLINE, and EMBASE databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were combined with Boolean operators to increase search sensitivity and specificity ('woven endobridge device' AND 'ruptured'). Nine studies comprising 377 acutely ruptured aneurysms were included. Overall, 82.7% were wide-necked, 85.9% were located in the anterior circulation, and 26.9% of patients presented with poor subarachnoid hemorrhage grade. Intraprocedure and postprocedure complications occurred in 8.4% (95% CI 3.6% to 13.3%) and 1% (95% CI 0% to 2%), respectively. The post-treatment rebleeding rate was 0%. Rates of adequate occlusion (complete occlusion to neck remnant) and retreatment at last follow-up were 84.8% (95% CI 73% to 96.6%) and 4.5% (95% CI 2.2% to 6.8%), respectively. The favorable outcome rate (modified Rankin Scale score 0-2) was 62.2% (95% CI 53% to 71.4%); mortality was 13.6% (95% CI 9.7% to 17.6%). WEB treatment of acutely ruptured aneurysms results in high adequate occlusion rates, low perioperative complication rates, no rebleeding, and low recurrence requiring retreatment. This device is promising for acutely ruptured aneurysms not amenable to clipping or coiling, considering the lower need for antiplatelet regimens during the procedure or follow-up.
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Affiliation(s)
- Andre Monteiro
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Audrey L Lazar
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Hamid H Rai
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Ammad A Baig
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | | | - Rimal H Dossani
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA .,Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Khorasanizadeh M, Ogilvy CS. Commentary: Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021; 88:E417-E419. [PMID: 33588441 DOI: 10.1093/neuros/nyab008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- MirHojjat Khorasanizadeh
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Cherian J, Chen SR, Puri A, Vakharia K, Levy E, Eshraghi S, Howard BM, Tong FC, Cawley CM, Gross B, Alexander MD, Grandhi R, Srinivasan VM, Burkhardt JK, Johnson JN, Kan P. Postmarket American Experience With Woven EndoBridge Device: Adjudicated Multicenter Case Series. Neurosurgery 2021; 89:275-282. [PMID: 33989398 DOI: 10.1093/neuros/nyab158] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/09/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The Woven EndoBridge (WEB) device was granted premarket approval in the United States following results of the Woven EndoBridge Intrasaccular Therapy (WEB-IT) study. WEB-IT reported excellent adequate angiographic occlusion of treated aneurysms with a high safety profile. These results were achieved, however, in the context of a prospective study with strict inclusion criteria and rigorous training support. OBJECTIVE To review early as-practiced clinical experience with the WEB device in the United States. METHODS Retrospective review across 6 institutions identified 91 patients undergoing 92 treatment sessions for WEB device placement in treatment of 91 intracranial aneurysms. Details regarding demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed in a multicenter database. Angiograms from the index procedure and follow-up studies were reviewed by a blinded and independent adjudicator. RESULTS The middle cerebral, anterior communicating, and basilar artery complexes were the commonly treated locations. Eight patients presented with ruptured aneurysms. A mean of 1.2 devices were introduced per case. Technical failure without deployment of a WEB device occurred in 2% (2/92) of sessions. Complete aneurysm occlusion for patients with imaging follow-up was 49% (mean follow-up of 8 mo). Four aneurysms were retreated. 90% of patients had modified Rankin Scale ≤ 2 at last clinical follow-up with no mortalities. CONCLUSION Immediate postmarket experience with the WEB device, newly introduced at American centers, confirms safe procedural use, but long-term efficacy remains unclear. Early challenges include accurate sizing and device selection.
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Affiliation(s)
- Jacob Cherian
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Stephen R Chen
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ajit Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kunal Vakharia
- Department of Neurological Surgery, Jacobs School of Medicine at Biomedical Sciences, Buffalo, New York, USA
| | - Elad Levy
- Department of Neurological Surgery, Jacobs School of Medicine at Biomedical Sciences, Buffalo, New York, USA
| | - Sheila Eshraghi
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Frank C Tong
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Bradley Gross
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew D Alexander
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Visish M Srinivasan
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
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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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50
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Won SY, Seifert V, Dubinski D, Kashefiolasl S, Dinc N, Bruder M, Konczalla J. Short- and midterm outcome of ruptured and unruptured intracerebral wide-necked aneurysms with microsurgical treatment. Sci Rep 2021; 11:4982. [PMID: 33654126 PMCID: PMC7925666 DOI: 10.1038/s41598-021-84339-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
To clip or coil has been matter of debates for several years and is the domain of interdisciplinary decision making. However, the microsurgical outcome has still been elusive concerning wide neck aneurysms (WNA). A retrospective single center study was performed with all patients with ruptured WNA (rWNA) and unruptured WNA (uWNA) admitted to author´s institute between 2007–2017. Microsurgical outcome was evaluated according to Raymond-Roy occlusion grade and follow-up angiography was performed to analyze the stability of neck/aneurysm remnants and retreatment poverty. Of 805 aneurysms, 139 were rWNA (17.3%) and 148 uWNA (18.4%). Complete occlusion was achieved in 102 of 139 rWNA (73.4%) and 112 of 148 uWNA (75.6%). Neck remnants were observed in 36 patients with rWNA (25.9%) and 30 patients with uWNA (20.3%), 1 (0.7%) and 6 (4.1%) patients had aneurysmal remnant, respectively. Overall complication rate was 11.5%. At follow-up (939/1504 months), all remnants were stable except for one, which was further conservatively treated with marginal retreatment rate under 1%. Even the risk of de-novo aneurysm was higher than the risk for remnant growth (2.6% vs 0% in rWNA; 8.7% vs 5.3% in uWNA) without significant difference. Microsurgical clipping is effective for complete occlusion of r/uWNA with low complication. Furthermore, the risk of remnant growth is marginal even lower than the risk of de-novo rate low retreatment rate.
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Affiliation(s)
- Sae-Yeon Won
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Sepide Kashefiolasl
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Markus Bruder
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Juergen Konczalla
- Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany
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