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Dmytriw AA, Salim H, Musmar B, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Dibas M, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, Naamani KE, Shotar E, Premat K, Möhlenbruch M, Kral M, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Tutino VM, Ibrahim MK, Mohammed MA, Imamoglu C, Bayrak A, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Ogilvie M, Sporns P, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Diestro JDB, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk R, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Clarençon F, Limbucci N, Cuellar-Saenz HH, Jabbour PM, Pereira VM, Patel AB, Adeeb N. Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis. Neurosurg Rev 2024; 47:116. [PMID: 38483647 DOI: 10.1007/s10143-024-02341-z] [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: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms. METHODS A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture. RESULTS Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23). CONCLUSION The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up.
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Affiliation(s)
- Adam A Dmytriw
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA.
| | - Hamza Salim
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Basel Musmar
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Assala Aslan
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Nicole M Cancelliere
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Rachel M McLellan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Oktay Algin
- Medical Faculty, Department of Radiology, Ankara University, Ankara, Turkey
| | - Sherief Ghozy
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Mahmoud Dibas
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgique
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Joseph Carnevale
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Guillaume Saliou
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eimad Shotar
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Kevin Premat
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Markus Möhlenbruch
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Kral
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Omer Doron
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Charlotte Chung
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Hamza Shaikh
- Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Joshua Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Muhammad Waqas
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mohamed K Ibrahim
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marwa A Mohammed
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Cetin Imamoglu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - Ahmet Bayrak
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Clemens M Schirmer
- Department of Neurosurgery and Radiology, Geisinger Health System, Danville, PA, USA
| | - Mariangela Piano
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Anna L Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | | | - Stéphanie Elens
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, FL, USA
| | - Ameer E Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Mark Ogilvie
- Deparments of Neurosurgery and Radiology, University of Alabama, Birmingham, AL, USA
| | - Peter Sporns
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama, Birmingham, AL, USA
| | - Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marie T Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Christian Ulfert
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jose Danilo Bengzon Diestro
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bryan Pukenas
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Thien Huynh
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Juan Carlos Martinez-Gutierrez
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunil A Sheth
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gary Spiegel
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rabih Tawk
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Boris Lubicz
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele Milano, Milan, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Erez Nossek
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Eytan Raz
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Monika Killer-Oberfalzer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Allan L Brook
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Frédéric Clarençon
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Nicola Limbucci
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vitor Mendes Pereira
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
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Semeraro V, Palmisano V, Limbucci N, Comelli S, Comelli C, Ganimede MP, Lozupone E, Barone M, Marrazzo A, Paladini A, Della Malva G, Briatico Vangosa A, Laiso A, Renieri L, Capasso F, Gandini R, Di Stasi C, Resta M, Mangiafico S, Burdi N. Woven EndoBridge Device for Unruptured Wide-Neck Bifurcation Aneurysm: A Multicenter 5-Year Follow-up. Neurosurgery 2023:00006123-990000000-00978. [PMID: 38038472 DOI: 10.1227/neu.0000000000002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This multicenter study aimed to assess the safety and efficacy of the Woven EndoBridge (WEB) device for treating unruptured wide-neck intracranial bifurcation aneurysms (WIBAs) with short-, mid-, and long-term follow-ups (FUPs). METHODS Consecutive patients with unruptured WIBAs treated with WEB between December 2014 and January 2018 were included. Patient, aneurysm, and device characteristics were collected and analyzed retrospectively. Morbidity and mortality rates were determined by collecting intraprocedural, periprocedural, and delayed complications. Aneurysm occlusion was assessed at 1, 3, and 5 years using a 3-grade scale: complete occlusion, neck remnant, and residual aneurysm. Complete occlusion and neck remnant were considered as adequate occlusion. Patients who received re-treatment were also evaluated. RESULTS The study included 104 consecutive patients (55.8% female, mean age 58.6 ± 11.8 years). Aneurysm maximum size, neck, and dome-to-neck mean were, respectively, 6.9 ± 2.1 mm, 4.5 ± 1.2 mm, and 1.4 ± 0.3 mm. One-year FUP was collected for 95 patients, and 3- and 5-year FUPs were collected for 83 patients. Adequate occlusion was observed at 1-year FUP in 90.5% (86/95), 91.6% (76/83) was observed at 3-year FUP, and 92.8% (77/83) at 5-year FUP. None of the aneurysms bled after treatment. During FUP, 6/83 patients (7.2%) were re-treated for residual aneurysm. Morbidity and mortality rates closely related to aneurysm occlusion were 0% (0/104). CONCLUSION The WEB device was safe and effective for treating unruptured WIBAs, both in short-term and long-term FUPs.
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Affiliation(s)
- Vittorio Semeraro
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Vitanio Palmisano
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simone Comelli
- Neuroradiology and Vascular Radiology Unit, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", Cagliari, Italy
| | - Chiara Comelli
- Radiology and Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | | | - Michele Barone
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Antonio Marrazzo
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Andrea Paladini
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | | | | | - Antonio Laiso
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Renieri
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesco Capasso
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Roberto Gandini
- Department of Interventional Radiology, University Hospital "Tor Vergata", Rome, Italy
| | - Carmine Di Stasi
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Maurizio Resta
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | | | - Nicola Burdi
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
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Sirakov A, Bhogal P, Sirakova K, Penkov M, Minkin K, Ninov K, Hristov H, Hadzhiyanev A, Karakostov V, Sirakov S. Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center. J Neurointerv Surg 2023; 15:989-994. [PMID: 36261278 PMCID: PMC10511998 DOI: 10.1136/jnis-2022-019295] [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: 06/24/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Endovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus. METHODS Clinical and radiological data were retrospectively collected for all patients treated with the Nautilus for an unruptured or ruptured intracranial aneurysm at our center between March 2021 and March 2022. Clinical outcomes (modified Rankin Scale (mRS) scores), Raymond-Roy angiographic occlusion, recanalization, and complications were measured immediately post-procedure and at 3-6-month follow-up. RESULTS A total of 41 patients of mean age 56.7 years (range 37-83 years) were treated with the Nautilus, with 41 saccular aneurysms (18 (43.9%) unruptured and 23 (56.1%) ruptured). The majority of aneurysms (39/41 (95.1%)) were located in the anterior circulation. We experienced no technical complications. One patient had an asymptomatic post-procedural minor stroke related to the procedure. Immediate Class I occlusion was achieved in 30 (73.1%) patients. The rate of all-cause mortality was 7.3% (3/41). One patient was lost to follow-up. At follow-up, 94.5% (35/37) of patients achieved Class I occlusion and 94.5% (35/37) had an mRS score of 0. There were no procedural-related deaths or permanent morbidities at discharge or follow-up. CONCLUSION This study demonstrates good safety and effectiveness using the Nautilus Intrasaccular System to treat both ruptured and unruptured intracranial aneurysms. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Alexander Sirakov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | | | - Kristina Sirakova
- Radiology Department, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Marin Penkov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Krasimir Minkin
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Kristian Ninov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Hristo Hristov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Asen Hadzhiyanev
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Vasil Karakostov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Stanimir Sirakov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
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Merritt WC, Norris N, Robertson S, Preul MC, Ducruet AF, Becker TA. Large, Wide-Neck, Side-Wall Aneurysm Treatment in Canines Using NeuroCURE: A Novel Liquid Embolic. STROKE (HOBOKEN, N.J.) 2023; 3:e000857. [PMID: 37711749 PMCID: PMC10500583 DOI: 10.1161/svin.123.000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/22/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Untreated intracranial aneurysms can rupture and result in high rates of morbidity and mortality. Although there are numerous approved endovascular aneurysm treatment devices, most require dual anti-platelet therapy, are minimally biocompatible, or are prone to recanalization. Neurovascular Controlled Uniform Rapid Embolic (NeuroCURE) is an innovative polymer gel material with long-term stability, biocompatibility, and hemocompatibility developed for the treatment of large, wide-neck aneurysms. METHODS Sidewall aneurysms were surgically created in 10 canines and NeuroCURE was injected through a 0.025 microcatheter under a single balloon inflation period. Aneurysm treatment was angiographically assessed post-embolization and pre-term with Raymond-Roy occlusion classification and a qualitative flow grade scale. Aneurysm neck stability and biocompatibility was histologically assessed to grade platelet/fibrin thrombus, percent endothelialization, and neointimal formation. Aneurysm sac stability was assessed by NeuroCURE sac content, inflammation, and neo-angiogenesis scales. RESULTS Explanted aneurysms exhibited a smooth surface at the aneurysm neck with nearly complete neointimal coverage at 3-months. By 6-months, neck endothelialization was 100% in all animals (average Raymond-Roy occlusion classification of 1.2), with no instances of aneurysm recanalization or parent vessel flow compromise. Biocompatibility assessments verified a lack of inflammatory response, neo-angiogenesis, and platelet/fibrin thrombus formation. CONCLUSION The NeuroCURE material promotes progressive occlusion of wide-necked side wall aneurysms over time without the need for dual antiplatelet agents. NeuroCURE also promotes neointimal tissue infill without dependence on thrombus formation and thus resists aneurysm recanalization. NeuroCURE remains a compelling investigational device for the treatment of intracranial aneurysms.
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Affiliation(s)
- William C Merritt
- Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, United States; Aneuvas Technologies, Inc., Flagstaff, AZ, United States
| | - Nicholas Norris
- Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, United States
| | - Sophia Robertson
- Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, United States
| | - Mark C Preul
- Aneuvas Technologies, Inc., Flagstaff, AZ, United States; Barrow Neurological Institute, Phoenix, AZ, United States
| | - Andrew F Ducruet
- Aneuvas Technologies, Inc., Flagstaff, AZ, United States; Barrow Neurological Institute, Phoenix, AZ, United States
| | - Timothy A Becker
- Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ, United States; Aneuvas Technologies, Inc., Flagstaff, AZ, United States
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Alpay K, Lindgren A, Rautio R, Parkkola R. The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months. Neuroradiol J 2023; 36:206-212. [PMID: 36028945 PMCID: PMC10034693 DOI: 10.1177/19714009221122216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To identify factors influencing short- and mid-term radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB). METHODS A total of 112 patients were treated for IAs with the WEB in at our institution between 2013 and 2020. Patients with 6- and/or 24-months follow-up data were included in the study. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification (RR). RR 1 and RR 2 were considered as adequate outcomes, while RR 3 inadequate. RESULTS Data were available for 91 patients (56 females, 62%) at 6 months and 62 of those patients (39 females, 58%) at 24 months. The adequate occlusion (RR 1/RR 2) rate was 89% (n = 81/91) at the 6-months follow-up and 91% (n = 56/62) at the 24-months follow-up. The treatment-related morbidity rate was 4% (n = 4/91), and mortality rate was 1% (n = 1/91). The predictor for inadequate occlusion at the 6-months follow-up was the lobular shape of an aneurysm (p = .01). The aneurysm's height (p = .02), maximal diameter (p = .001), width (p = .002), aspect ratio (p = .03), dome-to-neck ratio (p = .04), and lobular shape (p= .03) were predictive factors for inadequate occlusion at 24 months. All the thrombosed aneurysms (n = 3) showed unfavorable radiological outcomes and required re-treatment within 24 months. None of the patient-related factors were significant. CONCLUSIONS The WEB provides favorable occlusion rates and low complications for both ruptured and unruptured wide-necked IAs. Unfavorable radiological outcomes after WEB treatment may be related to aneurysm morphology and size.
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Affiliation(s)
- Kemal Alpay
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Antti Lindgren
- Department of Clinical Radiology, 60650Kuopio University Hospital, Kuopio, Finland
| | - Riitta Rautio
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
- 60652Turku University, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
- 60652Turku University, Turku, Finland
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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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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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Simulation of intra-saccular devices for pre-operative device size selection: Method and validation for sizing and porosity simulation. Comput Biol Med 2022; 147:105744. [PMID: 35763930 DOI: 10.1016/j.compbiomed.2022.105744] [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: 03/22/2022] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022]
Abstract
Intra-saccular devices (ID) are novel braided devices used for complex intracranial aneurysms treatment. Treatment success is associated with correct device size selection. A technique that predicts the ID size within the aneurysm before intervention will provide a powerful computational tool to aid the interventionist during device selection. We present a method to calculate the device's final height, radial expansion and porosity within the patient's anatomy, which allows assessing different device sizes before treatment takes place. The proposed sizing technique was tested in-vitro and in real patient's geometries obtained from 3DRA angiographic images of 8 unruptured aneurysms previously treated with IDs. The obtained simulated height was compared to the real height, with a mean error of less than 0.28 mm (±0.44). The porosity calculation method was tested in-vitro with an error of 0.02 (±0.022). The results of both sizing and porosity experiments resemble well measures from real patients. This methodology could be used before treatment to provide the interventionist with additional information that allows selecting the device that best fits the patient's aneurysm to be treated.
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9
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Laurent D, Lucke-Wold B, Leary O, Randall MH, Porche K, Koch M, Chalouhi N, Polifka A, Hoh BL. The Evolution of Endovascular Therapy for Intracranial Aneurysms: Historical Perspective and Next Frontiers. Neurosci Insights 2022; 17:26331055221117560. [PMID: 35924091 PMCID: PMC9340900 DOI: 10.1177/26331055221117560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
The history of cerebral aneurysm treatment has a rich and storied past with multiple notable luminaries contributing insights. The modern era has transitioned from primarily clip ligation to increasing use of endovascular therapy. Even more recently, the use of intrasaccular flow diverters has been introduced for the treatment of wide necked aneurysms. The field is continuing to transform, and bioactive coils and stents have resurfaced as promising adjuvants to promote aneurysm healing. Advanced imaging modalities are being developed that could further advance the endovascular arsenal and allow for porous memory polymer devices to enter the field. This focused review highlights notable historic contributions and advances to the point of futuristic technology that is actively being developed.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Owen Leary
- Department of Neurosurgery, Brown University, Providence, RI, USA
| | - Morgan H Randall
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - Ken Porche
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Matthew Koch
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Nohra Chalouhi
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Adam Polifka
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Brian L Hoh
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
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10
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Pierot L. Ten Years of Clinical Evaluation of the Woven EndoBridge: A Safe and Effective Treatment for Wide-Neck Bifurcation Aneurysms. Neurointervention 2021; 16:211-221. [PMID: 34674453 PMCID: PMC8561039 DOI: 10.5469/neuroint.2021.00395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Intrasaccular flow disruption is an innovative approach for the endovascular treatment of intracranial aneurysms. As of now, only one device is currently available worldwide: the Woven EndoBridge (WEB) device (MicroVention, Aliso Viejo, CA, USA). After 10 years of clinical use and careful clinical evaluation of the WEB device by multiple prospective, multicenter studies, this article is summarizing the current knowledge regarding this endovascular technique; indications, modalities, safety and efficacy of the WEB procedure are described.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
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11
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Essibayi MA, Lanzino G, Brinjikji W. Safety and Efficacy of the Woven EndoBridge Device for Treatment of Ruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2021; 42:1627-1632. [PMID: 34117016 DOI: 10.3174/ajnr.a7174] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Woven EndoBridge device has been increasingly used to treat wide-neck aneurysms, particularly ruptured ones. PURPOSE Our aim was to investigate the safety and efficacy of the Woven EndoBridge device in the treatment of ruptured intracranial aneurysms. DATA SOURCES All studies evaluating the outcomes of Woven EndoBridge device use in the treatment of ruptured intracranial aneurysms from inception through 2020 were searched on Ovid Evidence-Based Medicine Reviews, EMBASE, MEDLINE, Scopus, and the Web of Science Core Collection. STUDY SELECTION Eighteen studies encompassing 487 patients with 496 ruptured aneurysms treated with the Woven EndoBridge device were included. DATA ANALYSIS We studied rates of rerupture and retreatment, angiographic outcomes at the last follow-up point, complications, and mortality rates. Data were collected on anticoagulation and antiplatelet use. Meta-analysis was performed using the random effects model. DATA SYNTHESIS The rate of late rebleeding was 1.1% (95% CI, 0.1%-2.1%). The treatment-related perioperative complication rate and the overall clinical complication rate were 13.2% (95% CI, 9.2%-17.2%) and 3.2% (95% CI, 1.6%-4.7%), respectively. Thirteen hemorrhagic (2%; 95% CI, 0.8%-3.3%) and 41 thromboembolic (6.8%; 95% CI, 4.6%-9%) complications occurred. Favorable clinical outcomes were achieved in 85% of patients. Procedure-related mortality and overall mortality rates were 2.1% (95% CI, 0.8%-3.3%) and 11.5% (95% CI, 7%-16%), respectively. At last follow-up, an adequate occlusion rate was 87.3% (95% CI, 82.1%-92.4%) and the retreatment rate was 5.1% (95% CI, 3%-7.3%). LIMITATIONS Our meta-analysis is limited by selection bias and high heterogeneity. CONCLUSIONS This meta-analysis demonstrated the safety and efficacy of the Woven EndoBridge device in the management of ruptured aneurysms, but further studies are needed.
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Affiliation(s)
- M A Essibayi
- From the Department of Neurosurgery (M.A.E., G.L., W.B.)
| | - G Lanzino
- From the Department of Neurosurgery (M.A.E., G.L., W.B.)
- Radiology (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- From the Department of Neurosurgery (M.A.E., G.L., W.B.)
- Radiology (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
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12
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Huckleberry A, Merritt W, Cotter T, Settanni C, Preul MC, Ducruet AF, Becker TA. Application of a rabbit-elastase aneurysm model for preliminary histology assessment of the PPODA-QT liquid embolic. Surg Neurol Int 2021; 12:330. [PMID: 34345471 PMCID: PMC8326139 DOI: 10.25259/sni_163_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background PPODA-QT is a novel liquid embolic under development for the treatment of cerebral aneurysms. We sought to test the rabbit-elastase aneurysm model to evaluate the tissue response following PPODA-QT embolization. Methods Experimental elastase-induced aneurysms were created in fourteen New Zealand White Rabbits. Eight animals were used for aneurysm model and endovascular embolization technique development. Six PPODA-QT-treated animals were enrolled in the study. Control and aneurysm tissues were harvested at acute (n = 2), 1-month (n = 2), and 3-month (n = 2) timepoints and the tissues were prepared for histology assessment. Results All fourteen rabbit-elastase aneurysms resulted in small and medium aneurysm heights (<10 mm dome height) with highly variable neck morphologies, small midline dome diameters, and beyond-wide dome-to-neck (d: n) ratios. Histological evaluation of four aneurysms, treated with PPODA-QT, demonstrated reorganization of aneurysm wall elastin into a smooth muscle layer, and observed as early as the 1-month survival timepoint. At the aneurysm neck, a homogenous neointimal layer (200-300 μm) formed at the PPODA-QT interface, sealing off the parent vessel from the aneurysm dome. No adverse immune response was evident at 1- and 3-month survival timepoints. Conclusion PPODA-QT successfully embolized the treated aneurysms. Following PPODA-QT embolization, neointimal tissue growth and remodeling were noted with minimal immunological response. The experimental aneurysms created in rabbits were uniformly small with inconsistent neck morphology. Further testing of PPODA-QT will be conducted in larger aneurysm models for device delivery optimization and aneurysm healing assessment before human clinical investigation.
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Affiliation(s)
- April Huckleberry
- Department of Biology Northern Arizona University, Flagstaff, Arizona, United States
| | - William Merritt
- Department of Mechanical Engineering Northern Arizona University, Flagstaff, Arizona, United States
| | - Trevor Cotter
- Center for Materials Interfaces in Research and Applications, Northern Arizona University, Flagstaff, Arizona, United States
| | - Christopher Settanni
- Department of Mechanical Engineering Northern Arizona University, Flagstaff, Arizona, United States
| | - Mark C Preul
- Department of Neurosurgery Research, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Andrew F Ducruet
- Department of Neurosurgery Research, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Timothy Andrew Becker
- Department of Mechanical Engineering Northern Arizona University, Flagstaff, Arizona, United States
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13
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Shah KA, White TG, Teron I, Link T, Dehdashti AR, Katz JM, Woo HH. Volume-based sizing of the Woven EndoBridge (WEB) device: A preliminary assessment of a novel method for device size selection. Interv Neuroradiol 2021; 27:473-480. [PMID: 33478310 DOI: 10.1177/1591019920987685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Accurate sizing of the Woven EndoBridge (WEB) device is of critical importance as it determines procedural safety and successful occlusion of wide neck bifurcation aneurysms. The aim of this study was to assess the ability of aneurysm volume to assist in accurate WEB size selection. METHODS All patients with an intracranial aneurysm treated with the WEB SL or WEB SLS device between March 2019 and October 2019 were identified for this retrospective study. Aneurysm volumes were calculated with auto-segmentation using a three-dimensional volume rendering program on an independent Syngo workstation (Siemens Healthineers AG). Pearson correlation coefficients were calculated for aneurysm auto-segmented volumes and WEB volumes, as well as for aneurysm height × width and WEB height × width. Follow-up angiographic outcomes were collected at 6-9 months post-procedure. RESULTS Twenty-nine aneurysms were evaluated by 3D rotational angiography. The correlation coefficient with WEB size was larger for auto-segmented aneurysm volumes (r = 0.979) compared to height × width measurements (r = 0.867). Using Fisher r-to-z transformations, we found the difference between the two correlations to be statistically significant (p = 0.0007). Follow-up angiography available in 13 subjects demonstrated an 85% complete aneurysm occlusion rate. CONCLUSION Aneurysm volumes are highly correlated with WEB volumes, with auto-segmentation volumes displaying statistically significant difference against conventional height by width measurements. These results suggest that volumetric measurements of aneurysm size provide a useful adjuvant measure to assist in appropriate size selection of the WEB device.
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Affiliation(s)
- Kevin A Shah
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Timothy G White
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Ina Teron
- Department of Neurosurgery, Southside Hospital, Northwell Health, Bay Shore, USA
| | - Thomas Link
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, USA
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA
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14
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Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, Holtmannspötter M, Januel AC, Costalat V, Fiehler J, Klisch J, Gauvrit JY, Weber W, Desal H, Velasco S, Liebig T, Stockx L, Berkefeld J, Molyneux A, Byrne JV, Spelle L. Aneurysm Treatment With Woven EndoBridge in the Cumulative Population of 3 Prospective, Multicenter Series: 2-Year Follow-Up. Neurosurgery 2020; 87:357-367. [PMID: 31960052 PMCID: PMC7534535 DOI: 10.1093/neuros/nyz557] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Woven EndoBridge (WEB; Sequent Medical) treatment is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown high safety with good efficacy at short term confirmed by trials conducted in United States (WEB-Intrasaccular Therapy) and in Europe (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy [WEBCAST], French Observatory, and WEBCAST-2). OBJECTIVE To report the 2-yr clinical and anatomical results of WEB treatment in the combined population of 3 European trials. METHODS In a French Observatory, 2-yr clinical and anatomical data were collected. In WEBCAST and WEBCAST-2, 2-yr follow-up was optional, and data were collected when follow-up was performed. Aneurysm occlusion was evaluated using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The population for safety was 138/168 patients (82.1%), including 89 females (64.5%), with mean age of 55.5 ± 10.2 yr. The population for efficacy was 121/169 aneurysms (71.6%). Aneurysm locations were middle cerebral artery in 65/121 aneurysms (53.7%), anterior-communicating artery in 25/121 (20.7%), basilar artery in 17/121 (14.0%), and internal carotid artery terminus in 14/121 (11.6%). No clinically relevant adverse events occurred between years 1 and 2. At 2 yr, complete occlusion was observed in 62/121 (51.2%) aneurysms, neck remnant in 36/121 (29.8%) aneurysms, and aneurysm remnant in 23/121 (19.0%) aneurysms. The global retreatment rate at 2 yr was 9.3%. CONCLUSION This analysis confirms the high safety profile of WEB treatment at 2 yr. Aneurysm occlusion is generally stable at 2 yr, and the retreatment rate between 1 yr and 2 yr is low (2.0%).
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Jacques Moret
- Department of Neuroradiology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Istvan Szikora
- Department of Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | | | | | | | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Klisch
- Department of Neuroradiology, Helios General Hospital, Erfurt, Germany
| | | | - Werner Weber
- Department of Neuroradiology, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Hubert Desal
- Department of Neuroradiology, CHU Nantes, Nantes, France
| | | | - Thomas Liebig
- Institut of Neuroradiology, Ludwig-Maximilian University Hospital, Munich, Germany
| | - Luc Stockx
- Department of Neuroradiology, ZOL (Ziekenhuis Oost-Limburg) Genk, Genk, Belgium
| | - Joachim Berkefeld
- Department of Neuroradiology, Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt, Germany
| | - Andrew Molyneux
- Department of Neuroradiology, Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom
| | - James V Byrne
- Department of Neuroradiology, Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom
| | - Laurent Spelle
- Department of Neuroradiology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
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Bhogal P, Udani S, Cognard C, Piotin M, Brouwer P, Sourour NA, Andersson T, Makalanda L, Wong K, Fiorella D, Arthur AS, Yeo LLL, Soderman M, Henkes H, Pierot L. Endosaccular flow disruption: where are we now? J Neurointerv Surg 2019; 11:1024-1025. [DOI: 10.1136/neurintsurg-2018-014623] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/03/2022]
Abstract
Endosaccular flow disruption is an innovative method of treating wide-necked complex aneurysms. Currently four types of devices have obtained the CE mark for use within Europe. These are the Woven EndoBridge device (WEB), the Luna Aneurysm Embolization System, the Medina Embolic Device (Medtronic), and the Contour Neurovascular System. The aim of this article is to provide an overview of these devices and to summarize the evidence in the literature pertaining to the treatment of intracranial aneurysms with them.
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16
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Pierot L, Bannery C, Batchinsky-Parrou V, Kleiber JC, Soize S, Litre CF. Clipping of recanalized intracerebral aneurysms initially treated by the Woven EndoBridge device. J Neurointerv Surg 2019; 11:807-811. [DOI: 10.1136/neurintsurg-2019-014903] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeIntrasaccular flow disruption using the Woven EndoBridge (WEB) is a safe and effective method to treat intracranial aneurysms, particularly wide neck bifurcation aneurysms. However mid term and long term follow-up imaging can show aneurysm remnant or recanalization, and retreatment is therefore sometimes necessary. In most cases, retreatment is performed using an endovascular approach. The present series reports and analyzes aneurysm clipping of recanalized or incompletely occluded aneurysms following WEB treatment.MethodsAll patients treated with the WEB device since the beginning of our experience in June 2011 were prospectively collected in a local database. Among them, patients who were retreated by clipping for aneurysm remnants were included in the present series.ResultsIn the cumulative population of 130 patients with aneurysms treated by the WEB device from June 2011 to February 2019, 4 patients (3.1%) were retreated with surgical clipping due to incomplete occlusion (2 patients) and aneurysm recanalization (2 patients). Three of the four aneurysms retreated (75%) were located in the middle cerebral artery and one in the anterior communicating artery (25.0%). The aneurysm was ruptured in 1 of 4 patients (25%). Clipping was performed 10–54 months after initial treatment with the WEB. Surgical exposure showed that the WEB device was inside the aneurysm sac in all cases. Clipping was easily performed in all but 1 case. Control DSA showed complete occlusion in two aneurysms and a neck remnant in two.ConclusionClipping is a feasible option for treating aneurysm remnants following initial treatment with intrasaccular flow disruption using the WEB.
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17
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Zhu Y, Zhang H, Zhang Y, Wu H, Wei L, Zhou G, Zhang Y, Deng L, Cheng Y, Li M, Santos HA, Cui W. Endovascular Metal Devices for the Treatment of Cerebrovascular Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1805452. [PMID: 30589125 DOI: 10.1002/adma.201805452] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/20/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular disease involves various medical disorders that obstruct brain blood vessels or deteriorate cerebral circulation, resulting in ischemic or hemorrhagic stroke. Nowadays, platinum coils with or without biological modification have become routine embolization devices to reduce the risk of cerebral aneurysm bleeding. Additionally, many intracranial stents, flow diverters, and stent retrievers have been invented with uniquely designed structures. To accelerate the translation of these devices into clinical usage, an in-depth understanding of the mechanical and material performance of these metal-based devices is critical. However, considering the more distal location and tortuous anatomic characteristics of cerebral arteries, present devices still risk failing to arrive at target lesions. Consequently, more flexible endovascular devices and novel designs are under urgent demand to overcome the deficiencies of existing devices. Herein, the pros and cons of the current structural designs are discussed when these devices are applied to the treatment of diseases ranging broadly from hemorrhages to ischemic strokes, in order to encourage further development of such kind of devices and investigation of their use in the clinic. Moreover, novel biodegradable materials and drug elution techniques, and the design, safety, and efficacy of personalized devices for further clinical applications in cerebral vasculature are discussed.
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Affiliation(s)
- Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hongbo Zhang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Yiran Zhang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Huayin Wu
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Gen Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Yuezhou Zhang
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Minghua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, FI-00014, Helsinki, Finland
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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Pierot L, Arthur AS, Fiorella D, Spelle L. Intrasaccular Flow Disruption with WEB Device: Current Place and Results in Management of Intracranial Aneurysms. World Neurosurg 2018; 122:313-316. [PMID: 30471439 DOI: 10.1016/j.wneu.2018.11.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hospital Maison-Blanche, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neurosurgery, Cerebrovascular Center, State University of New York, Stony Brook, New York, USA
| | - Laurent Spelle
- NEURI Center, Interventional Neuroradiology, Hospital Bicêtre, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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19
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Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, Holtmannspötter M, Januel AC, Costalat V, Fiehler J, Klisch J, Gauvrit JY, Weber W, Desal H, Velasco S, Liebig T, Stockx L, Berkefeld J, Molyneux A, Byrne J, Spelle L. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series. J Neurointerv Surg 2018; 10:553-559. [PMID: 28965106 PMCID: PMC5969386 DOI: 10.1136/neurintsurg-2017-013448] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow disruption with the WEB is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown a low complication rate with good efficacy. PURPOSE To report clinical and anatomical results of the WEB treatment in the cumulative population of three Good Clinical Practice (GCP) studies: WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm), French Observatory, and WEBCAST-2. METHODS WEBCAST, French Observatory, and WEBCAST-2 are single-arm, prospective, multicenter, GCP studies dedicated to the evaluation of WEB treatment. Clinical data were independently evaluated. Postoperative and 1-year aneurysm occlusion was independently evaluated using the 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The cumulative population comprised 168 patients with 169 aneurysms, including 112 female subjects (66.7%). The patients' ages ranged between 27 and 77 years (mean 55.5±10.2 years). Aneurysm locations were middle cerebral artery in 86/169 aneurysms (50.9%), anterior communicating artery in 36/169 (21.3%), basilar artery in 30/169 (17.8%), and internal carotid artery terminus in 17/169 (10.1%). The aneurysm was ruptured in 14/169 (8.3%). There was no mortality at 1 month and procedure/device-related morbidity was 1.2% (2/168). At 1 year, complete aneurysm occlusion was observed in 81/153 aneurysms (52.9%), neck remnant in 40/153 aneurysms (26.1%), and aneurysm remnant in 32/153 aneurysms (20.9%). Re-treatment was carried out in 6.9%. CONCLUSIONS This series is at the moment the largest prospective, multicenter, GCP series of patients with aneurysms treated with WEB. It shows the high safety and good mid-term efficacy of this treatment. CLINICAL TRIAL REGISTRATION French Observatory: Unique identifier (NCT18069); WEBCAST and WEBCAST-2: Unique identifier (NCT01778322).
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Affiliation(s)
- Laurent Pierot
- Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Jacques Moret
- Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France
| | | | - Istvan Szikora
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | | | | | | | | | - Jens Fiehler
- Departrment of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Werner Weber
- Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | | | | | | | - Luc Stockx
- ZOL(Ziekenhuis Oost-Limburg) Genk, Genk, Belgium
| | - Joachim Berkefeld
- Institutfür Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt, Germany
| | - Andrew Molyneux
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
| | - James Byrne
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
| | - Laurent Spelle
- Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France
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Lv X, Zhang Y, Jiang W. Systematic Review of Woven EndoBridge for Wide-Necked Bifurcation Aneurysms: Complications, Adequate Occlusion Rate, Morbidity, and Mortality. World Neurosurg 2018; 110:20-25. [PMID: 29107726 DOI: 10.1016/j.wneu.2017.10.113] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the Woven EndoBridge (WEB [Sequent Medical, Aliso Viejo, California, USA]) is a highly innovative technique for the endovascular treatment of wide-necked bifurcation aneurysms (WNBAs), there are no studies available comparing this technique with surgical results or other endovascular results of stent-assisted coiling or balloon-assisted coiling for WNBAs. The purpose of this study was to assess complications, complete occlusion rate, and morbidity and mortality of the WEB in WNBA treatment. METHODS Published literature citing embolization results for WNBAs using the WEB was reviewed. A systematic review was performed to evaluate the complications, complete occlusion rate, and morbidity and mortality. RESULTS We identified 19 studies, including 935 patients. The most frequent aneurysm locations were the bifurcation of the middle cerebral artery (MCA) (42.8%), the anterior communicating artery (23%), and the basilar bifurcation (20.8%). The technical success rate of the WEB was 97% (95% confidence interval [CI], 96%-98%). The thromboembolic complication rate was 8% (95% CI, 6%-11%). The thromboembolic complication rate was 10% (95% CI, 7%-13%) in cases before 2013, which was higher than in cases after 2013 (6%; 95% CI, 4%-9%; P = 0.045). MCA bifurcation aneurysm has a higher thromboembolic complication rate than posterior circulation aneurysm. The overall bleeding complication rate of the WEB was 2% (95% CI, 1%-3%). The adequate occlusion rate was 81% (95% CI, 76%-85%). Morbidity during follow-up was 3% (95% CI, 1%-4%) (I2 = 30.4%), and mortality was 2% (95% CI, 1%-3%). CONCLUSIONS Adequate aneurysm occlusion was found in 81% of WEB cases with low morbidity and mortality.
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Affiliation(s)
- Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China; New Era Stroke Care and Research Institute, The PLA Rocket Force General Hospital, Beijing, China
| | - Yupeng Zhang
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weijian Jiang
- New Era Stroke Care and Research Institute, The PLA Rocket Force General Hospital, Beijing, China.
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Should indications for WEB aneurysm treatment be enlarged? Report of a series of 20 patients with aneurysms in “atypical” locations for WEB treatment. J Neuroradiol 2017; 44:203-209. [DOI: 10.1016/j.neurad.2016.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022]
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Mine B, Goutte A, Brisbois D, Lubicz B. Endovascular treatment of intracranial aneurysms with the Woven EndoBridge device: mid term and long term results. J Neurointerv Surg 2017; 10:127-132. [DOI: 10.1136/neurintsurg-2016-012964] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/03/2022]
Abstract
PurposeTo evaluate the clinical and anatomical results of treatment of intracranial aneurysms (IA) with the Woven EndoBridge (WEB) device, with emphasis on mid term and long term follow-up.MethodsBetween November 2010 and November 2015, we retrospectively identified, in our prospectively maintained database, all patients treated by WEB device placement for an IA at three institutions. Clinical charts, procedural data, and angiographic results were reviewed.Results48 patients with 49 IAs were identified. There were 35 women and 13 men with a mean age of 57 years (range 35–76 years). All IA were wide necked. Mean aneurysm size was 8.6 mm. There were 44 unruptured IA and 5 ruptured IA. During endovascular treatment (EVT), adjunctive devices were used in 22.4% of procedures. A good clinical outcome (modified Rankin Scale score ≤2) was achieved in 44/48 patients (92%). There was no mortality. Mean follow-up was 25 months (range 3–72 months; median 24 months). Between mid term and long term follow-up, occlusion was stable in 19/23 IA (82.6%), improved in 2/23 IA (8.7%), and worsened in 2/23 IA (8.7%). Retreatment was performed in 8/49 IA (16.3%). At the latest available follow-up, there were 34/47 (72.3%) complete occlusions and 13/47 (27.7%) neck remnants.ConclusionsOur study suggests that EVT of IA with the WEB device provides adequate and stable long term occlusion.
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23
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Lin LM, Colby GP, Bender MT, Xu R, Huang J, Tamargo RJ, Coon AL. Use of the 0.027-inch VIA microcatheter for delivery of Pipeline Flex: a technical note. J Neurointerv Surg 2017; 9:689-693. [PMID: 28151413 DOI: 10.1136/neurintsurg-2016-012971] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/18/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Pipeline Embolization Device (PED; Medtronic Neurovascular, Irvine, California, USA) is designed for delivery through a 0.027″ microcatheter. Challenges with the second-generation PED Flex include limited support from the Marksman microcatheter for consistent resheathing and transmission of push forces for device delivery. The VIA27 (Sequent Medical/MicroVention Terumo, Tustin, California, USA) is an alternative 0.027″ microcatheter originally designed for intrasaccular flow diverter delivery. Here we describe our experience with the VIA27 in the delivery of PED Flex. METHODS We retrospectively identified patients who underwent PED Flex treatment with the VIA27 microcatheter at our institution. Patient demographics, aneurysm characteristics, equipment utilized, and procedural details were documented. RESULTS A total of 127 cases were completed using the VIA27 microcatheter for PED Flex implantation. Mean patient age was 56.8±12.4 years (range 21-86 years). All but one of the cases were treatments for intracranial aneurysms. Average aneurysm size was 6.5±6 mm (range 2-38 mm). Of the 127 cases, 120 (95%) were anterior circulation cases and 7 (6%) were posterior circulation cases. Significant cervical internal carotid artery (ICA) tortuosity was present in 33/120 cases (28%). Moderate to severe cavernous ICA tortuosity was present in 54/120 cases (45%). Mean fluoroscopy time was 34.1±22.7 min. Large diameter PED devices (4.5-5 mm) were used in 42/127 cases (33%). Balloon post-processing of the PED was used in 15/127 cases (12%) to improve vessel wall apposition of the PED. CONCLUSIONS The VIA27 is a microcatheter capable of successful PED Flex delivery in neurointervention. We have shown its utility in enhancing both resheathing and push for optimal PED Flex implantation. The VIA27 microcatheter may be a useful and safe adjunct to the traditional Marksman microcatheter in PED Flex treatment of the cerebrovasculature.
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Affiliation(s)
- Li-Mei Lin
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Matthew T Bender
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Gascou G, Ferrara R, Ambard D, Sanchez M, Lobotesis K, Jourdan F, Costalat V. The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors. Interv Neuroradiol 2016; 23:41-46. [PMID: 27913801 DOI: 10.1177/1591019916673219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purpose Pore density (PD), surface metal coverage (SMC) and the number of wires are all different parameters which can influence the efficacy of a flow disruptor/diverter. Nevertheless, the relative importance of a parameter to induce intra-aneurysmal blood stasis is still poorly evaluated. Therefore, comparison between devices based on a unique value is not reliable. The aim of this study was to propose a new bench top parameter (the pressure reduction coefficient (PRC; ξ)) in order to assess the global haemodynamic effect of each flow diverter/disruptor to slow flow. Methods Eight devices were tested in vitro during three different flow conditions. For the eight devices, the PRC was computed at different volumetric flow rates to characterise flow reduction. Comparison was made with SMC, PD and the number of wires. Results The PRC obtained for flow disruptors was on average 1.5 times more efficient in reducing flow compared to flow diverters. PD (mm2) ranged from 24 to 38 for flow diverters and did not independently correlate with the PRC. The SMC of flow diverters ranged from 25% to 70%, and ranged from 20% to 100% for flow disruptors, without independent correlation to the PRC. The number of wires ranged from 48 to 96 for the flow diverters and did not correlate independently to the PRC. Conclusion There were no direct correlations between individual device characteristics and the PRC, suggesting a multifaceted and interrelating association of the overall design of each implant. Hence, the PRC could be used as a simple, reliable parameter to assess the overall capacity of flow disruptors/diverters to induce intra-aneurysmal blood stasis.
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Affiliation(s)
- Gregory Gascou
- 1 Department of Neuroradiology, CHU Gui de Chauliac, Montpellier, France
| | - Riccardo Ferrara
- 2 Laboratoire de mécanique et de génie civil, Universite de Montpellier, Montpellier, France
| | - Dominique Ambard
- 2 Laboratoire de mécanique et de génie civil, Universite de Montpellier, Montpellier, France
| | - Mathieu Sanchez
- 2 Laboratoire de mécanique et de génie civil, Universite de Montpellier, Montpellier, France
| | - Kyriakos Lobotesis
- 3 Charing Cross Hospital, Imperial College Hospitals, NHS Trust, London, UK
| | - Franck Jourdan
- 2 Laboratoire de mécanique et de génie civil, Universite de Montpellier, Montpellier, France
| | - Vincent Costalat
- 1 Department of Neuroradiology, CHU Gui de Chauliac, Montpellier, France
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Jiang B, Paff M, Colby GP, Coon AL, Lin LM. Cerebral aneurysm treatment: modern neurovascular techniques. Stroke Vasc Neurol 2016; 1:93-100. [PMID: 28959469 PMCID: PMC5435202 DOI: 10.1136/svn-2016-000027] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
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Affiliation(s)
- Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michelle Paff
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Li-Mei Lin
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
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Ambekar S, Khandelwal P, Bhattacharya P, Watanabe M, Yavagal DR. Treatment of unruptured intracranial aneurysms: a review. Expert Rev Neurother 2016; 16:1205-16. [PMID: 27292542 DOI: 10.1080/14737175.2016.1199958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Unruptured brain aneurysms (UIAs) present a challenge due to the lack of definitive understanding of their natural history and treatment outcomes. As the treatment of UIAs is aimed at preventing the possibility of rupture, the immediate risk of treatment must be weighed against the risk of rupture in the future. As such, treatment for a large proportion of UIAs is currently individualized. AREAS COVERED In this article, we discuss the important natural history studies of UIAs and discuss the existing scientific evidence and recent advances that help identify the rupture risk guide management of UIAs. We also address the recent advances in pharmacological therapy of UIAs. Expert commentary: In the recent years, there have been great advances in understanding the pathophysiology of UIAs and determining the rupture risk going beyond the traditional parameter of aneurysm size. Aneurysm morphology and hemodynamics play a pivotal role in growth and rupture. A true randomized trial for the management of UIAs is the need of the hour.
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Affiliation(s)
- Sudheer Ambekar
- a Department of Neurological Surgery , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Priyank Khandelwal
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Pallab Bhattacharya
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Mitsuyoshi Watanabe
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Dileep R Yavagal
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
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Anil G, Goddard AJP, Ross SM, Deniz K, Patankar T. WEB in Partially Thrombosed Intracranial Aneurysms: A Word of Caution. AJNR Am J Neuroradiol 2016; 37:892-6. [PMID: 26585255 DOI: 10.3174/ajnr.a4604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/22/2015] [Indexed: 11/07/2022]
Abstract
Despite the proved safety and efficacy of Woven EndoBridge (WEB) flow disruption in conventional intracranial saccular aneurysms, the literature on its use in partially thrombosed intracranial aneurysms is scarce. We report a series of 4 patients in whom partially thrombosed intracranial aneurysms were treated with the WEB. The 2 patients who received additional intraluminal treatment with conventional stents made a good clinical recovery. Meanwhile, those patients who were treated with the WEB alone had fatal rupture of the aneurysm at short- to medium-term follow-up. This small, select case series demonstrates that WEB placement with adjunctive stent placement may be an effective treatment in the management of partially thrombosed intracranial aneurysms, which merits further validation. However, exclusive intrasaccular flow disruption may have an adverse influence on the natural history of this disease.
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Affiliation(s)
- G Anil
- From the Departments of Neuroradiology (G.A., A.J.P.G., T.P.) Department of Diagnostic Imaging (G.A.), National University Hospital, Singapore.
| | - A J P Goddard
- From the Departments of Neuroradiology (G.A., A.J.P.G., T.P.)
| | - S M Ross
- Neurosurgery (S.M.R., K.D.), Leeds Teaching Hospitals, National Health Service Trust, Leeds, UK
| | - K Deniz
- Neurosurgery (S.M.R., K.D.), Leeds Teaching Hospitals, National Health Service Trust, Leeds, UK
| | - T Patankar
- From the Departments of Neuroradiology (G.A., A.J.P.G., T.P.)
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28
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Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Molyneux A, Byrne J, Spelle L. WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory. AJNR Am J Neuroradiol 2016. [PMID: 26514608 DOI: 10.3760/cma.j.issn.1000-6702.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up. MATERIALS AND METHODS Patients with bifurcation aneurysms for which WEB treatment was indicated were included in this prospective, multicenter Good Clinical Practice study. Clinical data, including adverse events and clinical status at 1 month and 1 year, were collected and independently analyzed by a medical monitor. An independent core laboratory evaluated the anatomic results at 1 year following the procedure. RESULTS Ten French neurointerventional centers included 62 patients (39 women), 33-74 years of age (mean, 56.6 ± 9.80 years) with 63 aneurysms. Aneurysm locations were the middle cerebral artery in 32 aneurysms (50.8%), anterior communicating artery in 16 (25.4%), basilar artery in 9 (14.3%), and internal carotid artery terminus in 6 (9.5%). Morbidity and mortality at 1 month were, respectively, 3.2% (2/62 patients) and 0.0% (0/62). Morbidity and mortality (unrelated to the treatment) at 1 year were, respectively, 0.0% (0/59) and 3.4% (2/59 patients). At 1 year, complete occlusion was observed in 30/58 aneurysms (51.7%); neck remnant, in 16/58 aneurysms (27.6%); and aneurysm remnant, in 12/58 aneurysms (20.7%). CONCLUSIONS This prospective French Observatory study showed very good safety of aneurysm treatment with the WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%).
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Moret
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - F Turjman
- Centre Hospitalier Universitaire de Lyon (F.T.), Lyon, France
| | - D Herbreteau
- Centre Hospitalier Universitaire de Tours (D.H.), Tours, France
| | - H Raoult
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - X Barreau
- Centre Hospitalier Universitaire de Bordeaux (X.B.), Bordeaux, France
| | - S Velasco
- Centre Hospitalier Universitaire de Poitiers (S.V.), Poitiers, France
| | - H Desal
- Centre Hospitalier Universitaire de Nantes (H.D.), Nantes, France
| | - A-C Januel
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - P Courtheoux
- Centre Hospitalier Universitaire de Caen (P.C.), Caen, France
| | - J-Y Gauvrit
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - C Cognard
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - A Molyneux
- Oxford Neurovascular and Neuroradiology Research Unit (A.M., J.B.), Oxford Radcliffe Hospital, Oxford, UK
| | - J Byrne
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - L Spelle
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
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29
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Pierot L, Spelle L, Molyneux A, Byrne J. Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device: 1-Year Follow-up Report in the Cumulated Population of 2 Prospective, Multicenter Series (WEBCAST and French Observatory). Neurosurgery 2016; 78:133-41. [PMID: 26552042 PMCID: PMC6975162 DOI: 10.1227/neu.0000000000001106] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Flow disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Initial series have shown a low complication rate with good efficacy. OBJECTIVE To report clinical and anatomical results of the WEB treatment in the cumulated population of WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm) and French Observatory series. METHODS WEBCAST and French Observatory are single-arm, prospective, multicenter, Good Clinical Practice studies dedicated to the evaluation of WEB treatment. Ruptured and unruptured bifurcation aneurysms located in the basilar artery, middle cerebral artery, anterior communicating artery, and internal carotid artery terminus were included in both studies. Clinical data were independently evaluated. Postoperative, 6-month (in WEBCAST), and 1-year aneurysm occlusion was independently evaluated with a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The cumulated population was 113 patients (74 female, 65.5%) 33 to 74 years of age with 114 aneurysms with a mean neck size of 5.6 mm. There was no mortality at 1 month, and morbidity was 2.7%. A statistically significant difference in the rate of occurrence of thromboembolic events was observed between the use of any antiplatelet agent and the use of no antiplatelet agent (P < .001). At 1 year, complete aneurysm occlusion was observed in 56.0%, neck remnant in 26.0%, and aneurysm remnant in 18.0%. Worsening of aneurysm occlusion between the procedure and 12 months was observed in 2.0% and between 6 months and 1 year in 7.1%. CONCLUSION The analysis in this large cumulated population of studies confirms favorable safety and efficacy of WEB treatment.
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Affiliation(s)
- Laurent Pierot
- *Department of Neuroradiology, Maison Blanche Hospital, University of Reims-Champagne-Ardenne, France;‡Department of Interventional Neuroradiology, CHU Kremlin-Bicêtre, Kremlin Bicêtre, France;§Oxford Neurovascular & Neuroradiology Research Unit, Oxford Radcliffe Hospital, Oxford, United Kingdom
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Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Molyneux A, Byrne J, Spelle L. WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory. AJNR Am J Neuroradiol 2015; 37:655-9. [PMID: 26514608 DOI: 10.3174/ajnr.a4578] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/30/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up. MATERIALS AND METHODS Patients with bifurcation aneurysms for which WEB treatment was indicated were included in this prospective, multicenter Good Clinical Practice study. Clinical data, including adverse events and clinical status at 1 month and 1 year, were collected and independently analyzed by a medical monitor. An independent core laboratory evaluated the anatomic results at 1 year following the procedure. RESULTS Ten French neurointerventional centers included 62 patients (39 women), 33-74 years of age (mean, 56.6 ± 9.80 years) with 63 aneurysms. Aneurysm locations were the middle cerebral artery in 32 aneurysms (50.8%), anterior communicating artery in 16 (25.4%), basilar artery in 9 (14.3%), and internal carotid artery terminus in 6 (9.5%). Morbidity and mortality at 1 month were, respectively, 3.2% (2/62 patients) and 0.0% (0/62). Morbidity and mortality (unrelated to the treatment) at 1 year were, respectively, 0.0% (0/59) and 3.4% (2/59 patients). At 1 year, complete occlusion was observed in 30/58 aneurysms (51.7%); neck remnant, in 16/58 aneurysms (27.6%); and aneurysm remnant, in 12/58 aneurysms (20.7%). CONCLUSIONS This prospective French Observatory study showed very good safety of aneurysm treatment with the WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%).
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Moret
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - F Turjman
- Centre Hospitalier Universitaire de Lyon (F.T.), Lyon, France
| | - D Herbreteau
- Centre Hospitalier Universitaire de Tours (D.H.), Tours, France
| | - H Raoult
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - X Barreau
- Centre Hospitalier Universitaire de Bordeaux (X.B.), Bordeaux, France
| | - S Velasco
- Centre Hospitalier Universitaire de Poitiers (S.V.), Poitiers, France
| | - H Desal
- Centre Hospitalier Universitaire de Nantes (H.D.), Nantes, France
| | - A-C Januel
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - P Courtheoux
- Centre Hospitalier Universitaire de Caen (P.C.), Caen, France
| | - J-Y Gauvrit
- Centre Hospitalier Universitaire de Rennes (H.R., J.-Y.G.), Rennes, France
| | - C Cognard
- Centre Hospitalier Universitaire de Toulouse (A.-C.J., C.C.), Toulouse, France
| | - A Molyneux
- Oxford Neurovascular and Neuroradiology Research Unit (A.M., J.B.), Oxford Radcliffe Hospital, Oxford, UK
| | - J Byrne
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - L Spelle
- Hôpital Beaujon, (J.M., L.S.), Assistance Publique-Hôpitaux de Paris, Clichy, France
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Ding D. Expanding the boundaries of endovascular aneurysm treatment: emerging technologies for wide-necked bifurcation aneurysms. Acta Neurochir (Wien) 2015; 157:1049-50. [PMID: 25236934 DOI: 10.1007/s00701-014-2238-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Dale Ding
- University of Virginia Department of Neurosurgery Surgery, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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Mine B, Tancredi I, Aljishi A, Alghamdi F, Beltran M, Herchuelz M, Lubicz B. Follow-up of intracranial aneurysms treated by a WEB flow disrupter: a comparative study of DSA and contrast-enhanced MR angiography. J Neurointerv Surg 2015; 8:615-20. [DOI: 10.1136/neurintsurg-2015-011644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/04/2015] [Indexed: 11/03/2022]
Abstract
ObjectiveTo compare contrast-enhanced MR angiography (CE-MRA) and DSA for the follow-up of intracranial aneurysms (IAs) treated with the Woven EndoBridge embolization system DL (WEB DL; Sequent Medical, Aliso Viejo, California, USA).Materials and methodsWe retrospectively identified all patients treated with a WEB DL between November 2010 and February 2013 in 2 hospitals. The IA occlusion was graded on follow-up CE-MRA and DSA by 4 independent readers and by 2 readers reaching a consensus, respectively. Interobserver agreement for MRA and intertechnique agreement was evaluated by calculating linear weighted κ.ResultsFifteen patients with 16 IAs were included. Mean delay between MRA and DSA was 2 months (range 0–16 months). Interobserver agreement for MRA was substantial to almost perfect (κ=0.686–0.921; mean κ=0.809). Intertechnique agreement was moderate to substantial (κ=0.579–0.724; mean κ=0.669). Only three out of five inadequately occluded IAs were detected by MRA.ConclusionsCE-MRA is a useful tool for the follow-up of IAs treated with a WEB DL. However, early follow-up with DSA remains mandatory to detect inadequately occluded IAs.
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Cognard C, Januel AC. Remnants and Recurrences After the Use of the WEB Intrasaccular Device in Large-Neck Bifurcation Aneurysms. Neurosurgery 2015; 76:522-30;discussion 530. [PMID: 25710103 DOI: 10.1227/neu.0000000000000669] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Flow disruption with the WEB technique has been developed to treat large-neck bifurcation aneurysms.
OBJECTIVE:
To report our anatomic angiographic results at first (3-6 months) and second (18 ± 3 months) angiographic follow-up in a series of 15 patients.
METHODS:
Fifteen patients (15 aneurysms) were consecutively treated in our center by 2 operators for a large-neck bifurcation aneurysm between March 2012 and February 2014. Results were evaluated by assessing WEB cage position at the aneurysm neck on angiography and high-resolution contrast-enhanced flat-panel detector computed tomography, contrast medium stagnation within the WEB and aneurysm on intraprocedural angiography, and 1-day time-of-flight magnetic resonance angiography. All aneurysms were followed up by angiography. Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. The 2 operators compared postprocedural and follow-up images and classified them as better, same, or worse. Subtracted images were compared in different projections to assess any WEB device compression or shape changes.
RESULTS:
A worsening was observed between the postprocedural and first follow-up angiography in 10 of 14 (71.5%) and in 4 of 7 (57.2%) between the first and second control angiography. Compression of the WEB cage was observed at first follow-up in 8 of 14 (57.2%) and in an additional 3 of 7 cases (42.8%) at second control. Last angiography showed complete occlusion in 1 of 14 (7.2%), neck remnant in 8 of 14 (57.2%), and residual aneurysm in 5 of 14 (35.7%) cases.
CONCLUSION:
This article draws attention to the risk of WEB compression and aneurysm recanalization. Future prospective studies should evaluate delayed WEB shape changes with different types of WEB devices (dual layer, single layer, single layer spherical).
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Affiliation(s)
- Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
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Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Soize S, Molyneux A, Spelle L. WEB Treatment of Intracranial Aneurysms: Feasibility, Complications, and 1-Month Safety Results with the WEB DL and WEB SL/SLS in the French Observatory. AJNR Am J Neuroradiol 2015; 36:922-7. [PMID: 25655876 DOI: 10.3174/ajnr.a4230] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/24/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Safety analyses in the French Observatory have shown that treatment of intracranial aneurysms by using flow disruption with the Woven EndoBridge Device (WEB) is safe, with low morbidity and no mortality. The objective of this study was to analyze treatment feasibility, complications, and safety results in patients treated with the Woven EndoBridge Device Dual-Layer (WEB DL) and Woven EndoBridge Device Single-Layer/Single-Layer Sphere (WEB SL/SLS) in the French Observatory. MATERIALS AND METHODS Patients with bifurcation aneurysms were included in this prospective, multicenter good clinical practices study. A medical monitor independently analyzed procedural and clinical data. The study started with the WEB DL, and secondarily, the WEB SL/SLS was authorized in the study. RESULTS Between November 2012 and January 2014, 10 French centers included 62 patients with 63 aneurysms. Thirty patients with 31 aneurysms were treated with the WEB DL, and 32 patients with 32 aneurysms, with the WEB SL/SLS. The percentage of anterior communicating artery aneurysms treated with WEB SL/SLS was significantly higher (37.5%) compared with WEB DL (12.9%) (P = .04). The WEB SL/SLS was more frequently used in aneurysms of <10 mm than the WEB DL (respectively, 96.9% and 67.7%; P = .002). Morbidity was similar in both groups (WEB DL, 3.3%; WEB SL/SLS, 3.1%), and mortality was 0.0% in both groups. CONCLUSIONS This comparative study shows increased use of WEB treatment in ruptured, small, and anterior communicating artery aneurysms when using WEB SL/SLS. There was a trend toward fewer thromboembolic complications with the WEB SL/SLS. With both the WEB DL and WEB SL/SLS, the treatment was safe, with low morbidity and no mortality.
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P., S.S.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Moret
- Department of Neuroradiology (J.M., L.S.), Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - F Turjman
- Department of Neuroradiology (F.T.), Centre Hospitalier Universitaire Lyon, Lyon, France
| | - D Herbreteau
- Department of Neuroradiology (D.H.), Centre Hospitalier Universitaire Tour, Tours, France
| | - H Raoult
- Department of Neuroradiology (H.R., J.-Y.G.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - X Barreau
- Department of Neuroradiology (X.B.), Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - S Velasco
- Department of Neuroradiology (S.V.), Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - H Desal
- Department of Neuroradiology (H.D.), Centre Hospitalier Universitaire Nantes, Nantes, France
| | - A-C Januel
- Department of Neuroradiology (A.-C.J., C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - P Courtheoux
- Department of Neuroradiology (P.C.), Centre Hospitalier Universitaire Caen, Caen, France
| | - J-Y Gauvrit
- Department of Neuroradiology (H.R., J.-Y.G.), Centre Hospitalier Universitaire Rennes, Rennes, France
| | - C Cognard
- Department of Neuroradiology (A.-C.J., C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - S Soize
- From the Department of Neuroradiology (L.P., S.S.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - A Molyneux
- Department of Neuroradiology (A.M.), Oxford Neurovascular and Neuroradiology Research Unit, Oxford Radcliffe Hospital, Oxford, United Kingdom
| | - L Spelle
- Department of Neuroradiology (J.M., L.S.), Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
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