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Chew HS, Chong MY, Butt W, Al-Ali S, Butler B, Al-Tibi M, Chavda S, Lamin S. Lateral Compression Manipulation: A Simple Approach for Sizing Taller-Than-Wide Intracranial Aneurysms with the Woven EndoBridge Device. AJNR Am J Neuroradiol 2024; 45:731-736. [PMID: 38290739 PMCID: PMC11288580 DOI: 10.3174/ajnr.a8172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) system has established itself as a safe and effective option for managing wide-neck bifurcation aneurysms. Addressing aneurysms with a greater height than width using conventional WEB-sizing methods has proved ineffective due to the inherent configuration of the devices. To overcome this limitation, we propose an intuitive approach that involves swapping the width and height dimensions of the aneurysm to determine the appropriate WEB size. MATERIALS AND METHODS A retrospective analysis was conducted on patients undergoing WEB embolization at a single neuroscience center from March 2013 to February 2023. RESULTS Twenty-five eligible aneurysms were identified, with the height dimension exceeding the width by an average of 2.33 mm (ranging from 1.4 to 4.5 mm). Of these, 20 cases adhered to the recommended sizing technique, resulting in a 100% success rate of adequate occlusion (14/20 complete occlusion, 6/20 proximal recess filling). In contrast, the outcomes for the remaining 5 cases that did not follow the proposed sizing method were less favorable (P < .05). Among these, 4 cases treated with undersized WEBs showed neck remnants during follow-up, and 1 patient who received an oversized WEB required device replacement during the same procedure. CONCLUSIONS The simple sizing method we proposed for treating taller-than-wide aneurysms has demonstrated promising results, allowing the WEB system to address twice the original size range of treatable aneurysms. Further research with a larger sample size is recommended.
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Affiliation(s)
- Han Seng Chew
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ming Yao Chong
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Waleed Butt
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Samer Al-Ali
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Benjamin Butler
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mohammad Al-Tibi
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Swarupsinh Chavda
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Saleh Lamin
- From the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Qu J, Niu H, Li Y, Chen T, Peng F, Xia J, He X, Xu B, Chen X, Li R, Liu A, Zhang X, Li C. A deep learning framework for intracranial aneurysms automatic segmentation and detection on magnetic resonance T1 images. Eur Radiol 2024; 34:2838-2848. [PMID: 37843574 DOI: 10.1007/s00330-023-10295-x] [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: 11/16/2022] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES To design a deep learning-based framework for automatic segmentation and detection of intracranial aneurysms (IAs) on magnetic resonance T1 images and test the robustness and performance of framework. METHODS A retrospective diagnostic study was conducted based on 159 IAs from 136 patients who underwent the T1 images. Among them, 127 cases were randomly selected for training and validation, and 32 cases were used to assess the accuracy and consistency of our algorithm. We developed and assembled three convolutional neural networks for the segmentation and detection of IAs. The segmentation and detection performance of the model were compared with the ground truth, and various metrics were calculated at the voxel level, IAs level, and patient level to show the performance of our framework. RESULTS Our assembled model achieved overall Dice, voxel-level sensitivity, specificity, balanced accuracy, and F1 score of 0.802, 0.874, 0.9998, 0.937, and 0.802, respectively. A coincidence greater than 0.7 between the aneurysms predicted by the model and the ground truth was considered as a true positive. For IAs detection, the sensitivity reached 90.63% with 0.58 false positives per case. The volume of IAs segmented by our model showed a high agreement and consistency with the volume of IAs labeled by experts. CONCLUSION The deep learning framework is achievable and robust for IAs segmentation and detection. Our model offers more clinical application opportunities compared to digital subtraction angiography (DSA)-based, CTA-based, and MRA-based methods. CLINICAL RELEVANCE STATEMENT Our deep learning framework effectively detects and segments intracranial aneurysms using clinical routine T1 sequences, showing remarkable effectiveness and offering great potential for improving the detection of latent intracranial aneurysms and enabling early identification. KEY POINTS •There is no segmentation method based on clinical routine T1 images. Our study shows that the proper deep learning framework can effectively localize the intracranial aneurysms. •The T1-based segmentation and detection method is more universal than other angiography-based detection methods, which can potentially reduce missed diagnoses caused by the absence of angiography images. •The deep learning framework is robust and has the potential to be applied in a clinical setting.
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Affiliation(s)
- Junda Qu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutang Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Ting Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuge Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China.
| | - Chunlin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China.
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Aquarius R, Elbertsen D, de Vries J, Boogaarts HD, Wever KE. A systematic review of the Woven EndoBridge device-do findings in pre-clinical animal models compare to clinical results? Acta Neurochir (Wien) 2023:10.1007/s00701-023-05638-y. [PMID: 37289301 DOI: 10.1007/s00701-023-05638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Woven Endobridge (WEB) is designed to treat intracranial wide-neck bifurcation aneurysms, preventing subarachnoid hemorrhage. The translational value of animal models used for WEB device testing is unknown. With this systematic review, we aim to identify the existing animal models used in testing the WEB device and compare the efficacy and safety outcomes to those of prospective clinical studies. METHODS This study was funded by ZonMw: project number 114024133. A comprehensive search was performed in PubMed and in EMBASE via the Ovid interface. The following exclusion criteria were used: 1) not an original full-length research paper, 2) not an in vivo animal study or a human study, 3) no WEB implantation, 4) if in humans: not a prospective study. The SYRCLE risk of bias tool (animal studies) and the Newcastle-Ottawa quality assessment scale for cohort studies (clinical studies) were used to assess risks of bias. A narrative synthesis was performed. RESULTS Six animal studies and 17 clinical studies met the inclusion criteria. The rabbit elastase aneurysm model was the only animal model used to assess WEB device performance. Safety outcomes were never reported in animal studies. Efficacy outcomes were more heterogeneous in animal studies than in clinical studies, which could be due to limited external validity of the animal models in terms of aneurysm induction and dimensions. Both animal and clinical studies were predominantly single-arm studies, and were at unclear risk of several types of bias. CONCLUSIONS The rabbit elastase aneurysm model was the only pre-clinical animal model used to assess WEB device performance. Safety outcomes were not evaluated in animal studies and could therefore not be compared to clinical outcomes. Efficacy outcomes were more heterogeneous in animal studies than in clinical studies. Future research should focus on improving methodology and reporting in order to draw accurate conclusions on the performance of the WEB device.
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Affiliation(s)
- René Aquarius
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, The Netherlands.
| | - Danique Elbertsen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, The Netherlands
| | - Kimberley E Wever
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
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Kashkoush A, El-Abtah ME, Srivatsa S, Desai A, Davison M, Achey R, Mahapatra A, Patterson T, Moore N, Bain M. Comparative effectiveness of stent-assisted coiling and Woven EndoBridge embolization for the treatment of unruptured wide-neck bifurcation intracranial aneurysms. J Neurosurg 2023; 138:1487-1493. [PMID: 36334292 DOI: 10.3171/2022.10.jns221138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs. METHODS Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices. RESULTS Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202-834] days vs 228 [177-494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8-3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630. CONCLUSIONS Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.
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Affiliation(s)
- Ahmed Kashkoush
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | | | - Shaarada Srivatsa
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Ansh Desai
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mark Davison
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Rebecca Achey
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Ashutosh Mahapatra
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Thomas Patterson
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Nina Moore
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
| | - Mark Bain
- 1Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland; and
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Lee KB, Suh CH, Song Y, Kwon B, Kim MH, Yoon JT, Lee DH. Trends of Expanding Indications of Woven EndoBridge Devices for the Treatment of Intracranial Aneurysms: A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:227-235. [PMID: 36036257 DOI: 10.1007/s00062-022-01207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Woven EndoBridge (WEB) was introduced for the endovascular therapy of wide-neck intracranial aneurysms. The safety and efficacy have been evaluated through several meta-analyses. However, these reviews did not cover the expanding indications in detail. Therefore, we aimed to show the changing trends for intracranial aneurysm treatment using the WEB device. METHODS A systematic review and meta-analysis was conducted with PubMed, Embase, and Cochrane databases. We searched for studies that reported baseline characteristics of aneurysms and the WEB devices, which had treated more than 20 aneurysms consecutively. The pooled proportions of aneurysm indications and used WEB device types were obtained. To evaluate the changing indications for the treated aneurysm size, including the neck diameter, a trend line and linear regression model was measured. RESULTS A total of 27 cohorts were included encompassing 1831 aneurysms treated with the WEB. A total of 86% were used in the four major locations as on-label indications (middle cerebral artery bifurcation; 34%, anterior communicating artery; 26%, basilar tip; 18%, internal carotid artery terminus; 7%). Among off-label indications, the most common location was the posterior communicating artery (8%), followed by the anterior cerebral artery including the pericallosal artery (6%). The median aneurysm size and neck diameter was 7 mm and 4.6 mm, respectively. The WEB device has been used for the treatment of smaller aneurysms than the initial indication. Also, the proportion for ruptured aneurysm treatment was increased up to 15%. CONCLUSION The mechanical and technical development of the WEB resulted in expanding the indications for the treatment of intracranial aneurysms. The off-label indications accounted for 14% in total and an increasing number of small aneurysms are treated with WEB devices. Moreover, the proportion for ruptured aneurysm treatment was currently increased up to 14% more than in the beginning.
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Affiliation(s)
- Ki Baek Lee
- Department of Radiologic Technology, Chungbuk Health & Science University, Cheongju, Korea (Republic of)
| | - Chong Hyun Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Boseong Kwon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Mi Hyeon Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Jong-Tae Yoon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of).
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Pierot L, Szikora I, Barreau X, Holtmannspoetter M, Spelle L, Klisch J, Herbreteau D, Costalat V, Fiehler J, Januel AC, Liebig T, Stockx L, Weber W, Berkefeld J, Moret J, Molyneux A, Byrne J. Aneurysm treatment with the Woven EndoBridge (WEB) device in the combined population of two prospective, multicenter series: 5-year follow-up. J Neurointerv Surg 2022; 15:552-557. [PMID: 35803731 DOI: 10.1136/neurintsurg-2021-018414] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evaluating a new endovascular treatment for intracranial aneurysms must not only demonstrate short-term safety and efficacy, but also evaluate longer-term outcomes (eg, delayed complications, anatomical results, retreatment). The current analysis reports the 5-year clinical and anatomical results of Woven EndoBridge (WEB) treatment in two European combined trial populations (WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy) and WEBCAST-2). METHODS All adverse events occurring between the procedure and 5-year follow-up were independently evaluated by an expert. Aneurysm occlusion was evaluated by an independent core laboratory using a three-grade scale: complete occlusion, neck remnant, and aneurysm remnant. In cases where data were not available at 5-year follow-up, the last observation carry forward (LOCF) method was used. RESULTS The safety and efficacy populations comprised 100 patients and 95 aneurysms, respectively. No adverse event related to the device occurred after the procedure during the 5-year follow-up period. Mortality at 5 years was 7.0% (7/100 patients) including mortality related to the WEB (0/100, 0.0%), the procedure (1/100, 1.0%), and another condition (6/100, 6.0%). At 5 years, complete aneurysm occlusion was observed in 49/95 (51.6%) aneurysms, neck remnant in 25/95 (26.3%), and aneurysm remnant in 21/95 (22.1%). Retreatment rate at 5 years was 11.6% (11/95 aneurysms). CONCLUSIONS This analysis conducted in a population of patients with wide-neck bifurcation aneurysms confirms WEB's safety profile. Additional evidence demonstrates good stability of aneurysm occlusion with adequate occlusion (complete occlusion or neck remnant) at 5 years in 77.9% of aneurysms with a low retreatment rate (11.6%). CLINICAL TRIAL REGISTRATION WEBCAST and WEBCAST-2: Unique identifier: NCT01778322.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, CHU Reims, Reims, Champagne-Ardenne, France
| | - Istvan Szikora
- Neurointerventions, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Xavier Barreau
- Neuroradiology Department, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Markus Holtmannspoetter
- Interventional and Diagnostic Neuroradiology, Nuremberg Hospital Campus South, Nurnberg, Germany
| | - Laurent Spelle
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France.,Neuroradiology, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Joachim Klisch
- Neuroradiology, Helios Klinikum Erfurt, Erfurt, Thüringen, Germany
| | | | - Vincent Costalat
- Neuroradiology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich, Munchen, Bayern, Germany
| | - Luc Stockx
- Neuroradiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Werner Weber
- Radiology and Neuroradiology, Ruhr-Universität Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Hessen, Germany
| | - Jacques Moret
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France
| | - Andy Molyneux
- Neurovascular and Neuroradiology Research Unit, Oxford University, Oxford, UK
| | - James Byrne
- Department of Neuroradiology, Oxford University, Oxford, UK
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Cortese J, Caroff J, Chalumeau V, Gallas S, Ikka L, Moret J, Sabuzi F, Popescu SD, Ozanne A, Grimaldi L, Mihalea C, Spelle L. Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up. J Neurointerv Surg 2022; 15:446-451. [PMID: 35428742 DOI: 10.1136/neurintsurg-2022-018780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
Abstract
BackgroundWoven EndoBridge (WEB) devices are becoming a reliable option for the treatment of wide-neck bifurcation aneurysms, but clear predictive factors are still missing to understand the one in five aneurysm remnant rate.ObjectiveTo evaluate occlusion outcomes after WEB treatment to identify potential determinants of aneurysm occlusion.MethodsA single-center database with consecutive aneurysms treated with WEB between July 2012 and October 2021 was reviewed for potential determinants of aneurysm adequate occlusion (defined as a Bicêtre Occlusion Scale Score (BOSS) of 0, 0’, 1 or 2), through univariate and multivariable analysis. Patients without angiographic follow-up were excluded.Results215 of 247 individual aneurysms were included in the final analysis, of which 59 (27%) were ruptured. Mean age of patients was 56 years (range 23–90 years) and 65% were female. Mean angiographic follow-up was at 18 months (range 3–97 months). Adequate and complete occlusion were achieved in 171/215 (79.5%) and 135/215 (62.8%) of cases, respectively. Aneurysm irregular shape (aOR=0.42, 95% CI 0.20 to 0.88; p=0.02), aneurysm height (aOR=0.79, 95% CI 0.66 to 0.94; p<0.01), and WEB shape modification (aOR=0.98, 95% CI 0.97 to 1.00; p=0.02) were all independent predictors of aneurysm recurrence, whereas the WEB oversizing ratio (WEB width/aneurysm mean width) (aOR=16.4, 95% CI 1.4 to 266.7; p=0.04) was an independent predictor of adequate occlusion.ConclusionIn this study we demonstrated that a width oversizing strategy of the WEB device was an independent predictor of aneurysm angiographic occlusion. Conversely, aneurysm height, irregular aneurysm, and WEB shape modification were all independent determinants of angiographic aneurysm remnant. These results may help to select aneurysms suitable for the WEB device and WEB sizing.
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Affiliation(s)
- Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
- INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Federico Sabuzi
- Interventional Radiology Department, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Septimiu Daniel Popescu
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP Paris-Saclay, Université de Versailles Saint-Quentin- en- Yvelines UFR des sciences de la santé Simone Veil, Montigny-Le- Bretonneux, France
- CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
- INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
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Gajera J, Maingard J, Foo M, Ren Y, Lamanna A, Nour D, Hall J, Kurda D, Tan D, Lalloo S, Bañez RMF, Russell J, Slater LA, Chandra RV, Chong W, Jhamb A, Brooks DM, Asadi H. The Woven EndoBridge Device for the Treatment of Intracranial Aneurysms: Initial Clinical Experience within an Australian Population. Neurointervention 2022; 17:28-36. [PMID: 35130672 PMCID: PMC8891585 DOI: 10.5469/neuroint.2021.00430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Advances in endovascular technology have expanded the treatment options for intracranial aneurysms. Intrasaccular flow diversion is a relatively new technique that aims to disrupt blood inflow at the neck of the aneurysm, hence promoting intrasaccular thrombosis. The Woven EndoBridge device (WEB; MicroVention, Aliso Viejo, CA, USA) is an US Food and Drug Administration approved intrasaccular flow diverter for wide-necked aneurysms. We report the early interim clinical and radiological outcomes of patients with both ruptured and unruptured intracranial aneurysms (IAs) treated using the WEB device in an Australian population. Materials and Methods A retrospective analysis was done of patients with ruptured or unruptured IAs who received treatment with WEB across 5 Australian neuroendovascular referral centers between May 2017 and November 2020. Angiographic occlusion was assessed with time-of-flight magnetic resonance angiography. Complications were recorded and clinical outcomes were assessed using the modified Rankin scale at follow-up. Results In total, 66 aneurysms were treated in 63 patients, with successful deployment of the WEB device in 98.5% (n=65). Eighteen (26.9%) ruptured aneurysms were included. Failure of deployment occurred in a single case. Adjunct coiling and/or stenting was performed in 20.9% (n=14) cases. Sixty-two patients with 65 aneurysms using a WEB device were followed up (mean=9.1 months), and 89.4% of these had complete aneurysm occlusion while 1.5% remained patent. Functional independence was achieved in 93.5% of cases. Conclusion Early results following the use of WEB devices in Australia demonstrate safety and adequate aneurysm occlusion comparable to international literature.
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Affiliation(s)
- Jay Gajera
- Department of Radiology, Royal North Shore Hospital, Sydney, NSW, Australia
- Correspondence to: Jay Gajera, BSc, MD Department of Radiology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia Fax: +61-3-9496-5431 E-mail:
| | - Julian Maingard
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Michelle Foo
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Yifan Ren
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Anthony Lamanna
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Daniel Nour
- Department of Radiology, Interventional Neuroradiology Service, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Jonathan Hall
- Department of Radiology, Interventional Neuroradiology Service, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Dylan Kurda
- Department of Medical Imaging, Interventional Neuroradiology Service, The Canberra Hospital, ACT Health, Canberra, NSW, Australia
| | - David Tan
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Shivendra Lalloo
- Department of Medical Imaging, Interventional Neuroradiology Service, The Canberra Hospital, ACT Health, Canberra, NSW, Australia
| | | | - Jeremy Russell
- Department of Neurosurgery, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Lee-Anne Slater
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - Ronil Vikesh Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - Winston Chong
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - Ashu Jhamb
- Department of Radiology, Interventional Neuroradiology Service, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
| | - Hamed Asadi
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, VIC, Australia
- Department of Medical Imaging, Interventional Neuroradiology Service, The Canberra Hospital, ACT Health, Canberra, NSW, Australia
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, TAS, Australia
- Department of Neurosurgery, Interventional Neuroradiology Service, Austin Health, Melbourne, VIC, Australia
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9
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Usefulness of contrast-enhanced 3D MR angiography and contrast-enhanced 3D T1 sequence for detecting intracranial infectious aneurysms in infectious endocarditis. Eur J Radiol 2021; 144:110008. [PMID: 34742109 DOI: 10.1016/j.ejrad.2021.110008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the diagnostic value of contrast-enhanced MRA (CE MRA) and CE 3D-T1 for identifying intracranial infectious aneurysms (IIAs) in infective endocarditis (IE) with digital substraction angiography (DSA) as reference. METHODS Twenty-one IE patients (14 males; mean age: 53 years) with 30 IIAs, diameter ranging 1.5-15 mm (<3mm, n = 14, 46.7%; 3-5 mm, n = 12,40%), underwent CE MRA and CE 3D-T1 at 1.5 T. Two readers evaluated images for aneurysm detection, characterization, quality of visualization. DSA was obtained at a median of 3 days (range 1-15) after MRI. RESULTS The sensitivity, specificity, positive and negative predictive values and accuracy of IIA detection were respectively: 80%, 100%, 100%, 82.3%, 90% for CE MRA and 86.7%, 100%, 100%, 88.2%, 93.3% for CE 3D T1 compared to DSA. No significant difference was observed between CE MRA and CE 3D-T1 for accuracy and quality of visualization. All IIAs of ≥3 mm in diameter (16/30; 53.%) were identified by both sequences, which were also able to detect IIAs ≤ 3 mm (n = 14/30, 46.7%). False negatives were observed with both sequences for 4 IIAs of <2 mm, 3 being compressed by hemorrhagic lesions. Two other IIAs of <2 mm were overlooked by CE MRA. CE 3D-T1 overestimated IIAs luminal diameter by 8% relatively to DSA (P = NS). Intra and inter-observer agreement were good and similar with both methods. CONCLUSION Both CE MRA and CE 3D-T1 have good accuracy compared to DSA detection and characterization of IIAs. CE 3D-T1 also evaluates anatomical relationships of IIAs, which could help DSA location and endovascular treatment.
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10
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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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11
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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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12
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Shao Q, Li Q, Wu Q, Li T, Li L, Chang K, He Y. Application of 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. J Interv Med 2021; 4:71-76. [PMID: 34805951 PMCID: PMC8562288 DOI: 10.1016/j.jimed.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. MATERIALS AND METHODS Between Oct 2018 and May 2019, we enrolled 25 patients with intracranial aneurysm who underwent stent-assisted coil embolization. All patients were followed up for 6 to10 months after endovascular treatment (EVT) using 3D-TOF MRA, 3D T1-SPACE and DSA to evaluate aneurysm occlusion and parent artery patency. RESULTS With regards to aneurysm occlusion, the specificity of 3D-TOF MRA was 86.9% (20/23) and the accuracy was 84% (21/25). There was no statistical significance (P = 0.409) compared with the DSA. The parent artery by 3D-TOF MRA showed that there were 14 patients with grade 3, 8 patients with grade 2 and 3 patients with grade 1. However, 3D T1-SPACE showed that all 25 patients were grade 4, and were clearly displayed without metal artifacts. The comparison of the two MR techniques demonstrated that 3D T1-SPACE was superior to 3D-TOF MRA in the evaluation of parent artery (P<0.001). CONCLUSIONS 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. This study also shows that 3D-TOF MRA has a merit to evaluate aneurysm occlusion. The combination of these two modalities can be used as an optional follow-up evaluation after EVT of intracranial aneurysms.
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Affiliation(s)
- Qiuji Shao
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Qiang Li
- Department of Radiology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Qiaowei Wu
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Li Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Kaitao Chang
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Yingkun He
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
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13
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Hostetter J, Miller TR, Gandhi D. Imaging for Treated Aneurysms (Including Clipping, Coiling, Stents, Flow Diverters). Neuroimaging Clin N Am 2021; 31:251-263. [PMID: 33902878 DOI: 10.1016/j.nic.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intracranial aneurysms are common in the adult population and carry a risk of rupture leading to catastrophic subarachnoid hemorrhage. Treatment of aneurysms has evolved significantly, with the introduction of new techniques and devices for minimally invasive and endovascular approaches. Follow-up imaging after aneurysm treatment is standard of care to monitor for recurrence or other complications, and the preferred imaging modality and schedule for follow-up are areas of active research. The modality and follow-up schedule should be tailored to treatment technique, aneurysm characteristics, and patient factors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA.
| | - Timothy R Miller
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
| | - Dheeraj Gandhi
- Neurology and Neurosurgery, Department of Radiology, Interventional Neuroradiology, CMIT Center, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
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14
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Pierot L, Szikora I, Barreau X, Holtmannspoetter M, Spelle L, Herbreteau D, Fiehler J, Costalat V, Klisch J, Januel AC, Weber W, Liebig T, Stockx L, Berkefeld J, Moret J, Molyneux A, Byrne J. Aneurysm treatment with WEB in the cumulative population of two prospective, multicenter series: 3-year follow-up. J Neurointerv Surg 2021; 13:363-368. [PMID: 32532858 PMCID: PMC7982938 DOI: 10.1136/neurintsurg-2020-016151] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND WEB treatment is an endovascular approach for wide-neck bifurcation aneurysms that has demonstrated high safety and good efficacy in mid-term follow-up. While evaluating safety in the long term is important to determine if delayed adverse events occur affecting late morbidity and mortality, the most important point to evaluate is the long-term stability of aneurysm occlusion. The current analysis reports the 3-year clinical and anatomical results of WEB treatment in the combined population of two European trials (WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy) and WEBCAST-2). METHODS Aneurysm occlusion was evaluated using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The safety population comprised 79 patients. The efficacy population comprised 61 aneurysms. Aneurysm locations were middle cerebral artery in 32/61 aneurysms (52.5%), anterior communicating artery in 13/61 (21.3%), basilar artery in 9/61 (14.8%), and internal carotid artery terminus in 7/61 (11.5%). No adverse events related to the device or procedure occurred between 2 and 3 years. At 3 years, complete occlusion was observed in 31/61 (50.8%) aneurysms, neck remnant in 20/61 (32.8%), and aneurysm remnant in 10/61 (16.4%). Between 1 year and 3 years, aneurysm occlusion was improved or stable in 53/61 (86.9%) aneurysms and worsened in 8/61 (13.1%). Worsening was mostly from complete occlusion to neck remnant in 6/61 (9.8%) aneurysms. The retreatment rate at 3 years was 11.4%. CONCLUSIONS This analysis confirms the high safety profile of WEB. Moreover, evidence demonstrates the great stability of aneurysm occlusion with adequate occlusion (complete occlusion or neck remnant) in 83.6% of aneurysms. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. WEBCAST and WEBCAST-2: Unique identifier: NCT01778322.
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Affiliation(s)
| | - Istvan Szikora
- Neurointerventions, National Institute of Clinical Neurosciences, Budapest, Budapest, Hungary
| | | | - Markus Holtmannspoetter
- Neuroradiology Department, Nuremberg General Hospital, Paracelsius Medical University, Nürnberg, Germany
| | - Laurent Spelle
- Interventional Neuroradiology, CHU Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
| | | | - Jens Fiehler
- Department of Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Vincent Costalat
- Neuroradiology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Joachim Klisch
- Institute of Diagnostic and Intervenional Radiology and Neuroradiology, HELIOS Klinikum Erfurt Klinik für Frauenheilkunde und Geburtshilfe, Erfurt, Thuringia, Germany
| | | | - Werner Weber
- Radiology and Neuroradiology, Ruhr-Universitat Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Thomas Liebig
- Neuroradiology, University Hospital Munich, Munchen, Bayern, Germany
| | - Luc Stockx
- Neuroradiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Joachim Berkefeld
- Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Jacques Moret
- Interventional Neuroradiology, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Andy Molyneux
- Neurovascular and Neuroradiology Research Unit, Oxford University, Oxford, Oxfordshire, UK
| | - James Byrne
- Department of Neuroradiology, Nuffield Department of Surgical Sciences, Oxford University, Oxford, Oxfordshire, UK
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15
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Gong Y, Cao C, Guo Y, Chang B, Sheng Z, Shen W, Zou Y, Lu X, Xing J, Xia S. Quantification of intracranial arterial stenotic degree evaluated by high-resolution vessel wall imaging and time-of-flight MR angiography: reproducibility, and diagnostic agreement with DSA. Eur Radiol 2021; 31:5479-5489. [PMID: 33585995 DOI: 10.1007/s00330-021-07719-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the reproducibility and diagnostic agreement of high-resolution vessel wall imaging (HR-VWI) and time-of-flight magnetic resonance angiography (TOF-MRA) with digital subtraction angiography (DSA) to evaluate intracranial arterial stenosis. METHODS We retrospectively enrolled patients who underwent HR-VWI and TOF-MRA with suspected intracranial artery disease and had DSA results from our institutional imaging database. Two neuroradiologists separately and independently evaluated anonymous image data for the stenotic lesions. DSA was analyzed by two neurointerventionalists and it served as a standard criterion. The reproducibility of these two MR techniques was determined by the intraclass correlation coefficients (ICCs). The diagnostic agreement to DSA was assessed by the concordance correlation coefficients (CCCs). RESULTS A total of 246 lesions from 106 individuals were analyzed for stenotic degrees. The total intra-observer and inter-observer reproducibility of HR-VWI was excellent for identifying stenosis and better than of TOF-MRA. The overall concordance of HR-VWI with DSA was excellent with CCC = 0.932, whereas TOF-MRA was 0.694. In addition, HR-VWI could provide additional vessel wall information. CONCLUSIONS HR-VWI has more advantages over TOF-MRA, such as better reproducibilities and diagnostic agreements with DSA to analyze intracranial arterial stenosis. It provides additional information that helps in clinical diagnosis and management. KEY POINTS • High-resolution vessel wall imaging can assess intracranial arterial stenosis with a better reproducibility than TOF-MRA and has a higher diagnostic agreement with DSA. • High-resolution vessel wall imaging had a higher diagnostic agreement with DSA compared with TOF-MRA. • Apart from evaluating vascular stenosis, HR-VWI provided additional vessel wall information to help in clinical diagnosis.
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Affiliation(s)
- Yan Gong
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, Tianjin Medical University Nankai Hospital, Tianjin, 300100, China
| | - Chen Cao
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, Tianjin Huanhu Hospital, Key Laboratory for Cerebral Artery and Neural Degeneration of Tianjin, Tianjin, 300350, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Binge Chang
- Department of Neurosurgery, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Zhiguo Sheng
- Department of Neurosurgery, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Ying Zou
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China
| | - Xiudi Lu
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China
| | - Jiahua Xing
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China.
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16
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[Woven-EndoBridge (WEB) as an intrasaccular method of aneurysm occlusion]. Radiologe 2020; 60:310-316. [PMID: 32179958 DOI: 10.1007/s00117-020-00671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CLINICAL PROBLEM The treatment of intracranial wide-necked bifurcation aneurysms-which account for approximately 26-36% of all brain aneurysms-can be challenging both endovascularly and surgically, as a complete cut-off of the blood flow into the aneurysm should be achieved without disruption of the flow into the bifurcation vessels. Intrasacular flow disruption with the Woven-EndoBridge (WEB) is an innovative technique for the treatment of such aneurysms. This review article discusses various aspects of the treatment of intracranial aneurysms with the WEB device, including indications, aneurysm/device selecting strategies, antiplatelet therapy requirements, procedural technique and potential complications. PRACTICAL RECOMMENDATIONS Intrasacular flow disruption with the WEB device is a safe and effective treatment method for intracranial wide-necked bifurcation aneurysms, especially for patients with ruptured aneurysms, in patients with contraindications for antiplatelet therapy, and for patients in whom clipping is associated with high risks.
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17
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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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Booth TC, Parra-Farinas C, deSouza RM, Kandasamy N, Bhattacharya J, Rangi P, Downer J. Woven Endobridge (WEB) Device as a Retreatment Strategy After Unsuccessful Surgical Clipping. World Neurosurg 2020; 139:111-120. [PMID: 32179191 PMCID: PMC7611019 DOI: 10.1016/j.wneu.2020.02.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical clipping of intracranial aneurysms is typically robust and durable. However, residual aneurysmal components may be seen after clipping. Furthermore, there may be occasional aneurysmal recurrence. These factors are both clinically relevant because subarachnoid hemorrhage after clipping is a rare but important event. The rationale for any treatment is to substantially decrease the future risk of hemorrhage. Small series have shown coiling as a retreatment strategy after unsuccessful clipping, but none has explored the feasibility of Woven Endobridge (WEB) implantation. CASE DESCRIPTION We examined the feasibility of WEB implantation as second-line treatment for wide-necked residual aneurysms after unsuccessful clipping. We also recorded the safety and efficacy in this small series of 6 patients. To determine safety, we measured the modified Rankin Scale score before and after the procedure, and at 2 later time points (mean follow-up, 5 months and 15 months). To determine efficacy, we obtained radiographic aneurysm occlusion outcomes (including WEB Occlusion Scale) at these 2 time points. Four middle cerebral artery and 2 anterior communicating artery complex aneurysms were treated with WEB implantation, showing feasibility in 6/6 cases (100%). Follow-up at 15 months showed no change from preprocedural modified Rankin Scale score and there were no other complications. There was adequate occlusion in 5/6 cases (83%). CONCLUSIONS WEB implantation provided a feasible option in this challenging retreatment scenario. This is a small series and prospective data are required to make outcome inferences for this population. Nonetheless, we observed no complications and high adequate occlusion rates.
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Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | | | - Ruth-Mary deSouza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Naga Kandasamy
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jo Bhattacharya
- Department of Neuroradiology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Prem Rangi
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jonathan Downer
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
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Nguyen HA, Soize S, Manceau PF, Vudang L, Pierot L. Persistent Blood Flow inside the Woven EndoBridge Device More Than 6 Months after Intracranial Aneurysm Treatment: Frequency, Mechanisms, and Management-A Retrospective Single-Center Study. AJNR Am J Neuroradiol 2020; 41:1225-1231. [PMID: 32527839 DOI: 10.3174/ajnr.a6593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Due to its high safety and great efficacy, flow disruption with the Woven EndoBridge (WEB) device is increasingly used to treat intracranial aneurysms. We recently identified patients with intracranial aneurysm treated with the WEB who presented with residual blood flow inside the device ("contrast-in-WEB" phenomenon) more than 6 months posttreatment. This series reports the frequency and underlying mechanisms and discusses management of this phenomenon. MATERIALS AND METHODS All patients presenting with the contrast-in-WEB phenomenon in the prospectively collected data base of patients with aneurysm treated with the WEB were retrospectively collected and analyzed. RESULTS From June 2011 to February 2019, one hundred twenty-seven patients with 133 aneurysms were treated with the WEB and had DSA follow-up at 6 months or later. Eight patients (6.3%) presented with the phenomenon. All aneurysms were wide-neck bifurcation aneurysms, including 7 unruptured and 1 ruptured aneurysm located at the MCA (5 aneurysms), anterior communicating artery (2 aneurysms), and basilar artery (1 aneurysm). All except 1 patient received dual-antiplatelet therapy preprocedure. All except 1 patient received dual-antiplatelet therapy postoperatively for at least 1 month. The most likely mechanism of the phenomenon is the absence of intradevice thrombosis related to perioperative dual-antiplatelet medication. The phenomenon is also likely associated with a low risk of bleeding except when there is residual blood flow against the aneurysm wall or in the dome. CONCLUSIONS Contrast-in-WEB is a relatively rare phenomenon possibly induced by dual-antiplatelet therapy continued post-WEB procedure. In most cases, no additional treatment is required.
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Affiliation(s)
- H A Nguyen
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - S Soize
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - P-F Manceau
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - L Vudang
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
| | - L Pierot
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France.
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20
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Goyal N, Hoit D, DiNitto J, Elijovich L, Fiorella D, Pierot L, Lamin S, Spelle L, Saatci I, Cekirge S, Arthur AS. How to WEB: a practical review of methodology for the use of the Woven EndoBridge. J Neurointerv Surg 2020; 12:512-520. [PMID: 32005760 PMCID: PMC7231463 DOI: 10.1136/neurintsurg-2019-015506] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
Wide-necked bifurcation aneurysms (WNBAs) make up 26-36% of all brain aneurysms. Treatments for WNBAs pose unique challenges due to the need to preserve major bifurcation vessels while achieving a durable occlusion of the aneurysm. Intrasaccular flow disruption is an innovative technique for the treatment of WNBAs. The Woven EndoBridge (WEB) device is the only United States Food and Drug Administration approved intrasaccular flow disruption device. In this review article we discuss various aspects of treating WNBAs with the WEB device, including indications for use, aneurysm/device selection strategies, antiplatelet therapy requirement, procedural technique, potential complications and bailouts, and management strategies for residual/recurrent aneurysms after initial WEB treatment.
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Affiliation(s)
- Nitin Goyal
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel Hoit
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Julie DiNitto
- Department of Research Collaborations, Siemens Medical Solutions USA Inc, Hoffman Estates, Illinois, USA
| | - Lucas Elijovich
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neuroradiology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Laurent Pierot
- Neuroradiology, Reims Champagne-Ardenne University, Reims, France
| | - Saleh Lamin
- Department of Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laurent Spelle
- Neuroradiology, NEURI Center, Bicetre Hospital, APHP, Paris-Saclay University, Saint-Aubin, France
| | - Isil Saatci
- Radiology, Koru Hospital, Yuksek Ihtisas Universitesi, Ankara, Turkey
| | - Saru Cekirge
- Radiology, Bayindir Hastanesi Kavaklidere, Ankara, Turkey
| | - Adam S Arthur
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
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21
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Song Y, Qi P, Huang J, Jiao S, Zhang J, Wang D, Chen M. Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography. Acta Radiol 2020; 61:480-486. [PMID: 31357872 DOI: 10.1177/0284185119865721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Intracranial aneurysm with endovascular treatment needs to be followed-up with a proper imaging method. Purpose To evaluate the performance of magnetic resonance angiography (MRA) with zero echo time at 1.5-T in assessing the intracranial aneurysm remnant and in-stent lumen as compared with time-of-flight MRA, with digital subtraction angiography as the gold standard. Material and Methods A total of 46 patients (17 men; mean age = 56.6±13.7 years) with 54 aneurysms who underwent coil embolization with or without stent were enrolled in this study. The presence of aneurysm remnant and the visualization of in-stent lumen were evaluated. The agreement of remnant identification between MRA with zero echo time and time-of-flight MRA with digital subtraction angiography was evaluated using Cohen’s kappa analysis. The performance of in-stent lumen visualization between MRA with zero echo time and time-of-flight MR angiography was compared with Chi-square test. Results Of 54 aneurysms, 27 were found to have remnants by digital subtraction angiography. The kappa value in identification of remnant of aneurysm was 0.852 between MRA with zero echo time and digital subtraction angiography and 0.741 between time-of-flight MRA and digital subtraction angiography. In detecting remnant of aneurysm, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.3%, 88.9%, 89.7%, and 96.0% for MRA with zero echo time and 91.7%, 83.3%, 81.5%, and 92.6% for time-of-flight MRA, respectively. In visualizing in-stent lumen, MRA with zero echo time had better performance than time-of-flight MRA ( P < 0.001). Conclusion MR angiography with zero echo time might be a better non-invasive approach in assessing remnant of aneurysms and in-stent lumen as compared with time-of-flight MRA.
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Affiliation(s)
- Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, PR China
| | - Juan Huang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, PR China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, PR China
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22
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Zhang SM, Liu LX, Ren PW, Xie XD, Miao J. Effectiveness, Safety and Risk Factors of Woven EndoBridge Device in the Treatment of Wide-Neck Intracranial Aneurysms: Systematic Review and Meta-Analysis. World Neurosurg 2020; 136:e1-e23. [DOI: 10.1016/j.wneu.2019.08.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022]
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23
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Letter to the Editor Regarding “PulseRider-Assisted Coil Embolization for Treatment of Intracranial Bifurcation Aneurysms: A Single-Center Case Series with 24-Month Follow-up”. World Neurosurg 2020; 133:433-435. [DOI: 10.1016/j.wneu.2019.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 11/20/2022]
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24
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Ahmed SU, Mocco J, Zhang X, Kelly M, Doshi A, Nael K, De Leacy R. MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 2019; 11:1009-1014. [PMID: 31048457 DOI: 10.1136/neurintsurg-2019-014936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. METHODS Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. RESULTS The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. CONCLUSION MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.
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Affiliation(s)
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kambiz Nael
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Ozpeynirci Y, Braun M, Schmitz B. CT Angiography in Occlusion Assessment of Intracranial Aneurysms Treated with the WEB Device. J Neuroimaging 2019; 29:481-486. [DOI: 10.1111/jon.12622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Michael Braun
- Section of NeuroradiologyUlm University Gunzburg Germany
| | - Bernd Schmitz
- Section of NeuroradiologyUlm University Gunzburg Germany
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26
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Gawlitza M, Soize S, Manceau PF, Pierot L. An update on intrasaccular flow disruption for the treatment of intracranial aneurysms. Expert Rev Med Devices 2019; 16:229-236. [DOI: 10.1080/17434440.2019.1584035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Matthias Gawlitza
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Sébastien Soize
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Pierre-François Manceau
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Laurent Pierot
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
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27
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van Rooij S, Peluso JP, Sluzewski M, Kortman HG, Boukrab I, van Rooij WJ. Mid-term 3T MRA follow-up of intracranial aneurysms treated with the Woven EndoBridge. Interv Neuroradiol 2018; 24:601-607. [PMID: 30001648 DOI: 10.1177/1591019918788346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Angiography is the standard follow-up modality for treated aneurysms with the Woven EndoBridge (WEB), and magnetic resonance angiography (MRA) is useful for extended follow-up. We present the results of WEB-treated aneurysms with angiographic follow-up at three months and at least 18 months' 3T MRA follow-up. MATERIALS AND METHODS Included were 52 patients with 53 aneurysms treated with the WEB between February 2015 and July 2016. There were 29 women and 23 men with a mean age of 60 years (median 62, range 23-76). Mean aneurysm size was 6.2 mm (median 6, range 3-16 mm). RESULTS 3T MRA follow-up was mean 19.6 months (median 18, range 18-36 months). One patient had an aneurysm remnant at three-month angiography that was additionally coiled and with stable complete occlusion at 18 months' 3T MRA follow-up. At three-month follow-up angiography, 44 aneurysms were completely occluded and eight had a neck remnant. At latest 3T MRA, stable complete occlusion was present in 43 aneurysms and stable neck remnant in eight. One posterior cerebral artery (PCA) dissection aneurysm was stable at three and six months but was enlarged and reopened at 18 months, confirmed with angiography. Focal signal loss by the proximal marker of the WEB was apparent in four patients without compromising diagnostic evaluation. CONCLUSION WEB-treated aneurysms with adequate occlusion at three-month angiography remained stable during serial 3T MRA follow-up of 18-36 months. One PCA aneurysm reopened during the 6- to 18-month interval. Once the WEB-treated aneurysm is adequately occluded in the short term, later reopening is uncommon.
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Affiliation(s)
- Sbt van Rooij
- 1 Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - J P Peluso
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - M Sluzewski
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - H G Kortman
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - I Boukrab
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - W J van Rooij
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
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28
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Boddu SR, Gobin P, Oliveira C, Dinkin M, Patsalides A. Contrast enhanced magnetic resonance venography in the follow-up evaluation of idiopathic intracranial hypertension patients with cerebral venous sinus stenting. Clin Imaging 2018; 50:330-335. [PMID: 29754068 DOI: 10.1016/j.clinimag.2018.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Role of contrast-enhanced magnetic resonance venography (CE-MRV) in the follow-up of venous sinus stenting (VSS) among the idiopathic intracranial hypertension (IIH) patients. MATERIALS AND METHODS Prospective evaluation of VSS patients with CE-MRV, DRCV and DSA for follow-up of clinically suspected recurrent stenosis. CE-MRV was evaluated against DRCV and DSA. RESULTS Ten patients with twelve episodes of recurrent symptoms. Sensitivity, specificity, PPV, NPV and accuracy of the CE-MRV for the detection of recurrent stenosis were: 100%, 33.33%, 81.82%, 100% and 83.3% respectively. CONCLUSION CE-MRV was a reliable first-line investigation for the detection of recurrent stenosis following VSS.
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Affiliation(s)
- Srikanth R Boddu
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East, 68th Street, New York, NY 10065, United States; Interventional Neuroradiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States.
| | - Pierre Gobin
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East, 68th Street, New York, NY 10065, United States.
| | - Cristiano Oliveira
- Department of Ophthalmology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10021, United States.
| | - Marc Dinkin
- Department of Ophthalmology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10021, United States.
| | - Athos Patsalides
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East, 68th Street, New York, NY 10065, United States.
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29
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Raoult H, Eugène F, Le Bras A, Mineur G, Carsin-Nicol B, Ferré JC, Gauvrit JY. CT angiography for one-year follow-up of intracranial aneurysms treated with the WEB device: Utility in evaluating aneurysm occlusion and WEB compression at one year. J Neuroradiol 2018. [PMID: 29524499 DOI: 10.1016/j.neurad.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The WEB is an innovative flow disruption device for cerebral aneurysm embolization with rapidly expanding indications. Our purpose was to evaluate the diagnostic performance of computed tomography angiography (CTA) at 1-year follow-up of aneurysms treated with the WEB. MATERIALS AND METHODS Between April 2014 and May 2016, the study prospectively included patients treated with the WEB at our institution, and followed up within 24hours by CTA and at 1year by CTA, time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). The diagnostic quality of imaging data was assessed based on the confidence index, artifacts, and WEB shape depiction. The imaging diagnostic performance was assessed using 3 criteria at 1year: aneurysm occlusion status and worsening, and WEB shape compression. Interobserver and intermodality agreement was determined by calculating κ values. RESULTS The study ultimately included 16 patients (9 women, mean age 53±7.6years). CTA quality confidence was scored as 2/2, artifacts 0.4/2 and WEB shape depiction 1.9/2, superior to TOF MRA for the latter two criteria. Aneurysm occlusion was adequate in 93.7% of patients, with CTA showing excellent interobserver reproducibility and agreement with DSA on a 4-grade scale (κ=1.00), while TOF MRA yielded good reproducibility (κ=0.76) and agreement with DSA (κ=0.69). CTA also identified aneurysm occlusion worsening (43.7%) and WEB compression (81.2%) in excellent agreement with DSA (κ=0.85 and 1.00). CONCLUSIONS CTA is a reproducible and reliable technique for the follow-up of aneurysms treated with the WEB device.
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Affiliation(s)
- Hélène Raoult
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - François Eugène
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Anthony Le Bras
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Géraldine Mineur
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Béatrice Carsin-Nicol
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Jean-Christophe Ferré
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Jean-Yves Gauvrit
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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Nawka MT, Sedlacik J, Frölich A, Bester M, Fiehler J, Buhk JH. Multiparametric MRI of intracranial aneurysms treated with the Woven EndoBridge (WEB): a case of Faraday's cage? J Neurointerv Surg 2018; 10:988-994. [PMID: 29440326 DOI: 10.1136/neurintsurg-2017-013625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate multiparametric MRI including non-contrast and contrast-enhanced morphological and angiographic techniques for intracranial aneurysms treated with the single-layer Woven EndoBridge (WEB) embolization system applying simultaneous digital subtraction angiography (DSA) as the reference of standard. MATERIALS AND METHODS We retrospectively identified all patients with incidental and acute ruptured intracranial aneurysms treated with a WEB device (WEB SL and WEB SLS) between March 2014 and June 2016 in our neurovascular center with early (within 7 days) postinterventional multiparametric MRI as well as mid-term (5-8 months) follow-up MRI and DSA available. Occlusion rates were recorded both in DSA and MR angiography (MRA). In MRI, signal intensities within the WEB as well as in the occluded dome distal to the WEB, if present, were measured by region-of-interest (ROI) analysis. RESULTS Twenty-five patients fulfilled the inclusion criteria. Rates of complete/adequate occlusion at mid-term follow-up were 84% with both MRA and DSA. A strong signal loss within the WEB was observed in all MR sequences at initial and follow-up examinations. ROI analysis did not reveal significant differences in non-contrast (P=0.946) and contrast-enhanced imaging (P=0.377). A T1-hyperintense thrombus in the non-WEB-carrying dome was a frequent observation. CONCLUSIONS Signal intensity measurements in multiparametric MRI suggest that neither contrast-enhanced MRA nor morphological sequences are capable of revealing reliable information on the WEB lumen, presumably due to radio frequency shielding. MRI is therefore not suitable for confirming complete thrombus formation within the WEB.
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Affiliation(s)
- Marie Teresa Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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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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Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, Spelle L, Berkefeld J, Januel AC, Molyneux A, Byrne JV, Fiehler J, Szikora I, Barreau X. Safety and Efficacy of Aneurysm Treatment with the WEB: Results of the WEBCAST 2 Study. AJNR Am J Neuroradiol 2017; 38:1151-1155. [PMID: 28450432 DOI: 10.3174/ajnr.a5178] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the Woven EndoBridge (WEB) device is an innovative technique for the endovascular treatment of wide-neck bifurcation aneurysms. The initial version of the device (WEB Double-Layer) was evaluated in the WEB Clinical Assessment of IntraSaccular Aneurysm Therapy (WEBCAST) study, whereas the French Observatory study evaluated both WEB Double-Layer and Single-Layer versions of the device. WEBCAST 2 was designed to evaluate the WEB Single-Layer with Enhanced Visualization. MATERIALS AND METHODS Patients with wide-neck bifurcation aneurysms for which WEB treatment was possible were included. Clinical data including adverse events and clinical status at 1 month and 1 year were collected and analyzed. A core laboratory evaluated anatomic results at 1 year following the procedure. RESULTS Ten European neurointerventional centers included 55 patients (38 women; 27-77 years of age; mean, 54.4 ± 10.0 years) with 55 aneurysms. Aneurysm locations were the middle cerebral artery in 25 aneurysms (45.5%), the anterior communicating artery in 16 (29.1%), the basilar artery in 9 (16.4%), and the internal carotid artery terminus in 5 (9.1%). Procedural morbidity and mortality at 1 month were, respectively, 1.8% (1/55 patients) and 0.0% (0/55 patients). Morbidity and mortality at 1 year were, respectively, 3.9% (2/51 patients) and 2.0% (1/51 patients). At 1 year, complete occlusion was observed in 27/50 aneurysms (54.0%); neck remnant, in 13/50 (26.0%); and aneurysm remnant, in 10/50 (20.0%) (adequate occlusion in 40/50, 80.0%). CONCLUSIONS WEBCAST 2 confirms the high safety and efficacy of WEB aneurysm treatment demonstrated in the WEBCAST and French Observatory studies.
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - I Gubucz
- National Institute of Clinical Neurosciences (I.G., I.S.), Budapest, Hungary
| | - J H Buhk
- Department of Neuroradiology (J.H.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - D Herbreteau
- Centre Hospitalier Universitaire Tours (D.H.), Tours, France
| | - L Stockx
- Ziekenhuis Oost-Limburg Genk (L. Stockx), Genk, Belgium
| | - L Spelle
- Hôpital Bicêtre (L. Spelle), Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - J Berkefeld
- Institut für Neuroradiologie (J.B.), Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt, Germany
| | - A-C Januel
- Centre Hospitalier Universitaire Toulouse (A.-C.J.), Toulouse, France
| | - A Molyneux
- Oxford Neurovascular and Neuroradiology Research Unit (J.V.B., A.M.), John Radcliffe Hospital, Oxford, UK
| | - J V Byrne
- Oxford Neurovascular and Neuroradiology Research Unit (J.V.B., A.M.), John Radcliffe Hospital, Oxford, UK
| | - J Fiehler
- Department of Neuroradiology (J.H.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Szikora
- National Institute of Clinical Neurosciences (I.G., I.S.), Budapest, Hungary
| | - X Barreau
- Centre Hospitalier Universitaire Bordeaux (X.B.), Bordeaux, France
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The Woven Endobridge Device for Treatment of Intracranial Aneurysms: A Systematic Review. World Neurosurg 2016; 98:809-817.e1. [PMID: 27856383 DOI: 10.1016/j.wneu.2016.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Woven Endobridge (WEB) device is an innovative endovascular device for treatment of intracranial aneurysms, especially bifurcation and wide-neck aneurysms. Although not approved by the U.S. Food and Drug Administration, it has been available in Europe since 2011. The aim of this review is to evaluate the outcomes of WEB device use for intracranial aneurysm treatment. METHODS A systematic review was conducted with MEDLINE search engines PubMed and Embase from 2011. The search strategy provided 6229 articles, and 19 articles were included. RESULTS A total of 19 papers were identified describing the use of WEB devices in 687 patients with 718 aneurysms. The 2 largest prospective multicenter studies (WEBCAST and the French Observatory Trial) reported successful treatment, defined as complete closure or a neck remnant, in 85% and 79% of aneurysms, respectively. The use of a WEB device in combination with coiling or stenting was described with varying results in multiple small series. Outcomes of WEB device use in ruptured aneurysms in 2 studies showed 94% and 80% adequate treatment. Thromboembolic events were described in 71 patients (10.3% of all patients) and infarctions in 8 patients (1.2% of all patients). CONCLUSIONS Despite initial promising results, the WEB device should be used with caution given its potentially large learning curve and because it has primarily been investigated only in wide-neck and bifurcation aneurysms. In addition, currently available prospective studies have short follow-up, and the device has not been directly compared with other treatment modalities.
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