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Janot K, Boulouis G, Forestier G, Bala F, Cortese J, Szatmáry Z, Bardet SM, Baudouin M, Perrin ML, Mounier J, Couquet C, Yardin C, Segonds G, Dubois N, Martinez A, Lesage PL, Ding YH, Kadirvel R, Dai D, Mounayer C, Terro F, Rouchaud A. WEB shape modifications: angiography-histopathology correlations in rabbits. J Neurointerv Surg 2024; 16:302-307. [PMID: 37192788 DOI: 10.1136/jnis-2023-020193] [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: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND WEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in rabbits treated with the Woven EndoBridge (WEB) procedure. METHODS Quantitative WSM was assessed using flat-panel computed tomography (FPCT) during follow-up by calculating height and width ratio (HR, WR), defined as the ratio between either measurement at an index time point and the measurement immediately after WEB implantation. The index time point varied from 1 day to 6 months. HR and WR were evaluated with angiographic and histopathological assessments of aneurysm healing. RESULTS Final HR of devices varied from 0.30 to 1.02 and final WR varied from 0.62 to 1.59. Altogether, at least 5% of HR and WR variations were observed in 37/40 (92.5%) and 28/40 (70%) WEB devices, respectively, at the time of final assessment. There was no significant correlation between complete or incomplete occlusion groups and HR or WR (p=0.15 and p=0.43). Histopathological analysis revealed a significant association between WR and aneurysm healing and fibrosis 1 month following aneurysm treatment (both p<0.05). CONCLUSION Using longitudinal FPCT assessment, we observed that WSM affects both the height and width of the WEB device. No significant association was found between WSM and aneurysm occlusion status. Although presumably a multifactorial phenomenon, the histopathological analysis highlighted a significant association between width variations, aneurysm healing and fibrosis in the first month following aneurysm treatment.
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Affiliation(s)
- Kevin Janot
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Géraud Forestier
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Fouzi Bala
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Jonathan Cortese
- NEURI The Brain Vascular Center, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | | | | | | | | | - Jérémy Mounier
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Claude Couquet
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Catherine Yardin
- Histology, Cytology, Cellular Biology and Cytogenetics, University Hospital of Limoges, Limoges, France
| | | | | | | | | | | | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Charbel Mounayer
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Faraj Terro
- Cell Biology, University Hospital of Limoges, Limoges, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
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Morioka J, Nakahara I, Matsumoto S, Hasebe A, Tanabe J, Suyama K, Watanabe S, Suyama Y, Kuwahara K. Persistent contrast-filling in the woven endobridge device three months after its implantation for cerebral aneurysm: Incidence, predictive factors, and outcome. Clin Neurol Neurosurg 2023; 231:107837. [PMID: 37356199 DOI: 10.1016/j.clineuro.2023.107837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The Woven EndoBridge (WEB) was developed to treat wide-neck bifurcation intracranial aneurysms. Occasionally, persistent contrast-filling has been observed in the WEB after treatment. The purpose of our study was to investigate its incidence, predictive factors, and clinical impact. METHODS All patients treated with the WEB between January 2021 and September 2021 at our institute were reviewed. Age, gender, antiplatelet therapy, and angioarchitecture were compared between the persistent-filling group and the no-filling group at the three-month follow-up angiography. RESULTS We included 20 patients with 20 unruptured aneurysms. Ten of the 20 intracranial aneurysms (50 %) showed contrast-filling in the WEB after three months. Two of the 10 had contrast not only inside, but around the device. Statistically significant differences were observed between the persistent-filling group and the no-filling group in neck size (median: 4.5 mm vs. 3.8 mm), deviation of the aneurysm axis from the inlet flow line where the orifice of the bifurcated arteries overlaps (mean: 15.1° vs. 33.0°), and postoperative dual antiplatelet therapy (DAPT) for at least a month (90 % vs. 20 %). One case had additional coil embolization six months after the WEB implantation. Including this case, one year after the treatment or the re-treatment, the filling in the device had disappeared in nine of 10 cases. No bleeding was observed during the mean follow-up period of 24 months. CONCLUSION Persistent contrast-filling was associated with postoperative DAPT for at least a month, a wide neck, and less deviation of the aneurysm axis from the inlet flow line. If the contrast-filling is only within the WEB and not between the aneurysmal wall and the WEB, we are not concerned. To further assess the clinical impact of this phenomenon, long-term follow-up will be needed.
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Affiliation(s)
- Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan.
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Akiko Hasebe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jun Tanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Kenichiro Suyama
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Yoshio Suyama
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Kiyonori Kuwahara
- Department of Neurosurgery, Nishichita General Hospital, Aichi, Japan
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Caroff J, Popescu SD, Mihalea C, Popica DA, Ikka L, Gallas S, Ozanne A, Chalumeau V, Moret J, Cortese J, Spelle L. Persistent Opacification of the Woven EndoBridge Device: A Conebeam CT Analysis of the Bicêtre Occlusion Scale Score 1 Phenomenon. AJNR Am J Neuroradiol 2023; 44:291-296. [PMID: 36759143 PMCID: PMC10187822 DOI: 10.3174/ajnr.a7783] [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: 10/26/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND PURPOSE Some Woven EndoBridge devices present a persistent intradevice opacification at imaging follow-up, described as the Bicêtre Occlusion Scale Score 1 (BOSS 1) phenomenon. The clinical implications remain unknown. We aimed here to analyze the factors influencing this occurrence and to precisely describe the evolution of BOSS 1 with time using conebeam CT. MATERIALS AND METHODS We retrospectively analyzed a prospectively maintained Woven EndoBridge database at our tertiary center and included all patients with isolated BOSS 1 and BOSS 1 associated with small neck remnant (BOSS 1 + 2). RESULTS Two hundred sixty-seven aneurysms were treated with a Woven EndoBridge device between July 2012 and December 2021. Follow-up with DSA was available for 220 aneurysms (median, 5 months), among which BOSS 1 and 1 + 2 were found in 9.1% (20/220) (95% CI, 5.5%-12.7%). A second DSA follow-up (median, 17 months) was performed in 15 of these 20 aneurysms, which revealed that 40% had evolved to complete Woven EndoBridge occlusion, 33% showed a decreased persistent opacification, and 27% remained stable. BOSS 1 was significantly associated with postoperative antiplatelet medication, a lower aneurysm aspect ratio, and the use of the Woven EndoBridge 17 (P < .05). The average Woven EndoBridge shape modification was less pronounced in the BOSS 1 population (P < .02). None of the BOSS 1 or 1 + 2 aneurysms required retreatment or were associated with hemorrhage occurrence. CONCLUSIONS Isolated persistent flow inside the Woven EndoBridge device at follow-up is rare and notably associated with antiplatelet prescription. It seems to present a benign course in most cases.
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Affiliation(s)
- J Caroff
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- INSERM Unit 1176 (J. Caroff)
| | - S D Popescu
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - C Mihalea
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - D A Popica
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - L Ikka
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - S Gallas
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - A Ozanne
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - J Moret
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - J Cortese
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- INSERM Unit 1195 (J. Cortese, L.S.), Le Kremlin-Bicêtre, France
| | - L Spelle
- From the Department of Interventional Neuroradiology (J. Caroff, S.D.P., C.M., D.A.P., L.I., S.G., A.O., V.C., J.M., J. Cortese, L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Paris-Saclay University Faculty of Medicine (L.S.), Le Kremlin-Bicêtre, France
- INSERM Unit 1195 (J. Cortese, L.S.), Le Kremlin-Bicêtre, France
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Algin O, Corabay S, Ayberk G. Long-term efficacy and safety of WovenEndoBridge (WEB)-assisted cerebral aneurysm embolization. Interv Neuroradiol 2022; 28:695-701. [PMID: 35098767 PMCID: PMC9706260 DOI: 10.1177/15910199211060970] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/24/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period. MATERIALS AND METHODS Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images. RESULTS The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group (p = 0.006, p = 0.019, respectively). There was a statistically significant positive relationship between preoperative height/neck measurements and the mean diameters of residual aneurysms (rs = 0.32 and p = 0.003; rs = 0.28 and p = 0.011, respectively). The WovenEndoBridge compaction/compression and migration were observed in 5 (45%) and 2 (18%) of the recurrent aneurysms. In 7 (64%) of the residual aneurysms, thrombosed areas were found within the aneurysm. In the follow-up period, four aneurysms (4.8%) were retreated due to widened residual aneurysm. Other aneurysms were improved or stable within 7 years. DISCUSSION Our adequate occlusion rate was 87%. Occlusion rates are less favorable than aneurysms with a long height, wide neck, or high neck-to-body ratio. Our study confirms the high safety and efficiency of the WovenEndoBridge. Compaction, compression, and/or migration of the WovenEndoBridge and the presence of intra-aneurysmal thrombosis are the main reasons for the recurrences.
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Affiliation(s)
- Oktay Algin
- Department of Radiology, City Hospital, Ankara, Turkey
- Department of Radiology, Yildirim Beyazit University, Ankara,
Turkey
- National MR Research Center, Bilkent University, Ankara, Turkey
| | - Seniha Corabay
- Biostatistics Department, Uludag University, Bursa, Turkey
| | - Gıyas Ayberk
- Department of Neurosurgery, Yildirim Beyazit University, Ankara,
Turkey
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