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Habibi MA, Rashidi F, Fallahi MS, Arshadi MR, Mehrtabar S, Ahmadi MR, Shafizadeh M, Majidi S. Woven endo bridge device for recurrent intracranial aneurysms: A systematic review and meta-analysis. Neuroradiol J 2024:19714009241247457. [PMID: 38613671 DOI: 10.1177/19714009241247457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Recurrent intracranial aneurysms present a significant clinical challenge, demanding innovative and effective treatment approaches. The Woven EndoBridge (WEB) device has emerged as a promising endovascular solution for managing these intricate cases. This study aims to assess the safety and efficacy of the WEB device in treating recurrent intracranial aneurysms. METHODS We conducted a comprehensive search across multiple databases, including PubMed, Scopus, Embase, and Web of Science, from inception to June 5, 2023. Eligible studies focused on evaluating WEB device performance and included a minimum of five patients with recurrent intracranial aneurysms. The complete and adequate occlusion rates, neck remnant rates, and periprocedural complication rates were pooled using SATA V.17. RESULTS Our analysis included five studies collectively enrolling 73 participants. Participant ages ranged from 52.9 to 65 years, with 64.4% being female. Aneurysms were wide-necked and predominantly located in the middle cerebral artery, basilar artery, and anterior cerebral artery. Previous treatments encompassed coiling, clipping, and the use of WEB devices. Our study found an overall adequate occlusion rate of 0.80 (95% CI 0.71-0.89), a complete occlusion rate of 0.39 (95% CI 0.28-0.50), and a neck remnant rate of 0.38 (95% CI 0.27-0.48). Periprocedural complications were reported at a rate of 0%, although heterogeneity was observed in this data. Notably, evidence of publication bias was identified in the reporting of periprocedural complication rates. CONCLUSION Our findings suggest that the WEB device is associated with favorable outcomes for treating recurrent wide-neck intracranial aneurysms.
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Affiliation(s)
- Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Farhang Rashidi
- School of Medicine, Tehran University of Medical Sciences, Iran
| | | | - Mohammad Reza Arshadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Iran
| | - Saba Mehrtabar
- Immunology Research Center, Tabriz University of Medical Sciences, Iran
| | | | - Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Kobeissi H, Ghozy S, Pakkam M, Bilgin C, Tolba H, Kadirvel R, Brinjikji W, Kallmes DF. Aneurysmal recurrence and retreatment modalities after Woven EndoBridge (WEB) device implantation: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231206082. [PMID: 37801545 DOI: 10.1177/15910199231206082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is used to treat wide-neck bifurcation aneurysms (WNBAs). We conducted a systematic review and meta-analysis to determine the retreatment rate strategies following aneurysmal recurrence of WEB device treated WNBAs. METHODS This study is reported following the PRISMA 2020 guidelines. We conducted a systematic review of the literature using PubMed, Scopus, Embase, and Web of Science. Data were pooled using a random-effects model. We calculated pooled prevalence and corresponding 95% confidence intervals (CI). RESULTS We included 11 studies. The overall retreatment rate was 171/1875 aneurysms (10.3%; 95% CI = 8.3-12.9). Stent-assisted coiling was used to treat 59 aneurysms (36.7%; 95% CI = 26.4-48.5), and flow diverters were used to treat 44 aneurysms (18.7%; 95% CI = 9.9-32.5). Following retreatment, the complete occlusion rate was 57/91 aneurysms (62.8%; 95% CI = 48.2-75.3) and the adequate occlusion rate was 24/91 aneurysms (26.4%; 18.4%-36.4%). The most common aneurysmal recurrence site was the anterior communicating artery (44/136 aneurysms, 32.4%; 95% CI = 25.0-40.7). CONCLUSIONS Roughly 10% of WNBAs initially treated with the WEB device will undergo retreatment. Retreatment is an effective strategy for WEB-treated aneurysms, with high rates of adequate and complete occlusion. Future studies should work to identify risk factors for aneurysmal recurrence.
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Affiliation(s)
- Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Madona Pakkam
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Hatem Tolba
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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3
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Papadopoulos F, Antonopoulos CN, Geroulakos G. Stent-Assisted Coiling of Unruptured Intracranial Aneurysms with Wide Neck. Asian J Neurosurg 2020; 15:821-827. [PMID: 33708649 PMCID: PMC7869257 DOI: 10.4103/ajns.ajns_57_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/18/2020] [Accepted: 04/25/2020] [Indexed: 11/06/2022] Open
Abstract
Objective: Morbidity and mortality in patients experiencing the rupture of intracranial aneurysm ruptures are high. We conducted a systematic review and meta-analysis to investigate the role of stent-assisted coiling (SAC) for unruptured intracranial aneurysms (UIAs) with wide neck. Materials and Methods: The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled proportions with 95% confidence intervals (CIs) of ten outcomes of interest were calculated. Results: We finally reviewed 13 studies, including 976 patients. The technical success of the method was 98.43% (95% CI: 95.62–99.95). Early outcomes included total periprocedural obliteration with a rate of 50.20% (95% CI: 36.09–64.30) and periprocedural rupture with zero rate. During the follow-up period, ranging from 6 months to 2 years, the total postprocedural obliteration rate was 63.83% (95% CI: 45.80–80.18) and the overall late rupture rate was 0.41% (95% CI: 0.00–2.38). The pooled in-stent stenosis rate was calculated at 1.24% (95% CI: 0.02–3.63). We also estimated a pooled rate of 0.02% (95% CI: 0.00–0.51) and 4.33% (95% CI: 2.03–7.23) for total mortality and overall neurological complications, respectively. A pooled rate of 3.94% (95% CI: 1.48–7.33) was found for stroke. Finally, the recanalization rate was recorded at 7.07% (95% CI: 4.35–10.26). Conclusions: SAC of UIAs with wide neck seems to be a safe and acceptable alternative to surgical clipping. Although early results concerning total periprocedural obliteration may be modest, follow-up outcomes may be indicative of adequate occlusion of treated UIAs.
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Affiliation(s)
| | - Constantine Nikolaos Antonopoulos
- Department of Vascular Surgery, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Background: Adverse morphological features of the proximal aortic neck have been identified as culprits for late failure after endovascular aneurysm repair (EVAR). Our objective was to investigate the prognostic role of wide proximal aortic neck in EVAR. Methods: We conducted a review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies comparing outcomes of EVAR in patients with large versus small proximal aortic neck. A meta-analysis of time-to-event data was performed with the inverse-variance method and the results were reported as summary hazard ratio (HR) and 95 % CI. We applied random-effects models of meta-analysis. Results: We identified 9 observational studies reporting on a total of 7,682 patients (1,961 with large diameter and 5,721 with small diameter neck). The hazard of death (HR 1.57, 95 % CI 1.23-2.01; P = 0.0003), aneurysm-related reintervention (HR 2.06, 95 % CI 1.23-3.45; P = 0.006), type Ia endoleak (HR 6.69, 95 % CI 4.39-10.20; P < 0.001), sac expansion (HR 10.07, 95 % CI 1.80-56.53; P = 0.009), aneurysm rupture (HR 2.96, 95 % CI 2.00-4.38; P < 0.0001), and neck-related adverse events (HR 10.33, 95 % CI 4.95-21.56; P < 0.0001) was higher in patients with large diameter proximal aortic neck than in those with small neck. Conclusions: Patients with a large proximal aortic neck were found to have poorer outcomes than those with small neck. This finding has implications in decision making when selecting methods for aneurysm treatment and in EVAR surveillance for aneurysm-related complications in this cohort of patients.
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Affiliation(s)
- George A Antoniou
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Aws Alfahad
- Department of Radiology, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - Stavros A Antoniou
- Department of Surgery, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Hassan Badri
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
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Srinivasan VM, Srivatsan A, Spiotta AM, Hendricks BK, Ducruet AF, Albuquerque FC, Puri A, Amans MR, Hetts SW, Cooke DL, Ogilvy CS, Thomas AJ, Enriquez-Marulanda A, Rai A, Boo S, Carlson AP, Crowley RW, Rangel-Castilla L, Lanzino G, Chen PR, Diaz O, Bohnstedt BN, O'Connor KP, Burkhardt JK, Johnson JN, Chen SR, Kan P. Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience. J Neurosurg 2019:1-10. [PMID: 31703202 DOI: 10.3171/2019.5.jns19313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device. METHODS This study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications. RESULTS A total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2. CONCLUSIONS PulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist's armamentarium, especially with regard to its off-label use.
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Affiliation(s)
| | | | - Alejandro M Spiotta
- 2Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Andrew F Ducruet
- 3Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Ajit Puri
- 4Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Matthew R Amans
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Steven W Hetts
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Daniel L Cooke
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Christopher S Ogilvy
- 6Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- 6Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Ansaar Rai
- 7Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia
| | - SoHyun Boo
- 7Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia
| | - Andrew P Carlson
- 8Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - R Webster Crowley
- 9Department of Neurosurgery, Rush Medical College, Chicago, Illinois
| | | | | | - Peng Roc Chen
- 11Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas
| | - Orlando Diaz
- 12The Cerebrovascular Center, Houston Methodist Hospital, Houston, Texas; and
| | - Bradley N Bohnstedt
- 13Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kyle P O'Connor
- 13Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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6
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Kaneko N, Minhas A, Tateshima S, Colby GP, Szeder V, Hinman JD, Nour M, Jahan R, Duckwiler G. Pre-procedural simulation for precision stent-assisted coiling of cerebral aneurysm. Interv Neuroradiol 2019; 25:419-422. [PMID: 30922200 DOI: 10.1177/1591019919831923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Artificial vascular models are emerging as a newly-inexpensive and accurate way to simulate a procedure before the treatment. Through utilization of precision three-dimensionally printed, silicone-reconstructed, patient-specific models of aneurysms, we can compare the performance of devices including stents, and accurately predict the behavior of the microcatheter and stent-assisted coiling in the aneurysm to not only reduce procedural time, but also make the procedure safer. Here we report two challenging cases of wide-necked aneurysms, which could be safely treated with stent-assisted coiling as simulated in the patient-specific aneurysm models.
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Affiliation(s)
- Naoki Kaneko
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Arjun Minhas
- 2 Georgetown University School of Medicine, Washington, DC, USA
| | - Satoshi Tateshima
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Geoffrey P Colby
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,3 Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Viktor Szeder
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jason D Hinman
- 4 Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - May Nour
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,4 Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Reza Jahan
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Gary Duckwiler
- 1 Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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7
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Sorenson TJ, Iacobucci M, Murad MH, Spelle L, Moret J, Lanzino G. The pCONUS bifurcation aneurysm implants for endovascular treatment of adults with intracranial aneurysms: A systematic review and meta-analysis. Surg Neurol Int 2019; 10:24. [PMID: 31123631 PMCID: PMC6416758 DOI: 10.4103/sni.sni_297_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/16/2018] [Indexed: 01/03/2023] Open
Abstract
Background The authors sought to assess the safety and early efficacy of the pCONUS Bifurcation Aneurysm Implants in a meaningful number of patients; we performed a systematic review and meta-analysis for the treatment of 203 intracranial aneurysms. Methods A literature search was performed by a reference librarian, and after screening nine case series were included in this analysis. We estimated from each study the cumulative incidence (event rate) and 95% confidence interval (CI) for each outcome. Event rates were pooled in a meta-analysis across studies using the random-effects model; descriptive statistics were reported when relevant. Results The pCONUS devices can be used with a technical success rate of 100% (95% CI: 0.98-1.00) and a technical complication rate of 0% (95% CI: 0.00-0.02). Perioperative morbidity and mortality rates were 7% (95% CI: 0.03-0.11) and 0% (95% CI: 0.00-0.01), respectively. Perioperative hemorrhage rate was 0% (95% CI: 0.00-0.02); rate of treatment-related long-term neurological deficit was 2% (95% CI: 0.00-0.06). The long-term complete occlusion rate was 60% (95% CI: 0.52-0.69) and retreatment rate was 14% (95% CI: 0.06-0.22). Conclusions The pCONUS devices are an additional tool for the treatment of wide-necked intracranial aneurysms with high rates of technical success and sufficiently low rates of morbidity and mortality. Comparative studies with longer-term follow-up are needed to clarify the role of this device in the management of challenging aneurysms.
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Affiliation(s)
- Thomas J Sorenson
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, USA
| | - Marta Iacobucci
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Mohammad H Murad
- Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Laurent Spelle
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
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