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Spelle L, Costalat V, Caroff J, Wodarg F, Fischer S, Herbreteau D, Möhlenbruch MA, Januel AC, Papagiannaki C, Klisch J, Numminen J, Rautio R, Berlis A, Mihalea C, Chalumeau V, Downer J, Cortese J, Ikka L, Gallas S, Bester M, Liebig T, Velasco S, Grimaldi L, Byrne J, Szikora I, Pierot L, Cognard C. CLinical EValuation of WEB 17 device in intracranial aneuRysms (CLEVER): 1-year effectiveness results for ruptured and unruptured aneurysms. J Neurointerv Surg 2024:jnis-2024-021918. [PMID: 38991733 DOI: 10.1136/jnis-2024-021918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is designed to treat wide-necked bifurcation aneurysms. The WEB 17 is the latest iteration and can be delivered through a 0.017″ microcatheter. The CLEVER study demonstrated that WEB 17 is safe and effective for providing protection against bleeding or rebleeding at 1 month and 1 year. OBJECTIVE To evaluate angiographic stability at 1 year. METHODS The CLEVER study was a prospective multicenter study conducted in 17 European centers, involved 163 subjects, comprising 60 ruptured and 103 unruptured aneurysms. Independent assessment of 1-year follow-up imaging was incorporated into the study design. RESULTS Aneurysm diameters ranged from 2.0 to 9.2 mm, with 95.7% being broad-based (dome-to-neck ratio <2). Follow-up imaging at 1 year was completed for 146 out of 163 subjects (89.6%) and evaluated by an independent core laboratory. The primary efficacy endpoint of adequate occlusion without re-treatment at 1 year was achieved for 120 (82.2%) of all subjects. At 1 year, the adequate occlusion rate was 86.5% for ruptured aneurysms (73.1% complete occlusion) and 82.4% for unruptured aneurysms (57.1% complete occlusion). The overall re-treatment rate at 1 year was 2.6% (4/152), with 3.1% (3/97) for unruptured aneurysms and 1.8% (1/55) for ruptured aneurysms CONCLUSION: Delivery of the WEB 17 via 0.017 inch catheters represents a significant evolution of the WEB design. The results of CLEVER presented here demonstrate that it maintains the same efficacy as previous generations of WEB.
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Affiliation(s)
- Laurent Spelle
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Jildaz Caroff
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Fritz Wodarg
- Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Sebastian Fischer
- Department of Neuroradiology, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Germany
| | | | - Markus A Möhlenbruch
- Department of Neuroradiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Anne-Christine Januel
- Department of Diagnostic and Therapeutic Neuroradiology, Pierre Paul Riquet Hospital, Toulouse, France
| | | | - Joachim Klisch
- Department of Neuroradiology, HELIOS Klinikum, Erfurt, Germany
| | - Jussi Numminen
- Department of Neuroradiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Riitta Rautio
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Ansgar Berlis
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Cristian Mihalea
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Jonathan Downer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Jonathan Cortese
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Leon Ikka
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Sophie Gallas
- NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig-Maximilian University Hospital, Munchen, Germany
| | | | - Lamiae Grimaldi
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
- Clinical research unit, Bicetre Hospital, Assitance Publique - Hôpitaux de Paris, Le Kremlin-Bicetre, France
| | - James Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
| | - Istvan Szikora
- Department of Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Laurent Pierot
- Department of Neuroradiology, Maison Blanche Hospital, Reims-Champagne-Ardenne University, Reims, France
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Pierre Paul Riquet Hospital, Toulouse, France
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Liu X, Guo Y, Zhang K, Yu J. Endovascular treatment of intracranial internal carotid artery bifurcation region aneurysms. Front Neurol 2024; 15:1344388. [PMID: 38606281 PMCID: PMC11008469 DOI: 10.3389/fneur.2024.1344388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
Intracranial internal carotid artery (ICA) bifurcation region aneurysms are uncommon. When treatment is necessary for ICA, endovascular treatment (EVT) can be a useful option. Due to the complexity of these aneurysms and the variability of EVT techniques, EVT for ICA bifurcation aneurysms is challenging. Currently, it is necessary to perform a review to explore this issue further. In this review, the following issues were discussed: the anatomy of the ICA bifurcation region; the classification, natural history and EVT status of ICA bifurcation region aneurysms; the technique used for identifying ICA bifurcation region aneurysms; and the prognosis and complications of EVT for ICA bifurcation region aneurysms. According to the review and our experience, traditional coiling is currently the preferred therapy for ICA bifurcation region aneurysms. In addition, in select cases, new devices, such as flow diverters and Woven EndoBridge devices, can also be used to treat ICA bifurcation region aneurysms. Generally, EVT is an alternative treatment option for ICA bifurcation region aneurysms.
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Affiliation(s)
- Xu Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yunbao Guo
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Kun Zhang
- Department of Cerebrovascular Disease, Henan Provincial People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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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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Ghozy S, Motawei AS, Moussalem C, Elrefaei A, Kobeissi H, Abbas AS, Dmytriw AA, Kallmes DF, Kadirvel R. Safety and efficacy of the Woven Endo-Bridge-17 device for intracranial aneurysm treatment: A systematic review and meta-analysis. Interv Neuroradiol 2024:15910199231226294. [PMID: 38234203 DOI: 10.1177/15910199231226294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The Woven Endo-Bridge (WEB) device revolutionized the treatment of wide-necked bifurcation aneurysms by intrasaccular flow diversion. The latest advancement is the WEB-17 system, offering greater flexibility with fewer wires, enabling treatment of smaller distal aneurysms using smaller microcatheters than the WEB-21 system. METHODS We conducted a systematic review following preferred reporting items for systematic reviews and meta-analyses guidelines, analyzing data from seven retrospective cohort studies involving 483 aneurysms treated with the WEB-17 device. Statistical analysis computed pooled prevalence rates and 95% confidence intervals using appropriate models for each outcome and R software version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS Technical success was achieved in 475 out of 483 aneurysms treated with the WEB-17 device, with a success rate of 98.34% (95% confidence interval (CI) = 96.72-99.17). Among the successful cases, 4.97% (95% CI = 1.60-14.39) required adjunctive devices. Adequate occlusion, defined as complete occlusion or neck remnants, was observed in 94.41% (95% CI = 88.17-97.46) of cases. Periprocedural complications were infrequent, with thromboembolic complications occurring in 4.93% (95% CI = 3.29-7.30) of cases, hemorrhagic complications in 1.28% (95% CI = 0.58-2.83), and postprocedural neurologic complications in 0.99% (95% CI = 0.31-3.14). Procedure-related morbidity was observed in 1.71% (95% CI = 0.86-3.39) of cases, and there was one procedure-related mortality reported at 0.21% (95% CI = .03-1.50). Mortality unrelated to the procedure occurred in 1% (95% CI = 0.23-4.15). CONCLUSION Our findings suggest that the WEB-17 device is associated with a high rate of technical success, favorable angiographic outcomes, and a low rate of periprocedural complications. Further research, including prospective trials, is needed to confirm these findings and establish its safety and efficacy definitively.
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Affiliation(s)
- Sherief Ghozy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Amro Elrefaei
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Alzhraa S Abbas
- Evidence-based Practice Center, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St Michael's Hospital, Toronto, ON, Canada
| | | | - Ramanathan Kadirvel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Rodriguez-Erazú F, Cortese J, Mihalea C, Popica A, Chalumeau V, Vasconcellos N, Gallas S, Ikka L, Grimaldi L, Caroff J, Spelle L. Thromboembolic Events With the Woven Endobridge Device: Incidence, Predictive Factors, and Management. Neurosurgery 2024; 94:183-192. [PMID: 37728333 DOI: 10.1227/neu.0000000000002696] [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: 05/24/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Woven EndoBridge (WEB) device has been increasingly used to treat wide-neck aneurysms showing a safe and effective profile, but a relatively high number of thromboembolic events (TEEs) have been reported with such treatment. We aimed to evaluate the incidence and management of TEEs and possible predictive factors related to WEB embolization of ruptured and unruptured intracranial aneurysms. METHODS A single-center database with consecutive aneurysms treated with a WEB device between July 2012 and May 2022 was reviewed for intraoperative and delayed TEEs. Univariate and multivariable analyses were used to determine factors associated with TEEs. RESULTS A total of 266 independent aneurysms were treated with WEB devices in 245 patients (mean age 55.78 ± 11.64 years, 169 (63.5%) females, 80 (30%) ruptured). The overall rate of TEEs is 13% (35/266), including 8.7% intraoperative. Symptomatic TEEs with clinical sequelae at a 3-month follow-up are reported to be 2.6% (7/266) with no TEE-related mortality. Both the replacement of a WEB device during the procedure (adjusted odds ratio = 2.61, 95% CI 1.24-5.49; P = .01) and ruptured aneurysms (adjusted odds ratio = 2.74, 95% CI 1.31-5.7; P = .007) were independent predictors of TEEs. A case-by-case management of intraprocedural TEE is also presented; tirofiban was successfully used in most cases of this cohort. CONCLUSION In this study, we demonstrated that ruptured aneurysms and WEB device replacement during the procedure were independent predictive factors for TEEs. As a result, making the correct choice of WEB is crucial for improving treatment outcomes. Moreover, with proper medical management of TEEs, minimal morbidity and no mortality could be achieved, which reinforces the safety of the technique.
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Affiliation(s)
- Fernanda Rodriguez-Erazú
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Department of Neurological Surgery, University Hospital Dr Manuel Quintela, Montevideo , Uruguay
| | - Jonathan Cortese
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1195, Paris , France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Adrian Popica
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Natalia Vasconcellos
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Sophie Gallas
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
| | - Leon Ikka
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , 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
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1176, Paris , France
| | - Laurent Spelle
- Department of Interventional Neuroradiology, Bicêtre University Hospital, Paris , France
- Paris-Saclay University, Faculty of Medicine, INSERM U1195, Paris , France
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Spelle L, Costalat V, Caroff J, Wodarg F, Fischer S, Herbreteau D, Möhlenbruch MA, Januel AC, Papagiannaki C, Klisch J, Numminen J, Rautio R, Berlis A, Mihalea C, Chalumeau V, Downer J, Cortese J, Ikka L, Gallas S, Bester M, Liebig T, Velasco S, Grimaldi L, Byrne J, Szikora I, Pierot L, Cognard C. CLinical EValuation of WEB 17 device in intracranial aneuRysms (CLEVER): procedural, 30-day and 1-year safety results for ruptured and unruptured aneurysms. J Neurointerv Surg 2023:jnis-2023-020866. [PMID: 37914392 DOI: 10.1136/jnis-2023-020866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Intrasaccular flow disruption is an endovascular approach for the treatment of wide-neck aneurysms and, more specifically, wide-neck bifurcation aneurysms, which are challenging to treat with previously developed technologies. The Woven EndoBridge (WEB) device has demonstrated its efficacy and safety, for both unruptured and ruptured aneurysms. METHODS The CLEVER study was an observational, multicenter, prospective study conducted in 17 European investigational sites using the WEB 17 device, for the treatment of ruptured and unruptured aneurysms. The study objective was to provide safety and efficacy data on the WEB 17 device in the treatment of wide-neck bifurcation aneurysms. Imaging results were assessed independently by a Corelab and adverse events adjudicated by a Clinical Event Adjudicator. This analysis reports procedural results and safety at 30 days and 12 months. RESULTS A total of 163 patients (mean age 58.1 years; 68.1% women) with 103 unruptured aneurysms and 60 ruptured aneurysms were enrolled. Most aneurysms were located on the anterior communicating artery (ACom) (37.4%) or the middle cerebral artery (MCA) bifurcation (30.1%). Aneurysm widths ranged from 2.0-9.2 mm, and the mean sac width was 5.0 mm. The WEB procedure was successfully completed in 163 patients (100%). At the 12-month follow-up, major stroke events occurred in 3 of 163 patients (1.8%), and no device-related mortality was observed. CONCLUSION Endovascular treatment of ruptured and unruptured wide-neck bifurcation aneurysms using WEB 17 is safe, with a low complication rate and no device-related mortality. In particular, none of the ruptured aneurysms bled again up to 1 year of follow-up. TRIAL REGISTRATION NUMBER NCT03844334.
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Affiliation(s)
- Laurent Spelle
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Vincent Costalat
- Interventional Neuroradiology, Gui de Chauliac University hospital, Montpellier, France
| | - Jildaz Caroff
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Sebastian Fischer
- Neuroradiology, Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Nordrhein-Westfalen, Germany
| | - Denis Herbreteau
- Inreventional Neuroradiology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Markus A Möhlenbruch
- Neuroradiology, UniversitätsKlinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Anne-Christine Januel
- Diagnostic and Therapeutic Neuroradiology, Hospital Pierre Paul Riquet, Toulouse, Occitanie, France
| | | | - Joachim Klisch
- Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Thüringen, Germany
| | - Jussi Numminen
- Interventional Neuroradiology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | | | - Ansgar Berlis
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Cristian Mihalea
- NEURI The Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Jonathan Downer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Jonathan Cortese
- Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- UMR CNRS no 7252, XLIM, Limoges, Aquitaine, France
| | - Léon Ikka
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Sophie Gallas
- NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, Île-de-France, France
- Assistance Publique - Hôpitaux de Paris Université Paris Saclay, Le Kremlin-Bicetre, Île-de-France, France
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | | | - Lamiae Grimaldi
- Clinical Research Unit Bicetre hospital, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - James Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Istvan Szikora
- Interventional Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Budapest, Hungary
| | - Laurent Pierot
- Department of Interventional Neuroradiology, CHU de Reims, Reims, Grand Est, France
- Champagne University Hospital Group, Reims, Grand Est, France
| | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, Occitanie, France
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Javed K, Fortunel A, Holland R, Khatri D, Ahmad S, Haranhalli N, Altschul D. Identifying risk factors for perioperative thromboembolic complications in patients treated with the Woven EndoBridge device. Interv Neuroradiol 2023; 29:561-569. [PMID: 35837721 PMCID: PMC10549708 DOI: 10.1177/15910199221113907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Woven EndoBridge (WEB) is a new endovascular treatment option for wide necked bifurcation aneurysms. Results from the WEB-IT trial showed a 0% risk of thromboembolic complications within 30 days post-op but the rate reported in the literature is as high as 10%. We are exploring potential risk factors associated with immediate thromboembolic complications in patients treated with the WEB device. METHODS Retrospective study of forty-two patients with intracranial aneurysms who were treated with WEB at a single center from 2019-2021. Data was collected on patient demographics, comorbidities, aneurysm characteristics, procedural details, and hospital course. Bivariate analyses were performed to compare patients who experienced a periprocedural ischemic stroke to those who did not. Multiple logistic regression modeling was performed to identify independent risk factors for thromboembolic complications. RESULTS Of the 42 patients that were treated with WEB, 6 suffered an ischemic stroke (AIS). These patients were more likely to have an underlying diagnosis of arrythmias (p value = 0.007). Furthermore, they had a median angle of 32.0° in the true neck view on diagnostic angiogram compared to 19.5° (p value = 0.046). Lastly, they had a longer procedure length of 228 min compared to 178 min (p value = 0.002). Patients with thromboembolic complications had a longer length of stay in the hospital and worse outcomes at three months follow up. On logistic regression modeling, these risk factors did not reach statistical significance. CONCLUSION Risk factors of thromboembolic complications after WEB placement include cardiac arrythmias, acute aneurysmal angle in the true neck view and a longer procedure length.
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Affiliation(s)
- Kainaat Javed
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Adisson Fortunel
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Deepak Khatri
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Samuel Ahmad
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Neil Haranhalli
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
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Sabuzi F, Cortese J, Da Ros V, Mihalea C, Chalumeau V, Moret J, Caroff J, Spelle L. How a decade of aneurysms embolization with the Woven EndoBridge has changed our understanding and practices? J Neuroradiol 2023; 50:518-522. [PMID: 36868371 DOI: 10.1016/j.neurad.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Safety and efficacy of the WEB (Woven EndoBridge) device have been extensively evaluated in several good clinical practice studies. Nonetheless, the WEB had several structural evolutions overtime up to the fifth generation WEB device (WEB17). Here, we tried to understand how this may have modified our practices and enlarged our indications for its use. METHODS We retrospectively analyzed data from all patients with aneurysms treated (or intended to be treated) with a WEB at our institution between July 2012 and February 2022. The time frame was split in two periods: before and after the arrival of the WEB17 in our center (February 2017). RESULTS 252 patients with 276 wide-necked aneurysms were included; 78 aneurysms (28.2%) were ruptured. Successful embolization with a WEB device was achieved in 263/276 aneurysms (95.3%). With the availability of WEB17, treated aneurysms were significantly smaller (8.2 mm versus 5.9 mm, p<0.001) and off-label location significantly increased (4.4% versus 17.3%, p = 0.02) with an increase of sidewall aneurysm (4.4% versus 11.6%, p = 0.06). Also, WEB were more significantly oversized (1.05 versus 1.11, p<0.01). Adequate and complete occlusion rates increased constantly during the two periods (54.8% versus 67.5%, p = 0.08 and 74.2% versus 83.7%, p = 0.10, respectively). The proportion of ruptured aneurysms slightly increased between the two periods (24.6% versus 29.5%, p = 0.44). CONCLUSIONS Over the first decade of its availability, the WEB device usage shifted towards smaller aneurysms and broader indications, including ruptured aneurysms. The oversizing strategy also became the standard of practice for WEB deployment in our institution.
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Affiliation(s)
- Federico Sabuzi
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Jonathan Cortese
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France.
| | - Valerio Da Ros
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Cristian Mihalea
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | - Jacques Moret
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France; Paris-Saclay University Faculty of Medicine, INSERM U1195, Le Kremlin-Bicêtre, France
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9
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Pagano P, Cortese J, Soize S, Caroff J, Manceau PF, Moret J, Spelle L, Pierot L. Aneurysm Treatment with Woven EndoBridge-17: Angiographic and Clinical Results at 12 Months from a Retrospective, 2-Center Series. AJNR Am J Neuroradiol 2023; 44:467-473. [PMID: 36997284 PMCID: PMC10084902 DOI: 10.3174/ajnr.a7830] [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: 11/10/2022] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND PURPOSE This retrospective, 2-center study investigated the feasibility, safety, and efficacy at 12-month follow-up of the treatment of ruptured, unruptured, and recurrent intracranial aneurysms using the latest generation of the Woven EndoBridge (WEB) device, the WEB-17 system. MATERIALS AND METHODS Aneurysms treated with WEB-17 were extracted from the databases of 2 neurovascular centers. Patients, aneurysm characteristics, complications, and clinical and anatomic results were analyzed. RESULTS From February 2017 to May 2021, two hundred twelve patients with 233 aneurysms (181/233, 77.7%, unruptured-recurrent, and 52/233, 22.3%, ruptured) were included. High treatment feasibility (95.3%) was reported and was similar in ruptured aneurysms (94.2%) and unruptured-recurrent aneurysms (95.6%) (P = .71) and in typical (95.4%) and atypical (94.7%) locations (P = .70), but it was lower in aneurysms with an angle between the parent artery and main aneurysm axis of ≥45° (90.2%) compared with those with an angle of <45° (97.1%) (P = .03). Global mortality and morbidity were 1.9% and 3.8% at 1 month, respectively, and 4.4% and 1.9% at 12 months, respectively. One-month morbidity (P = .02) and mortality (P = .003) were higher in the ruptured group (10.0% and 8.0%, respectively) compared with unruptured-recurrent group (1.9% and 0.0%, respectively). Overall adequate occlusion (complete occlusion and neck remnant) was 86.3%. The percentage of adequate occlusion was higher (P = .05) in the unruptured-recurrent group (88.5%) compared with the ruptured group (77.5%). CONCLUSIONS The WEB-17 system showed high feasibility for ruptured and unruptured aneurysms, typical and atypical locations, and some aneurysms with an angle of ≥45°. As the most recent generation device, the WEB-17 also demonstrates high safety and good efficacy.
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Affiliation(s)
- P Pagano
- Department of Neuroradiology (P.P., S.S., P.F.M., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire, Reims, France
- Faculty of Medicine (P.P., S.S., L.P.), Champagne-Ardenne University, Reims, Grand-Est, France
| | - J Cortese
- NEURI Brain Vascular Center (J. Cortese, J. Caroff, J.M., L.S.), Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Faculty of Medicine (J. Cortese, L.S.), Paris-Saclay University, L'Institut National de la Santé et de la Recherche Médicale U1195, Le Kremlin-Bicetre, France
| | - S Soize
- Department of Neuroradiology (P.P., S.S., P.F.M., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire, Reims, France
- Faculty of Medicine (P.P., S.S., L.P.), Champagne-Ardenne University, Reims, Grand-Est, France
| | - J Caroff
- NEURI Brain Vascular Center (J. Cortese, J. Caroff, J.M., L.S.), Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
| | - P F Manceau
- Department of Neuroradiology (P.P., S.S., P.F.M., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire, Reims, France
| | - J Moret
- NEURI Brain Vascular Center (J. Cortese, J. Caroff, J.M., L.S.), Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
| | - L Spelle
- NEURI Brain Vascular Center (J. Cortese, J. Caroff, J.M., L.S.), Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
- Faculty of Medicine (J. Cortese, L.S.), Paris-Saclay University, L'Institut National de la Santé et de la Recherche Médicale U1195, Le Kremlin-Bicetre, France
| | - L Pierot
- Department of Neuroradiology (P.P., S.S., P.F.M., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire, Reims, France
- Faculty of Medicine (P.P., S.S., L.P.), Champagne-Ardenne University, Reims, Grand-Est, France
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10
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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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Simgen A, Weyrich A, Dietrich P, Roumia S, Mühl-Benninghaus R, Yilmaz U, Reith W, Kettner M. Treatment of Wide-Necked Cerebral Aneurysms Using the WEB Device Including Flow Alteration Assessment With Color-Coded Imaging: A Single Center Experience. World Neurosurg X 2022; 17:100143. [PMCID: PMC9626383 DOI: 10.1016/j.wnsx.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The Woven EndoBridge (WEB) device (MicroVention, Tustin, CA) has extended the treatment of cerebral aneurysms. Despite the fact that the WEB device has shown promising clinical results, little is known about the caused intra-aneurysmal flow alterations. Here we present our clinical experience with the WEB, including examining various syngo iFlow (Siemens AG, Erlangen, Germany) parameters to predict aneurysm occlusion. Methods We reviewed the data from patients with unruptured cerebral aneurysms treated with a WEB device between 2016 and 2020. Aneurysm occlusion and complications were assessed. Furthermore, different quantitative criteria were evaluated using syngo iFlow after digital subtraction angiography. Results A total of 26 patients hosting 26 cerebral aneurysms met the inclusion criteria. Follow-up was available for 21 patients, with a mean of 7.3 ± 6.3 months. A total of 71.4% (n = 15) of the aneurysms included were located in the anterior and 28.6% (n = 6) in the posterior circulation. Adequate aneurysm occlusion was achieved in 85.7% (n = 18). The iFlow parameters for reduced aneurysm outflow (ID-R) differed significantly from the parameters for reduced inflow (PI-R and PI-D) (P < 0.001). The parameters did not differ significantly between adequately and insufficiently occluded aneurysms. Only a trend towards a lower ID-R of insufficiently occluded aneurysms was observed (P = 0.063), indicating a potential predictive value for insufficient aneurysmal outflow. There was no treatment-related morbidity or mortality. Conclusions The applied syngo iFlow parameters confirmed that flow changes induced by the WEB device significantly affect outflow compared to inflow and have potential predictive value for adequate aneurysm occlusion.
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Key Words
- cerebral aneurysm
- syngo iflow
- web
- 2d, 2-dimensional
- boss, beaujon occlusion scale score
- cfd, computational fluid dynamics
- dsa, digital subtraction angiography
- id, intensity decrease
- id-r, intensity decrease ratio
- mrs, modified rankin scale
- pi, peak intensity
- pi-d, peak intensity delay
- pi-r, peak intensity ratio
- roi, region of interest
- tdc, time density curve
- ttp, time to peak
- web, woven endobridge
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Affiliation(s)
- Andreas Simgen
- To whom correspondence should be addressed: Andreas Simgen, M.D., Ph.D.
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12
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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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13
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Abbas R, El Naamani K, Sweid A, Birkenstock L, Ruiz R, Tjoumakaris S, Gooch MR, Herial NA, Rosenwasser RH, Jabbour P. Retreatment Strategies in Aneurysm Woven Endobridge Recurrences: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:201-207. [PMID: 35240675 DOI: 10.1227/ons.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of wide-necked and bifurcation aneurysms has become a common indication for the Woven Endobridge (WEB) device. In many instances, WEB embolization fails and retreatment strategies for the recanalized aneurysms have not been established and may be challenging. OBJECTIVE To report an experience with retreatment strategies after WEB failure in 7 cases involving various aneurysm shapes, sizes, and location using multiple strategies including endovascular modalities and microsurgical clip ligation. METHODS Data were retrospectively collected from 1 high-volume cerebrovascular center for 7 patients treated with a WEB device for an aneurysm who subsequently required retreatment for that same aneurysm from 2015 through January 2021. RESULTS We identified 7 patients with WEB recurrences over a period of 6 years. Four patients initially presented with incidental findings, whereas 3 patients presented with subarachnoid hemorrhage. One patient was lost to follow-up and presented with a rerupture, whereas the 6 other patients were diagnosed with routine follow-up. Two patients received clip ligation, 2 had simple coil embolization, 1 had stent-assisted coil embolization, 1 had a flow-diverting stent, and 1 patient required 2 retreatments; he received stent-assisted coil embolization for the first retreatment and a simple coil embolization for the second retreatment. All patients had excellent angiographic outcomes and no complications. CONCLUSION The authors conclude that aneurysm recurrence after WEB is very diverse, and no single modality can properly address all recurrences. Rather, an individualized approach based on aneurysm features, neurointerventionalist expertise, and patient preference should be implemented.
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Affiliation(s)
- Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Lyena Birkenstock
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramon Ruiz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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14
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Pagano P, Paiusan L, Soize S, Pierot L. Intracranial aneurysm treatment with intrasaccular flow disruption: comparison of WEB-21 and WEB-17 systems. J Neurointerv Surg 2021; 14:904-909. [PMID: 34611031 PMCID: PMC9380482 DOI: 10.1136/neurintsurg-2021-017876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND New generations of Woven EndoBridge (WEB) devices (WEB-21 and WEB-17) are available to treat aneurysms with a width <6.5 mm. Limited comparisons between both systems exist in the literature, but mid-term efficacy has not been compared. Our study aimed to compare the indications, feasibility, and safety of both systems and to evaluate their efficacy at mid-term follow-up (12 months). METHODS Aneurysms treated with WEB-21 and WEB-17 were extracted from a prospective database. Patient and aneurysm characteristics, complications, and anatomical results were analyzed by an interventional neuroradiologist, independent of the procedures. RESULTS From June 2015 to November 2019, 87 patients with 92 aneurysms were treated with WEB-21 (38/92, 41.3%) and WEB-17 (54/92, 58.7%). WEB-21 and WEB-17 had high treatment feasibility (97.4% and 94.4%, respectively). A higher percentage of ruptured aneurysms were treated with WEB-17 (9.3%) than with WEB-21 (2.6%; p=0.03). Morbidity and mortality at 1 month were similar in both groups (no morbidity in either group, and mortality 2.7% in the WEB-21 group and 2.0% in the WEB-17 group). The rate of complete and adequate aneurysm occlusion was not significantly higher with the WEB-17 system (59.2% and 95.9%, respectively) compared with the WEB-21 (52.9% and 85.3%, respectively). CONCLUSIONS This study showed the high feasibility of aneurysm treatment with both the WEB-21 and WEB-17 systems. Indications were relatively similar with both devices except for ruptured aneurysms, which were more frequently treated with the WEB-17 device. Efficacy at 12 months (complete and adequate occlusions) was slightly, but not significantly, better with the WEB-17 device.
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Affiliation(s)
- Paolo Pagano
- Neuroradiology, Hopital Maison Blanche, Reims, Champagne-Ardenne, France
| | - Laurentiu Paiusan
- Neuroradiology, Hopital Maison Blanche, Reims, Champagne-Ardenne, France
| | - Sebastien Soize
- Neuroradiology, Hopital Maison Blanche, Reims, Champagne-Ardenne, France
| | - Laurent Pierot
- Neuroradiology, Hopital Maison Blanche, Reims, Champagne-Ardenne, France
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Vardar Z, King RM, Kraitem A, Langan ET, Peterson LM, Duncan BH, Raskett CM, Anagnostakou V, Gounis MJ, Puri AS, Ughi GJ. High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography. J Neurointerv Surg 2021; 13:669-673. [PMID: 32989033 PMCID: PMC8205185 DOI: 10.1136/neurintsurg-2020-016447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND High-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 µm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates. METHODS In a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition >50%) were binary coded. A device was considered 'adequately deployed' by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM). RESULTS Adequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R²=0.96; P<0.001). More neointimal coverage of 78%±32% was found on 'adequate deployment' cases versus 31%±24% for the 'inadequate deployment' cases (P=0.001). CONCLUSION HF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.
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Affiliation(s)
- Zeynep Vardar
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Robert M King
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Afif Kraitem
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erin T Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | - Christopher M Raskett
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vania Anagnostakou
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Giovanni J Ughi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Research and Development, Gentuity, Sudbury, Massachusetts, USA
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Girot JB, Caroff J, Cortese J, Mihalea C, Rouchaud A, Ros VD, Martinez JV, Contreras L, Ikka L, Chalumeau V, Ozanne A, Aguiar GBD, Gallas S, Moret J, Spelle L. Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device. AJNR Am J Neuroradiol 2021; 42:1276-1281. [PMID: 33926902 DOI: 10.3174/ajnr.a7115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge has proved to be a safe and effective treatment, especially for wide-neck intracranial aneurysms. The recent fifth-generation Woven EndoBridge came with smaller devices. The purpose of this study was to assess the safety and efficiency of Woven EndoBridge treatment of small and very small aneurysms. MATERIALS AND METHODS Between September 2017 and March 2020, all consecutive patients treated with a 3- or 3.5 mm-width Woven EndoBridge device were included in this retrospective intention-to-treat study. Clinical and radiologic findings were evaluated at immediate and last-available follow-up. Angiographic outcome was assessed by an external expert reader. RESULTS One hundred twenty-eight aneurysms were treated with a fifth-generation Woven EndoBridge device including 29 with a width of ≤3.5 mm. Ten aneurysms were ruptured (34%). In 3 cases (10%), Woven EndoBridge treatment could not be performed because the aneurysm was still too small for the smallest available Woven EndoBridge device and another endovascular strategy was chosen. The median follow-up time was 11.2 months. Complete and adequate occlusion was obtained in 71% and 90% of the treated aneurysms, respectively. Retreatment was needed in 2 cases (10%). Symptomatic ischemic complications leading to transient neurologic deficits occurred in 2 cases (7%) (1 procedure-related and 1 device-related) but with full spontaneous recovery at discharge. CONCLUSIONS The fifth-generation Woven EndoBridge device seems to be a safe and technically feasible treatment for both ruptured and unruptured small and very small intracranial aneurysms, with satisfactory occlusion rates on midterm follow-up. However, further study is needed to evaluate longer-term efficiency.
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Affiliation(s)
- J-B Girot
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Radiology Department (J.-B.G.), Angers University Hospital, Angers, France
| | - J Caroff
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - J Cortese
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - C Mihalea
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - A Rouchaud
- Department of Radiology (A.R.), Centre Hospitalier et Universitaire Dupuytren, Centre National de la Recherche Scientifique, XLIM, Unité Mixte de Recherche Limoges, France
| | - V Da Ros
- Department of Biomedicine and Prevention (V.D.R.), University Hospital of Rome Tor Vergata, Rome, Italy
| | - J V Martinez
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - L Contreras
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Department of Neurosurgery (L.C.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - L Ikka
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - A Ozanne
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - G B D Aguiar
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Department of Surgery, Discipline Neurosurgery (G.B.D.A.), Santa Casa de Sao Paulo School of Medical Sciences. São Paulo, Brazil
| | - S Gallas
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - J Moret
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Université Paris Sud, faculté de Médecine (J.M., L.S.), Le Kremlin-Bicêtre, France
| | - L Spelle
- From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Université Paris Sud, faculté de Médecine (J.M., L.S.), Le Kremlin-Bicêtre, France
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Cortese J, Caroff J, Girot JB, Mihalea C, Da Ros V, Aguiar G, Elawady A, Ikka L, Gallas S, Ozanne A, Chalumeau V, Rouchaud A, Moret J, Spelle L. Impact of A1 Asymmetry on the Woven EndoBridge Device in Anterior Communicating Artery Aneurysms. AJNR Am J Neuroradiol 2021; 42:1479-1485. [PMID: 34117022 DOI: 10.3174/ajnr.a7189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Woven EndoBridge (WEB) devices are increasingly used to treat intracranial aneurysms. A1 asymmetry contributes to anterior communicating artery aneurysm formation and to treatment instability after coiling. We sought to evaluate whether A1 asymmetry had an impact on angiographic outcome in anterior communicating artery aneurysms treated with the WEB. MATERIALS AND METHODS Anterior communicating artery aneurysms treated between July 2012 and July 2020 with the WEB from an institutional review board-approved database were reviewed. A1 asymmetry was categorized as the following: absence of the A1 segment on 1 side (unilateral A1) versus bilateral A1. Univariate and multivariable analyses assessed independent predictors of adequate (WEB Occlusion Scale A, B, and C) and complete occlusion (WEB Occlusion Scale A and B). RESULTS Forty-eight individual aneurysms (47 patients) were included in the final analysis, of which 16 (33%) were acutely ruptured. The mean size was 6.5 (SD, 2.2) mm. Adequate and complete occlusion was achieved in 33 (69%) and 30 (63%) cases, respectively. Unilateral A1 was associated with significantly higher rates of adequate (92% versus 60% for bilateral A1; P = .03) and complete occlusion (92% versus 50% for bilateral A1; P < .01). Multivariable logistic regression confirmed unilateral A1 as an independent predictor of both adequate (OR = 10.6; 95% CI, 1.6-220.7; P = .04) and complete occlusion (OR = 9.5, 95% CI, 1.5-190.2; P = .04. A sensitivity analysis comparing unilateral "functional" A1 with bilateral "functional" A1 showed similar results. WEB shape modification was not influenced by the unilateral A1 configuration (P = .70). CONCLUSIONS Anterior communicating artery aneurysms with a unilateral A1 configuration treated with WEB devices are associated with better angiographic outcome than those with bilateral A1. This finding supports the hypothesis that WEB devices are resistant to unilateral flow in the aneurysm as opposed to coils.
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Affiliation(s)
- J Cortese
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J Caroff
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J-B Girot
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Department of Radiology (J.-B.G.), Angers University Hospital, Angers, France
| | - C Mihalea
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Da Ros
- Department of Biomedicine (V.D.R.), Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - G Aguiar
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Elawady
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Ikka
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - S Gallas
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Ozanne
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Rouchaud
- Department of Interventional Neuroradiology (A.R.), Limoges University Hospital, Limoges, France.,University of Limoges (A.R.), XLIM UMR CNRS 7252, Limoges, France
| | - J Moret
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Spelle
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
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Caroff J, Cortese J, Girot JB, Mihalea C, Aguiar G, Vergara Martinez J, Ikka L, Chalumeau V, Rehem M, Gallas S, Ozanne A, Moret J, Spelle L. Woven EndoBridge device shape modification can be mitigated with an appropriate oversizing strategy: a VasoCT based study. J Neurointerv Surg 2021; 14:neurintsurg-2020-017232. [PMID: 33727411 DOI: 10.1136/neurintsurg-2020-017232] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Woven EndoBridge (WEB) shape modification (WShM) during follow-up may be a potential cause of poor angiographic outcomes. WShM predisposing factors have not yet been determined. Our systematic use of rotational cone beam computed tomography (VasoCT) imaging during follow-up allowed us to perform the first quantitative analysis of the shape of WEBs over time. Our goal was to identify possible strategies to reduce the occurrence of this phenomenon. METHODS All patients treated in our hospital with a WEB device between October 2015 and January 2019 were included. Using VasoCT acquisitions, systematically performed after implantation and during follow-up, we analyzed WEB morphology. WShM was defined as the percentage reduction in the distance between the two WEB markers. RESULTS Sixty-three aneurysms treated with a WEB device were finally included in this analysis. At the last follow-up (mean 15.5 months), mean WShM was 48%±24. The mean WShM was significantly higher in the aneurysm recurrence group than in the adequate occlusion group (51±6.5% vs 36±3.4%, difference 15% points (95% CI 0.7 to 30); p<0.05). Conversely, the extent of WShM did not directly correlate with occlusion rates. Indeed, 32% of completely occluded aneurysms presented severe WShM (≥50%). Importantly, the absence of WShM guaranteed complete occlusion in our study (n=12). We demonstrated that oversizing the width of the WEB significantly correlated with WShM reduction during follow-up (r=-0.38, p=0.002). CONCLUSION WShM can be partly overcome by use of an appropriate width oversizing strategy that could lead to improved angiographic results.
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Affiliation(s)
- Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | | | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Guilherme Aguiar
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Jeickson Vergara Martinez
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Marcelle Rehem
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France.,Faculty of Medicine, Paris - Saclay University, Le Kremlin-Bicêtre, France
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Zimmer S, Maus V, Maurer C, Berlis A, Weber W, Fischer S. Widening the Indications for Intrasaccular Flow Disruption: WEB 17 in the Treatment of Aneurysm Locations Different from Those in the Good Clinical Practice Trials. AJNR Am J Neuroradiol 2021; 42:524-529. [PMID: 33509918 DOI: 10.3174/ajnr.a6946] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of the Woven EndoBridge (WEB) device has been shown in multiple good clinical practice trials, whereas aneurysm locations in these trials were restricted to bifurcation aneurysms located at the circle of Willis (MCA bifurcation, ICA bifurcation, anterior communicating artery, basilar artery tip). Our aim was to evaluate angiographic and clinical results with the WEB 17 in aneurysm locations that were excluded from the good clinical practice trials, assuming that the angiographic and clinical results are similar to those of the good clinical practice trials for aneurysms in traditional locations. MATERIALS AND METHODS We performed retrospective analysis of immediate and follow-up results of aneurysms in locations outside the good clinical practice trials in which the WEB 17 was used on an intention-to-treat approach. RESULTS Between June 2017 and May 2020, forty-seven aneurysms in 44 patients met the inclusion criteria. Aneurysm locations were the ICA posterior communicating artery in 19 (40.3%), the ICA paraophthalmic or choroidal locations in 4 (8.6%), anterior cerebral artery A2 segment in 13 (27.7%), MCA M1 segment in 2 (4.3%), posterior cerebral artery P2 segment in 2 (4.3%), PICA in 3 (6.4%), and the superior cerebellar artery in 4 (8.4%) cases. The procedure-related morbidity and mortality rates in the entire series were 0.0%. The early and late (<12 and >12 months) complete occlusion rates were 63.9% (23/36) and 77.8% (14/18), respectively. CONCLUSIONS The WEB 17 is safe and effective in aneurysm locations different from the traditional bifurcation aneurysms included in the good clinical practice trials. Further studies will help to define the entire spectrum of aneurysm morphologies and locations suitable for the WEB 17.
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Affiliation(s)
- S Zimmer
- From the Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin (S.Z., V.M., W.W., S.F.), Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Bochum, Germany
| | - V Maus
- From the Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin (S.Z., V.M., W.W., S.F.), Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Bochum, Germany
| | - C Maurer
- Klinik für Diagnostische Radiologie und Neuroradiologie (C.M., A.B.), Klinikum Augsburg, Augsburg, Germany
| | - A Berlis
- Klinik für Diagnostische Radiologie und Neuroradiologie (C.M., A.B.), Klinikum Augsburg, Augsburg, Germany
| | - W Weber
- From the Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin (S.Z., V.M., W.W., S.F.), Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Bochum, Germany
| | - S Fischer
- From the Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin (S.Z., V.M., W.W., S.F.), Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Bochum, Germany
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Treatment of Ruptured and Unruptured Intracranial Aneurysms with WEB 17 Versus WEB 21 Systems : Comparison of Indications and Early Angiographic Outcomes. Clin Neuroradiol 2020; 31:691-697. [PMID: 32880656 DOI: 10.1007/s00062-020-00946-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The concept of intrasaccular flow diversion using the Woven EndoBridge (WEB) device changed the traditional endovascular concept for wide-necked bifurcation aneurysms. The latest technical advancement resulted in the WEB 17 system, a softer device composed of fewer wires which enables treatment of smaller more distally located aneurysms by using smaller microcatheters as compared to the WEB 21 system. OBJECTIVE This retrospective observational study aimed to evaluate and compare the angiographic and clinical results achieved with WEB 21 and WEB 17 in aneurysm morphologies eligible for both systems (maximum width 3-6 mm). METHODS Between August 2014 and August 2019 a total of 63 and 130 aneurysms with a maximum width of 3-6 mm were treated with either WEB 21 and WEB 17, respectively, at 2 neurovascular centers. Cases were analyzed based on a comparison regarding aneurysm size, location and rupture status. RESULTS The technical success, the periprocedural complication rate and the rate of additional devices used showed no relevant differences between the two groups. Aneurysms treated with the WEB 17 system were smaller and more frequently distally located. The overall complete occlusion rate at 3 months was higher in the WEB 17 group (65.5% versus 55.1%). The superiority of complete aneurysm occlusion achieved with WEB 17 was statistically significant in the subgroup of unruptured middle cerebral artery aneurysms. CONCLUSION The use of WEB 17 expands the treatment indications for intrasaccular flow-diversion towards smaller and more distally located aneurysms with a safety profile comparable with that of the WEB 21.
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Youssef PP, Dornbos Iii D, Peterson J, Sweid A, Zakeri A, Nimjee SM, Jabbour P, Arthur AS. Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms. J Neurointerv Surg 2020; 13:443-446. [PMID: 32719167 DOI: 10.1136/neurintsurg-2020-016405] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Wide-necked bifurcation aneurysms (WNBAs) present unique challenges for endovascular treatment. The Woven EndoBridge (WEB) device is an intrasaccular braided device, recently approved by the FDA for treatment of WNBAs. While treatment of intracranial aneurysms with the WEB device has been shown to yield an adequate occlusion rate of 85% at 1 year, few data have been published for patients with ruptured aneurysms. OBJECTIVE To present a multi-institutional series depicting the safety and efficacy of using the WEB device as the primary treatment modality in ruptured intracranial aneurysms. METHODS A multi-institutional retrospective analysis was conducted, assessing patients presenting with aneurysmal subarachnoid hemorrhage treated with the WEB between January 2014 and April 2020. Baseline demographics, aneurysm characteristics, adverse events, and long-term outcomes (occlusion, re-treatment, functional status) were collected. A descriptive analysis was performed, and variables potentially associated with aneurysm recurrence or re-treatment were assessed. RESULTS Forty-eight patients were included. Anterior communicating artery aneurysms were the most common (35.4%) location for treatment, followed by middle cerebral artery (20.8%) and basilar apex (16.7%). Procedural success was noted in 95.8% of patients, and clinically significant periprocedural adverse events occurred in 12.5%. After a median follow-up of 5.5 months, 54.2% of patients had follow-up angiographic imaging. Complete occlusion was seen in 61.5% of cases with adequate occlusion in 92.3%. Re-treatment was required in only 4.2% of patients during the study period. Tobacco use was significantly higher in patients with aneurysm recurrence (88.9% vs 35.7%; p=0.012). No other characteristics were associated with recurrence/re-treatment. At 30 days, 81.1% were functionally independent (modified Rankin Scale score ≤2). CONCLUSION Treatment of acutely ruptured aneurysms with the WEB device demonstrates both safety and efficacy on par with rates of conventional treatment strategies.
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Affiliation(s)
- Patrick P Youssef
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - David Dornbos Iii
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jeremy Peterson
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Amanda Zakeri
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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22
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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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23
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Maurer C, König I, Berlis A, Weber W, Fischer S. Two-Center Experience in the Endovascular Treatment of Intracranial Aneurysms Using the Woven EndoBridge 17 Device Including Midterm Follow-Up Results: A Retrospective Analysis. AJNR Am J Neuroradiol 2020; 40:1517-1522. [PMID: 31467237 DOI: 10.3174/ajnr.a6177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/05/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge device proved its effectiveness in the treatment of ruptured and unruptured intracranial aneurysms as a stand-alone device. Before 2016, Woven EndoBridge deployment required at least a 0.021-inch microcatheter. In 2016, a smaller device, the Woven EndoBridge 17 with finer size increments that used a 0.017-inch microcatheter, was introduced. We retrospectively analyzed our initial and follow-up results with the Woven EndoBridge 17 in ruptured and unruptured aneurysms. MATERIALS AND METHODS One hundred twenty-seven intracranial aneurysms in 117 patients were scheduled for treatment with the Woven EndoBridge 17 between June 2017 and February 2019. Twenty-nine aneurysms were ruptured. RESULTS Treatment was performed as intended in 124 of 127 cases (97.6%). Additional devices such as stents or coils were used in 12 cases (9.7%). Five thromboembolic complications and 1 hemorrhagic complication were encountered, resulting in clinical deterioration in 2 patients. The overall morbidity and mortality in the entire series have been 1.7% and 0.0% to date, respectively. The follow-up results at 3 and 12 months revealed complete occlusion in 76.1% (70/92) and 78.0% (32/41). CONCLUSIONS The Woven EndoBridge 17 device is safe in the treatment of small broad-based aneurysms without the general need for additional devices. The low complication rate and the promising follow-up results underline the value of this technique in a growing range of endovascular treatment options for intracranial aneurysms.
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Affiliation(s)
- C Maurer
- Klinikum Augsburg (C.M., A.B.), Klinik für Diagnostische Radiologie und Neuroradiologie, Ausburg, Germany
| | - I König
- From the Knappschaftskrankenhaus Bochum-Langendreer (I.K., W.W., S.F.), Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
| | - A Berlis
- Klinikum Augsburg (C.M., A.B.), Klinik für Diagnostische Radiologie und Neuroradiologie, Ausburg, Germany
| | - W Weber
- From the Knappschaftskrankenhaus Bochum-Langendreer (I.K., W.W., S.F.), Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
| | - S Fischer
- From the Knappschaftskrankenhaus Bochum-Langendreer (I.K., W.W., S.F.), Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
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24
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Oushy S, Rinaldo L, Brinjikji W, Cloft H, Lanzino G. Recent advances in stent-assisted coiling of cerebral aneurysms. Expert Rev Med Devices 2020; 17:519-532. [PMID: 32500761 DOI: 10.1080/17434440.2020.1778463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. AREAS COVERED The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. EXPERT OPINION technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.
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Affiliation(s)
- Soliman Oushy
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Harry Cloft
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
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25
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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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26
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Simgen A, Yilmaz U, Dietrich P, Tomori T, Mühl-Benninghaus R, Laschke MW, Menger MD, Reith W, Kettner M. Rescue of migrated Woven Endobridge devices using a stent-retriever-technique in a porcine model. Interv Neuroradiol 2020; 26:772-778. [PMID: 32340514 DOI: 10.1177/1591019920920984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The Woven Endobridge device (WEB) has become widely applied for the treatment of intracranial aneurysms. Complications are rare, however, especially dislocations and migrations can potentially increase poor clinical outcome. The aim of this study was to assess the feasibility and effectiveness of rescuing migrated Woven Endobridges using different stent retrievers. METHODS In a porcine model, Woven Endobridges of different sizes (SLS 4, SLS 7, SL 5 × 3, SL 4 × 3) were placed into the axillary arteries. By means of two different stent retrievers (Solitaire Platinum and 3D Revascularization Device), a total of 20 rescue maneuvers were performed. For this purpose, the retrievers were deployed distally of the migrated Woven Endobridges. After retracting the stent retrievers partially, the Woven Endobridges were trapped within the microcatheter. Rescue rates, time, attempts and complications were assessed. RESULTS Successful rescue of the migrated Woven Endobridges was observed in all cases (100%). Rescue was slightly faster (177.8 ± 72.8 s vs. 223.4 ± 104.1 s) with fewer attempts (1.5 ± 0.8 vs. 1.8 ± 0.9) when using the 3D Revascularization Device compared to the Solitaire Platinum. However, there were no significant differences (p = 0.327; p = 0.554). Migration of the Woven Endobridges during rescue was seen with both stent retrievers in a comparable frequency (p = 0.642). Further complications, such as entrapment of the stent-retriever-WovenEndobridge-complex at the intermediate catheter, vasospasm, perforation or dissection, were not observed. CONCLUSIONS Rescue of migrated Woven Endobridges using stent retrievers is a feasible and effective method. Rescue rates, times and attempts with the Solitaire Platinum and 3D Revascularization Device are comparable with each other.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
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27
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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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28
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Different Rescue Approaches of Migrated Woven Endobridge (WEB) Devices: an Animal Study. Clin Neuroradiol 2020; 31:431-438. [PMID: 32166403 PMCID: PMC8211610 DOI: 10.1007/s00062-020-00893-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022]
Abstract
Purpose Treatment of wide-necked intracranial aneurysms using the Woven Endobridge (WEB) device has become broadly accepted. Feared complications with the potential of increased poor clinical outcome include dislocations and migration of the device. This study was carried out to determine the effectiveness of a variety of different strategies to rescue migrated WEB devices. Methods In a porcine model, WEB devices of different sizes (SL [single layer] 3.5 × 2mm and SL 4.0 × 3 mm, SL 8 × 5 mm and SLS 8 mm [single layer spherical]) were placed into both the subclavian and axillary arteries. A total of 32 rescue maneuvers (8 per rescue device) were performed. Small WEBs were rescued using reperfusion catheters (RC) (SOFIA Plus and JET 7), larger WEBs were rescued using dedicated rescue devices (Microsnare and Alligator). Rescue rates, times, attempts and complications were assessed. Results Rescue attempts of migrated WEBs were successful in all cases (100%). Rescue time (p = 0.421) and attempts (p = 0.619) of small WEBs using RCs were comparable without significant differences. Aspiration alone was not successful for larger WEBs. Rescue of larger WEBs was slightly faster (122.75 ± 41.15 s vs. 137.50 ± 54.46 s) with fewer attempts (1 vs. 1.37) when using the Microsnare compared to the Alligator device. Complications such as entrapment of the WEB in the RCs, vasospasm, perforation, or dissection were not observed. Conclusion Rescue of migrated WEB devices is a feasible and effective method and 100% successful rescue rates and appropriate rescue times can be achieved for small WEBs using RCs and for larger WEBs using dedicated rescue devices (Microsnare and Alligator).
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29
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Goertz L, Liebig T, Siebert E, Herzberg M, Pennig L, Schlamann M, Borggrefe J, Krischek B, Dorn F, Kabbasch C. Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility. AJNR Am J Neuroradiol 2019; 40:1766-1772. [PMID: 31488499 DOI: 10.3174/ajnr.a6183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge 17 has recently been introduced to the market for facilitated endovascular treatment of small bifurcation aneurysms (≤7 mm) with low-profile microcatheters. We compared the Woven EndoBridge 17 with its predecessor versions in terms of procedural safety and feasibility. MATERIALS AND METHODS This was a multicenter review of aneurysms ranging from 3 to 7 mm treated with the Woven EndoBridge between 2011 and 2019. Aneurysm characteristics, procedural parameters, and complications were retrospectively compared between treatment with the Woven EndoBridge 17 and a control group that was treated with its predecessor versions, using inverse probability of treatment weighting. RESULTS Thirty-eight aneurysms treated with a Woven EndoBridge 17 (mean size, 4.9 ± 1.5 mm) and 70 treated with a predecessor version of the Woven EndoBridge 17 (mean size, 5.6 ± 1.4 mm) were included. The predecessor version of the Woven EndoBridge 17 had a higher failure rate (10.3%) than the Woven EndoBridge 17 (0%, P = .05). Additional stent placement was performed more often with the predecessor version of the Woven EndoBridge 17 (10.0%) than with the Woven EndoBridge 17 (2.6%, adjusted P = .005). The predecessor version of the Woven EndoBridge 17 was associated with a higher thromboembolic event rate (14.3%) than the Woven EndoBridge 17 (5.3%, adjusted P = .002). Neurologic complications (Woven EndoBridge 17: 2.6%; predecessor version of the Woven EndoBridge 17: 2.9%, adjusted P = 1.0) and immediate complete aneurysm occlusion rates (Woven EndoBridge 17: 57.9%; predecessor version of the Woven EndoBridge 17: 54.3%, adjusted P = .21) did not differ significantly between groups. CONCLUSIONS In the current study, the Woven EndoBridge 17 was associated with a potentially lower thromboembolic event rate than the predecessor version of the Woven EndoBridge 17, without compromising the immediate aneurysm occlusion rate. Long-term clinical and angiographic outcome analysis will be necessary to draw a definite conclusion.
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Affiliation(s)
- L Goertz
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany .,Center for Neurosurgery (L.G., B.K.), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - T Liebig
- Department of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
| | - E Siebert
- Department of Neuroradiology (E.S.), University Hospital of Berlin (Charité), Berlin, Germany
| | - M Herzberg
- Department of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
| | - L Pennig
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
| | - M Schlamann
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
| | - J Borggrefe
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
| | - B Krischek
- Center for Neurosurgery (L.G., B.K.), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - F Dorn
- Department of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
| | - C Kabbasch
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
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30
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Ozpeynirci Y, Braun M, Pala A, Schick M, Schmitz B. WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms. Acta Neurochir (Wien) 2019; 161:1507-1513. [PMID: 31240584 DOI: 10.1007/s00701-019-03988-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND WEB (Woven EndoBridge) device is an intrasaccular flow diverter designed for endovascular treatment of intracranial aneurysms. Recent clinical trials showed good feasibility, safety, and efficacy profiles. In most of the published studies however, aneurysms treated with adjunctive devices other than WEB such as coils or stents were included which might make it difficult to reflect the real potential of this device. The purpose of this single-center study was to present the results of ruptured and unruptured aneurysms treated only with WEB device. METHOD Between April 2013 and July 2018, 47 (ruptured, 12; 25.5%) intracranial aneurysms treated only with WEB and a follow-up of at least 3 months were included in the study. Angiographic outcome at follow-up, peri-procedural complication rate, and rate of retreatment were recorded. RESULTS Of the 47 aneurysms, 12 (25.5%) were ruptured. The mean size of the aneurysms was 6.3 mm (ruptured, 5.4 mm; unruptured, 6.6 mm). Median follow-up period was 9 months. Complete occlusion was observed in 26/47 aneurysms (55.3%; ruptured, 66.6%; unruptured, 51.4%). Thirteen aneurysms (27.6%; ruptured, 16.6%; unruptured, 31.4%) showed a neck remnant. In 4/47 aneurysms (8.5%; ruptured, 8%; unruptured, 8.5%), persistent contrast enhancement inside the WEB was recorded. In 4/47 patients (8.5%; ruptured, 8%; unruptured, 8.5%), an aneurysm remnant was noted. Adequate occlusion (complete occlusion and neck remnant) was observed in 43/47 aneurysms (91.4%; ruptured, 91.6%; unruptured, 91.4%). Retreatment rate was 6.3% (ruptured, 8%; unruptured, 5.7%). Six (12.7%; ruptured, 25%; unruptured, 8.5%) thromboembolic events were recorded. Hemorrhagic complications occurred in two patients (4.2%; ruptured, 16.6%; unruptured, 0%). CONCLUSIONS WEB enables adequate occlusion of ruptured and unruptured intracranial aneurysms mostly without requirement of long-term antiplatelet therapy. The benefit is seen especially by the wide-necked aneurysms, but indications should be extended to include narrow-necked, smaller, and side-wall aneurysms.
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Affiliation(s)
- Yigit Ozpeynirci
- Section of Neuroradiology, Bezirkskrankenhaus Gunzburg, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312, Gunzburg, Germany.
| | - Michael Braun
- Section of Neuroradiology, Bezirkskrankenhaus Gunzburg, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312, Gunzburg, Germany
| | - Andrej Pala
- Department of Neurosurgery, Ulm University, Gunzburg, Germany
| | - Melanie Schick
- Section of Neuroradiology, Bezirkskrankenhaus Gunzburg, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312, Gunzburg, Germany
| | - Bernd Schmitz
- Section of Neuroradiology, Bezirkskrankenhaus Gunzburg, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312, Gunzburg, Germany
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