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  • Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up

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Hemorrhagic stroke
Original research
Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up
  1. Jonathan Cortese1,2,
  2. Jildaz Caroff1,
  3. Vanessa Chalumeau1,
  4. Sophie Gallas1,
  5. Léon Ikka1,
  6. Jacques Moret1,
  7. Federico Sabuzi3,
  8. Septimiu Daniel Popescu1,
  9. Augustin Ozanne1,
  10. Lamiae Grimaldi4,5,
  11. Cristian Mihalea1,
  12. Laurent Spelle1,2
  1. 1 Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre University-Hospital, Le Kremlin-Bicetre, France
  2. 2 INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
  3. 3 Interventional Radiology Department, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
  4. 4 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
  5. 5 CESP Anti-Infective Evasion and Pharmacoepidemiology Team, INSERM, Paris, France
  1. Correspondence to Dr Jonathan Cortese, NEURI- Neurointerventional Radiology, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France; jonathan.cortese{at}aphp.fr

Abstract

Background Woven 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.

Objective To evaluate occlusion outcomes after WEB treatment to identify potential determinants of aneurysm occlusion.

Methods A 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.

Results 215 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.

Conclusion In 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.

  • Aneurysm
  • Intervention
  • Technique
  • Device

Data availability statement

Data are available upon reasonable request. Study data are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/neurintsurg-2022-018780

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    Data availability statement

    Data are available upon reasonable request. Study data are available from the corresponding author upon reasonable request.

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    Footnotes

    • Twitter @jildazz, @doc soph, @SeptimiuPopescu, @CRISTIANMIHALEA

    • Contributors JCo, JCa, and LS they contributed to the conception and design of the studies and interpretation of the data. All authors contributed to the acquisition and/or the analysis of the data and/or drafted the work or revised it for significant intellectual content; All authors approved the final version of the manuscript; agree to be accountable for all aspects of the work, including its accuracy and integrity. JCo, JCa, and LS are acting as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests LS is a consultant for Microvention, Balt, Phenox, Stryker, Medtronic; data safety monitoring board or advisory board for CHOICE Study, INSPIRE Study, CLEVER study, COATING study; grant or contract from Philips with institution. JM is a consultant for Microvention and Balt.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.