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Woven EndoBridge device shape modification can be mitigated with an appropriate oversizing strategy: a VasoCT based study
  1. Jildaz Caroff1,
  2. Jonathan Cortese1,
  3. Jean-Baptiste Girot2,
  4. Cristian Mihalea1,
  5. Guilherme Aguiar1,
  6. Jeickson Vergara Martinez1,
  7. Léon Ikka1,
  8. Vanessa Chalumeau1,
  9. Marcelle Rehem1,
  10. Sophie Gallas1,
  11. Augustin Ozanne1,
  12. Jacques Moret1,
  13. Laurent Spelle1,3
  1. 1Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
  2. 2Radiology Department, CHU Angers, Angers, Pays de la Loire, France
  3. 3Faculty of Medicine, Paris - Saclay University, Le Kremlin-Bicêtre, France
  1. Correspondence to Dr Jildaz Caroff, Department of Interventional Neuroradiology-NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, 94270, France; jildaz.caroff{at}aphp.fr

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.

  • aneurysm
  • device
  • intervention

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Footnotes

  • Twitter @jildazz, @CRISTIANMIHALEA, @doc soph

  • JCo and J-BG contributed equally.

  • Contributors JC contributed to the conception and design of the study, and drafting the manuscript. JC, JCo, and J-BG contributed to data collection and analysis. JC, JM, and LS contributed to revising the manuscript for important intellectual content. All authors approved the final version to be published.

  • 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 JC has received educational scholarships from Medtronic Neurovascular and Microvention/Terumo in 2017. JM is a consultant for Microvention, Medtronic, and Balt. LS is a consultant for Stryker, Microvention, Medtronic, and Balt.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the commission nationale de l’informatique et des libertés (CNIL) (No 20200525115905).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • 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.

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