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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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.
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