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Abstract
Background Sealing of the aneurysm neck with a Woven EndoBridge (WEB) device is recommended for disrupting the blood flow inside the aneurysm. This study investigates the relationship between WEB neck apposition and aneurysm occlusion rates.
Methods Aneurysms treated with a WEB from March 2017 to May 2022 at a single center were included. WEB neck apposition (poor/good) and WEB protrusion (yes/no) were evaluated on post-detachment high resolution cone beam CT images. Angiographic occlusion was assessed with the Bicêtre Occlusion Scale score (BOSS). Univariate and multivariable analysis tested the association between neck apposition and occlusion rates.
Results The study included 159 aneurysms in 141 patients (mean age 55.8±11.2 years; 64.2% women). Good neck apposition and protrusion were noted in 123 (77.4%) and 30 (18.9%) cases, respectively. Inter-rater agreements were good for neck apposition (κ=0.75) and protrusion (κ=0.78). Complete and adequate occlusion was achieved in 104 (65%) and 130 (82%) cases, respectively (median follow-up 18 months). Good neck apposition was a strong independent predictor for both adequate (adjusted OR (aOR)=5.9, 95% CI 2.4 to 14.9; P<0.001) and complete occlusion (aOR=7.1, 95% CI 3.0 to 18.1; P<0.001). Protrusion was more frequent in the adequate occlusion group versus the aneurysm recurrence group without reaching statistical significance (P=0.06), but was associated with more thromboembolic complications (9/30 (30%) vs 12/129 (9%); P<0.01). WEB shape modification was significantly greater in poor apposition cases (P=0.03).
Conclusions Achieving good neck apposition of the WEB strongly predicts aneurysm occlusion during follow-up. WEB protrusion should be minimized due to the increase in thromboembolic risk with limited impact on aneurysm occlusion.
- Aneurysm
- Device
Data availability statement
Data are available upon reasonable request. Study data are available from the corresponding author upon reasonable request by a qualified investigator, and after clearance by the local institutional review board.
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Contributors JCo, JJ, FR-E, SG, EAB, DFK, and RK contributed to the conception and design of the studies and the interpretation of the data. CM, AZ, YU, JCa, and LS contributed to the acquisition and/or analysis of the data. All authors drafted the work or revised it for significant intellectual content. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work, including its accuracy and integrity. JCo is the guarantor.
Funding JCo received educational grants from the French Society of Neuroradiology (SFNR), French Society of Radiology, Philippe Foundation, and Foundation Thérèse and René Planiol. JJ received an educational grant from the ESMINT society. Research reported in this publication was in part supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, under award No R01 NS076491. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests JCo received an educational grant from Medtronic, Phenox, and Microvention, and received honoraria for lectures from Balt. DFK received research support from Cerenovus, Sensome, Neurogami Medical, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, Stryker, and National Institutes of Health; royalties from Medtronic; is on the data safety monitoring board of NoNO and Vesalio; and is a stockholder of Nested Knowledge, Superior Medical Experts, Marblehead Medical, and Conway Medical. JCa received honoraria from Balt, Cerenovus, and Medtronic for lectures. LS is a consultant for Microvention, Balt, Phenox, Stryker, and Medtronic; data safety monitoring board or advisory board for CHOICE Study, INSPIRE Study, CLEVER study, and COATING study; and grant or contract from Philips with institution.
Provenance and peer review Not commissioned; internally peer reviewed.
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