Skip to main content
Log in

Angiographic C-arm CT visualization of the Woven EndoBridge Cerebral Aneurysm Embolization Device (WEB): First Experience in an Animal Aneurysm Model

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Improvements in the imaging capabilities of angiographic C-arm computed tomography (CT) using flat detector angiographic (FD-CT) systems now provide a means for the in vivo visualization of devices used for the treatment of intracranial aneurysms. One such device, the WEB embolization device, is made of a braided mesh of nitinol wires, the size of which are near to the limits of visualization using conventional x-ray fluoroscopy. Our hypothesis was that the imaging of these implants C-arm CT would provide useful information regarding their positioning and deployment.

Methods

In five New Zealand white rabbits elastase induced aneurysms were created and subsequently treated using a WEB. Imaging was performed using digital subtraction angiography (DSA), X-ray imaging and two different Angiographic C-arm CT protocols. The images were evaluated by two neuroradiologists using an evaluation scale.

Results

The mesh of the WEB was barely visible on the DSA or x-ray fluoroscopy images. Volume rendering technique (VRT) reconstruction and multiplanar reconstruction (MPR) of images done using the C-arm CT protocols clearly delineated the shape and structure of the device. Contrast-enhanced MPR and VRT reconstructions allowed assessment of the status of blood flow in the aneurysms. Beam hardening artifacts caused by platinum markers on the WEB were present.

Conclusion

In vivo C-arm CT imaging of the WEB is feasible and allows precise determination of the position and deployment status of the device. On contrast-enhanced images the occlusion status of aneurysms and the positioning of the WEB in relationship to the parent artery can be evaluated. C-arm-CT may serve as a minimal-invasive follow-up imaging modality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ding YH, Lewis DA, Kadirvel R, Dai D, Kallmes DF. The woven EndoBridge: a new aneurysm occlusion device. AJNR Am J Neuroradiol. 2011;32:607–11.

    Article  CAS  PubMed  Google Scholar 

  2. Klisch J, Sychra V, Strasilla C, Liebig T, Fiorella D. The woven EndoBridge cerebral aneurysm embolization device (WEB II): initial clinical experience. Neuroradiology. 2011;53:599–607.

    Article  PubMed  Google Scholar 

  3. Pierot L, Liebig T, Sychra V, Kadziolka K, Dorn F, Strasilla C, et al. Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol. 2012;33:1232–38.

    Article  CAS  PubMed  Google Scholar 

  4. Lubicz B, Mine B, Collignon L, Brisbois D, Duckwiler G, Strother C. WEB device for endovascular treatment of wide-neck bifurcation aneurysms. AJNR Am J Neuroradiol. 2013 Jan 4. (Epub ahead of print)

  5. Wallner AK, Broussalis E, Hauser T, Trinka E, Killer-Oberpfalzer M. Coiling after treatment with the woven EndoBridge cerebral aneurysm embolization device. A case report. Interv Neuroradiol. 2012;18:208–12.

    CAS  PubMed Central  PubMed  Google Scholar 

  6. Pfaff J, Struffert T, Gölitz P, Doerfler A. Angiographic CT for intraprocedural monitoring of complex neuroendovascular procedures. AJNR Am J Neuroradiol. 2012 Apr 5. (Epub ahead of print)

  7. Gölitz P, Struffert T, Saake M, Knossalla F, Doerfler A. Intraprocedural angiographic CT as a valuable tool in the course of endovascular treatment of direct sinus cavernous fistulas. Interv Neuroradiol. 2012;18:326–32.

    PubMed Central  PubMed  Google Scholar 

  8. Benndorf G, Klucznik RP, Strother CM. Images in cardiovascular medicine. Angiographic computed tomography for imaging of underdeployed intracranial stent. Circulation. 2006;114:e499–500.

    Article  PubMed  Google Scholar 

  9. Benndorf G, Claus B, Strother CM, Chang L, Klucznik RP. Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report. Neurosurgery. 2006;58(4 Suppl 2):ONS-E380.

    PubMed  Google Scholar 

  10. Benndorf G, Strother CM, Claus B, Naeini R, Morsi H, et al. Angiographic CT in cerebrovascular stenting. AJNR Am J Neuroradiol. 2005;26:1813–8.

    PubMed  Google Scholar 

  11. Buhk JH, Lingor P, Knauth M. Angiographic CT with intravenous administration of contrast medium is a noninvasive option for follow-up after intracranial stenting. Neuroradiology. 2008;50:349–54.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Struffert T, Doelken M, Adamek E, Schwarz M, Engelhorn T, Kloska S, et al. Flat-detector computed tomography with intravenous contrast material application in experimental aneurysms: comparison with multislice CT and conventional angiography. Acta Radiol. 2010;51:431–7.

    Article  PubMed  Google Scholar 

  13. Struffert T, Ott S, Adamek E, Schwarz M, Engelhorn T, Kloska S, et al. Flat-detector computed tomography in the assessment of intracranial stents: comparison with multi detector CT and conventional angiography in a new animal model. Eur Radiol. 2011;21:1779–87.

    Article  PubMed  Google Scholar 

  14. Psychogios MN, Schramm P, Buhk JH, Xyda A, Gröschel K, Jung K, et al. Angiographic CT after intravenous contrast agent application: a noninvasive follow-up tool after intracranial angioplasty and stenting. AJNR Am J Neuroradiol. 2010;31:1886–91.

    Article  PubMed  Google Scholar 

  15. Psychogios MN, Wachter D, Mohr A, Schramm P, Frölich AM, Jung K, et al. Feasibility of flat panel angiographic CT after intravenous contrast agent application in the postoperative evaluation of patients with clipped aneurysms. AJNR Am J Neuroradiol. 2011;32:1956–62.

    Article  PubMed  Google Scholar 

  16. Gölitz P, Struffert T, Ganslandt O, Saake M, Lücking H, Rösch J, et al. Optimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms? J Neurosurg. 2012;117:29–36.

    Article  PubMed  Google Scholar 

  17. Saake M, Struffert T, Goelitz P, Ott S, Seifert F, Ganslandt O, et al. Angiographic CT with intravenous contrast agent application for monitoring of intracranial flow diverting stents. Neuroradiology. 2012;54:727–35.

    Article  PubMed  Google Scholar 

  18. Struffert T, Saake M, Ott S, Engelhorn T, Gölitz P, Kloska S, et al. Intravenous flat detector CT angiography for noninvasive visualization of intracranial flow diverter: technical feasibility. Eur Radiol. 2011;21:1797–1801.

    Article  PubMed  Google Scholar 

  19. Struffert T, Kloska S, Engelhorn T, Deuerling-Zheng Y, Ott S, Doelken M, et al. Optimized intravenous flat detector CT for noninvasive visualization of intracranial stents: first results. Eur Radiol. 2011;21:411–8.

    Article  PubMed  Google Scholar 

  20. Cloft HJ, Altes TA, Marx WF, Raible RJ, Hudson SB, Helm GA, et al. Endovascular creation of an in vivo bifurcation aneurysm model in rabbits. Radiology. 1999;213:223–8.

    Article  CAS  PubMed  Google Scholar 

  21. Kallmes DF, Helm GA, Hudson SB, Altes TA, Do HM, Mandell JW, et al. Histologic evaluation of platinum coil embolization in an aneurysm model in rabbits. Radiology. 1999;213:217–22.

    Article  CAS  PubMed  Google Scholar 

  22. Struffert T, Ott S, Kowarschik M, Bender F, Adamek E, Engelhorn T, Gölitz P, Lang S, Strother CM, Doerfler A. Measurement of quantifiable parameters by time-density curves in the elastase-induced aneurysm model: first results in the comparison of a flow diverter and a conventional aneurysm stent. Eur Radiol. 2013;23:521–7.

    Article  PubMed  Google Scholar 

  23. Struffert T, Roth C, Romeike B, Grunwald IO, Reith W. Onyx in an experimental aneurysm model: histological and angiographic results. J Neurosurg. 2008;109:77–82.

    Article  PubMed  Google Scholar 

  24. Prell D, Kyriakou Y, Struffert T, Dörfler A, Kalender WA. Metal artifact reduction for clipping and coiling in interventional C-arm CT. AJNR Am J Neuroradiol. 2010;31:634–9.

    Article  CAS  PubMed  Google Scholar 

  25. Kyriakou Y, Richter G, Dörfler A, Kalender WA. Neuroradiologic applications with routine C-arm flat panel detector CT: evaluation of patient dose measurements. AJNR Am J Neuroradiol. 2008;29:1930–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. Struffert MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Struffert, T., Lang, S., Adamek, E. et al. Angiographic C-arm CT visualization of the Woven EndoBridge Cerebral Aneurysm Embolization Device (WEB): First Experience in an Animal Aneurysm Model. Clin Neuroradiol 24, 43–49 (2014). https://doi.org/10.1007/s00062-013-0224-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-013-0224-z

Keywords

Navigation