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Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms
  1. Cristian Mihalea1,2,
  2. Simon Escalard3,
  3. Jildaz Caroff1,
  4. Léon Ikka1,
  5. Aymeric Rouchaud4,
  6. Valerio Da Ros1,5,
  7. Igor Pagiola1,6,
  8. Joaquin Jose Marenco de la Torre1,
  9. Thomas Yasuda1,
  10. Bogdan Valeriu Popa7,8,
  11. Horia Ples2,
  12. Nidhal Benachour1,
  13. Augustin Ozanne1,
  14. Jacques Moret1,
  15. Laurent Spelle1
  1. 1 Department of Interventional Neuroradiology, Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Paris, France
  2. 2 Department of Neurosurgery, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
  3. 3 Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
  4. 4 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Department of Diagnostic Imaging and Interventional Radiology, University Hospital of Rome "Tor Vergata", Rome, Italy
  6. 6 Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo, France
  7. 7 Department of Radiology and Medical Imaging, “Floreasca” Clinical Emergency Hospital, Bucharest, Romania
  8. 8 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  1. Correspondence to Dr Cristian Mihalea, Department of Interventional Neuroradiology, Neuro Brain Vascular Center, Hopital Bicetre, APHP, Paris Sud Université, Paris 92110, France; cristianmihalea{at}yahoo.com

Abstract

Background Woven EndoBridge (WEB) deployment remains challenging in aneurysms with a complex shape or orientation.

Objective To show that embolization of wide-neck bifurcation aneurysms using the WEB device balloon remodeling-assisted technique is a feasible and elegant endovascular solution compared with other techniques, such as balloon remodeling or stent-assisted coiling.

Materials and methods 10 cases (10 aneurysms in 9 patients) of balloon remodeling-assisted WEB treatment of unruptured complex bifurcation aneurysms were treated in our institution and retrospectively analyzed. Details of clinical presentations, technical details, perioperative and postoperative complications, and outcomes were collected. Immediate and long-term angiographic results were also evaluated.

Results Aneurysms included six middle cerebral artery aneurysms, one anterior communicating artery aneurysm, one posterior communicating artery aneurysm, one basilar artery aneurysm, and one T-shaped carotid aneurysm. Mean dome width was 6.55 mm, mean neck size 4.5 mm, mean height 4.79 mm, and mean dome-to-neck ratio was 1:1.46. Treatment was performed exclusively with the balloon remodeling-assisted WEB technique in all cases. The device was successfully deployed in every case. Periprocedural thromboembolic or hemorrhagic events did not occur. The modified Rankin Scale score at discharge was 0 for all patients. At mid-term or long-term angiographic follow-up, adequate occlusion was observed in 7 aneurysms from 8 controlled cases (87.5%), and one patient (2 aneurysms) did not have angiographic follow-up.

Conclusion The balloon remodeling-assisted WEB technique seems to be a safe and effective solution for endovascular treatment of unruptured wide-neck bifurcation aneurysms with specific complex anatomy. However, further studies are needed to evaluate the rate of complications and long-term efficacy.

  • aneurysm
  • balloon
  • intervention
  • technique
  • stent

https://doi.org/10.1136/neurintsurg-2018-014104

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    Footnotes

    • Contributors All authors have contributed equally to this work. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work was done by CM, SE, JC, LI, AR, VDR, and IP. Drafting the work or revising it critically for important intellectual content was finalized by TY, JJMdlT, BVP, and HP. Final approval of the version to be published was given by NB , AO, JM, and LS. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: CM, JC, IP.

    • 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 None declared.

    • Patient consent Obtained.

    • Ethics approval AP-HP ethical committee.

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