Abstract
While WEB devices have been shown to be safe and effective for aneurysm treatment, WEB-shape modification compression has been associated with incomplete aneurysm occlusion. We explored the relationship between occlusion rates and WEB-shape modification in different WEB device types in an experimental aneurysm model. Elastase-induced aneurysms were created in rabbits and treated with dual-layer (n = 12), single-layer (n = 12), or single-layer sphere (n = 12) WEB devices. Aneurysms were followed up either at 3 or 12 months. Angiographic occlusion was graded using the WEB Occlusion Scale: grade I, complete; grade II, complete but recess filling; grade III, residual neck; or grade IV, residual aneurysm. WEB-shape modification and histologic features were also analyzed. Grade I or II occlusion was seen in 16 (44%) aneurysms, and grade I, II, or III ("adequate") occlusion was observed in 22 (61.1%) aneurysms at follow-up. WEB-shape modification was observed in 22 (61.1%) aneurysms. WEB-shape modification was higher in single-layer (9/12) and dual-layer (10/12) devices compared with single-layer sphere devices (3/12). Aneurysms with WEB-shape modification had a higher level of thrombus organization in the dome compared with those without WEB-shape modification (68% [15/22] versus 50% [7/14]). WEB-shape modification was not correlated with angiographic or histologic outcomes but was significantly correlated with levels of fibrosis and smooth muscle cells in the aneurysm. WEB-shape modification is not associated with incomplete aneurysm occlusion of WEB devices in the rabbit model but may be related to connective tissue formation and the healing response to WEB device implantation.
Highlights
BACKGROUND AND PURPOSEWhile Woven EndoBridge (WEB) devices have been shown to be safe and effective for aneurysm treatment, WEB-shape modification compression has been associated with incomplete aneurysm occlusion
WEB-shape modification was higher in single-layer (9/12) and dual-layer (10/12) devices compared with single-layer sphere devices (3/12)
WEB-shape modification is not associated with incomplete aneurysm occlusion of WEB devices in the rabbit model but may be related to connective tissue formation and the healing response to WEB device implantation
Summary
Elastase-induced aneurysms were created in rabbits and treated with dual-layer (n 1⁄4 12), single-layer (n 1⁄4 12), or single-layer sphere (n 1⁄4 12) WEB devices. Elastase-induced aneurysms were created in 36 New Zealand white rabbits. Aneurysm-creation procedures were performed using an elastase-induction model as previously described.[19] Endovascular treatment of each aneurysm was undertaken at least 3 weeks after aneurysm creation.[20]. Devices WEB devices are classified according to shape and the number of mesh layers each one contains. DL devices consist of 2 layers of braided, nitinol wire mesh. SL and SLS devices consist of a single layer of braided, nitinol/platinum wire mesh; SLS implants have a more rounded 3D shape than the “barrel-like” SL and DL devices. The specific qualities of the WEB devices have been previously described.[21,22]
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