Abstract
PurposeEndovascular therapy with the Woven EndoBridge (WEB) device is a safe treatment approach, whereby neoendothelialization at the neck area is a crucial element for aneurysm occlusion. We hypothesized that WEB sizing at the aneurysmal neck level has an impact on early aneurysm occlusion.MethodsPatients with short-term follow-up digital subtraction angiography following WEB treatment of unruptured aneurysms were included. Aneurysms were categorized according to the Bicêtre Occlusion Scale Score (BOSS) as adequately (BOSS 0, 0′, 1) or partially occluded (BOSS 2, 3, 1 + 3). The WEB device dimensions, including the average aneurysm diameter (AADi) and the average neck diameter (ANDi) as well as baseline patient characteristics were documented.ResultsIn this study 75 patients with 76 aneurysms were included and 65 aneurysms showed adequate occlusion at short-term follow-up (86%). In univariable logistic regression analysis, smaller differences in WEB size to ANDi (D-ANDi) were significantly associated with adequate aneurysm occlusion (odds ratio, OR = 0.41, 95% confidence interval, CI 0.23–0.71, p = 0.002). Receiver operating characteristic (ROC) curve analyses displayed higher discriminative power for the D‑ANDi (AUC = 0.77, 95% CI 0.66–0.86, cut-off ≤2.9 mm) compared to the difference in WEB size to the average aneurysm diameter (D-AADi, AUC = 0.65, 95% CI 0.53–0.75, cut-off ≤1.0 mm).ConclusionSmaller differences between the WEB width and ANDi were associated with adequate early aneurysm occlusion and might thus have a higher impact on the results than the traditional device sizing considering the mean aneurysm diameter. D‑ANDi ≤2.9 mm served as an optimal cut-off to classify occlusion after WEB treatment at the short-term follow-up. Further external validation is warranted.
Highlights
The Woven EndoBridge system (WEB; MicroVention, Tustin, CA, USA) has been shown to be a valuable treatment option for both unruptured and ruptured wide-necked bifurcation (WNBA) intracranial aneurysms (IA) [1]
The braided dense mesh surface of the WEB device serves as an interface between the aneurysm neck and the parent vessel, while the neck area represents a barrier to the inflow of blood [6]
The variables WEB width, average aneurysm diameter (OR = 0.62, 95% CI 0.42–0.92, p = 0.017), D-average neck diameter (ANDi) (OR = 0.41, 95% CI 0.23–0.71, p = 0.002), and dome-neckratio (OR = 0.12, 95% CI 0.02–0.86, p = 0.035) were significantly associated with adequate aneurysm occlusion
Summary
The Woven EndoBridge system (WEB; MicroVention, Tustin, CA, USA) has been shown to be a valuable treatment option for both unruptured and ruptured wide-necked bifurcation (WNBA) intracranial aneurysms (IA) [1]. Despite excellent treatment results applying the aforementioned device selection rules, sizing of the device at the aneurysm neck level appears to be crucial. The braided dense mesh surface of the WEB device serves as an interface between the aneurysm neck and the parent vessel, while the neck area represents a barrier to the inflow of blood [6]. This in turn leads to neointimal coverage of the WEB device in the direction of the parent artery, resulting in aneurysm thrombosis and eventually aneurysm occlusion [6, 15, 16]
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