Adequate Aneurysm Occlusion Research Articles

Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization.

The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment. The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size. The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters. This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.

The DERIVO2 Heal Embolization Device in the Treatment of Ruptured and Unruptured Intracranial Aneurysms: aRetrospective Multicenter Study.

The use of flow diverting stents in the treatment of intracranial aneurysms is associated with arisk of neurological morbidity due to their thrombogenicity. To reduce this risk different surface modifications have been developed. The Derivo2 Embolization Device (Acandis, Pforzheim, Germany) has proven to be asafe and effective flow diverter. To overcome the risk of thrombo-embolism, the device was modified by adding an anti-thrombogenic fibrin-heparin coating. We aimed to assess the safety and effectiveness of the Derivo2 heal Embolization Device. Retrospective multicenter data from nine German neurovascular centers between February 2022 until December 2023 were used. Patients treated with the Derivo2 heal Embolization Device for unruptured or ruptured intracranial aneurysms were included. Peri- and postprocedural adverse events, clinical outcomes, and angiographic follow-up results were evaluated. 84patients (73.8% female; mean age58.7 years) with 89aneurysms (mean size 9.8 mm) were included. 87.6% were located in the anterior circulation. Most of them were sidewall aneurysms (88.8%). 96flow diverters were used. 99.0% were successfully implanted. An in-stent balloon angioplasty was performed in 6.0% of the cases. An additional coiling was performed in 28.6%. Technical difficulties were present in 12.0% of the cases. Thrombotic events occurred in 4.8% with no neurological sequelae. Mortality and morbidity were 0 and 1.2% respectively. Adequate aneurysm occlusion was achieved in 80.7% with amean follow-up time of 6.6months. The Derivo2 heal Embolization Device showed asatisfying aneurysm occlusion and safety with alow rate of neurological morbidity.

Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database.

Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond-Roy classification 1 or 2) remains challenging. Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort. We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity. A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535-0.929], p = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024-0.681], p = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c-statistic of 0.744. Hosmer-Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p-value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/. The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization.

The impact of the Woven EndoBridge device on the treatment of anterior circulation wide-neck bifurcation aneurysms: a single-center experience.

The paucity of literature comparing Woven EndoBridge (WEB) embolization to microsurgical clipping for anterior circulation wide-neck bifurcation aneurysms (WNBAs) underscores the need for further investigation into the optimal management of this patient subpopulation. The objective of this study was to compare the rate of endovascular and microsurgical treatment of WNBAs before and after the introduction of the WEB device. In addition, the authors performed a comparison of demographics, aneurysm characteristics, and treatment outcomes in patients before and after the introduction of the WEB device. This study was a retrospective review of the usage rate of different treatment modalities for WNBAs before and after the WEB device was approved by the US FDA on September 27, 2018. The study cohort comprised 235 patients with anterior circulation WNBAs treated at the authors' institution, including 127 aneurysms treated pre-WEB and 108 treated post-WEB. Generally, the rate of endovascular treatment of anterior circulation WNBAs was significantly higher post-WEB (86.1% vs 46.5%, p < 0.001), while the rate of clipping was significantly lower (13.9% vs 53.5%, p < 0.001). During follow-up, the rate of adequate aneurysm occlusion (Raymond-Roy occlusion classification [RROC] grades 1 and 2) was nonsignificantly higher in the post-WEB cohort (83.9% vs 78.5%, p = 0.34), while the rate of RROC grade 3 was nonsignificantly higher in the pre-WEB cohort (21.5% vs 16.1%, p = 0.34). Additionally, and although nonsignificant, the rates of recurrence (pre-WEB 25.3% vs post-WEB 14.9%, p = 0.12) and retreatment (pre-WEB 22.8% vs post-WEB 14.9%, p = 0.22) were higher in the pre-WEB cohort. Recurrence was assessed before retreatment. After the introduction of the WEB device, the rate of endovascular treatment of WNBAs increased while the rate of microsurgical clipping decreased. It is essential for neurointerventionalists to become familiar with the indications, advantages, and shortcomings of all these different techniques to be able to match the right patient with the right technique to produce the best outcome.

Mid-term safety and efficacy in small intracranial aneurysm coiling: results from TARGET® nano prospective independent core lab adjudicated multicenter registry.

The primary objective is to evaluate the safety and effectiveness of Stryker second generation Target® Nano Coils in the treatment of ruptured and unruptured small (<7 mm) intracranial aneurysms. The TARGET Registry is a prospective, two-arm study with independent medical event monitoring and core-lab adjudication. This paper describes the second arm of the TARGET registry. Patients with de novo intracranial aneurysms were embolized with 2nd generation TARGET Nano coils in 12 US centers. The primary efficacy outcome was adequate aneurysm occlusion (RR occlusion grade I-II) on follow-up. Primary safety outcome was treatment-related morbidity and mortality. Secondary outcomes included aneurysm packing density immediately post-procedure, immediate adequate occlusion, aneurysm re-access rate, retreatment rate and clinical outcomes using modified ranking scale. A secondary analysis investigated the influence of using Nano-predominant coils (≥2/3 of total coil-length) vs. non-Nano-predominant coils (<2/3 of total length). 150 patients with 155 aneurysms met the inclusion and exclusion criteria. (31%) patients with ruptured and (69%) with unruptured aneurysms were treated using TARGET coils. Median age was 58.8 (SD 12.7), 74.7% were females, and 80% were Caucasians. Mean follow-up was 5.23 (SD 2.27) months. Peri-procedural mortality was seen in 2.0% of patients. Good outcome at discharge (mRS 0-2) was seen in 81.3% of the cohort. The median packing density (SD) was 29.4% (14.9). Mid-term complete/near complete occlusion rate was seen in 96% of aneurysms and complete obliteration was seen in 75.2% of aneurysms. Patients treated predominantly with Nano coils had higher PD (32.6% vs. 26.1%, p < 0.001). There was no significant difference in clinical and angiographic outcomes. The mid-term mRS0-2 was achieved in 106/109 (97.2%) patients. All-cause mortality was 5/115 (4.3%). In the multicenter TARGET Registry, 75.8% of aneurysms achieved mid-term complete occlusion, and 96% achieved complete/near complete occlusion with excellent independent functional outcome.

A large UK single-centre experience in the long-term safety and efficacy of Woven Endobridge in the treatment of wide-neck intracranial aneurysms and risk factors associated with re-bleeding and re-treatment.

Endovascular treatment of wide neck aneurysms remains complicated with a determined and continuous technological effort towards treatment options that can offer safer and efficacious outcomes. The Woven Endobridge device was introduced in 2010 and has become a mainstay endovascular treatment for wide neck and large intracranial aneurysms. A recent review of the Woven Endobridge Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) and WEBCAST2 trials and the five-year follow-up of patients was published. Our aim is to demonstrate real-life experience of aneurysms and patients treated with Woven Endobridge from a large high-volume specialist centre. A retrospective review was performed of patients treated with Woven Endobridge from March 2013 to March 2018. Primary efficacy outcomes were defined as per Raymond-Roy Occlusion Criteria (RROC) resulting in long-term complete occlusion (RROC1) and adequate occlusion (RROC1 and RROC2). Primary Safety outcomes were defined as procedure-related morbidity, rate of re-bleeding and rate of re-treatment. Seventy-nine aneurysms were treated during the five-year period. Adequate aneurysm occlusion (RROC1 and RROC2) achieved was 81%. Retreatment was required in 18% of patients (14/79). Greater retreatment rate was demonstrated in partially thrombosed aneurysms, aneurysms with larger neck and dome diameter and dome heights. Woven Endobridge treatment of wide-neck intracranial aneurysms offers a safe and efficacious outcome. This large UK single-centre experience demonstrates congruity with recent five-year outcomes of WEBCAST and WEBCAST2 trials.

Efficacy and safety of low profile stents in Y-stent assisted coil embolization of wide-necked bifurcation aneurysms: a systematic review and meta-analysis.

Low-profile stents may provide significant advantages in Y-stent-assisted coiling due to their miniaturized design and capability to be delivered through a 0.0165-inch microcatheter. We aim to investigate the safety and efficacy of using these newer versions of stents in Y-stent-assisted coiling for the treatment of wide-necked bifurcation aneurysms. We conducted a systematic review of the PubMed, Embase, Cochrane Library, and Web of Science databases up to September 2023, following the PRISMA guidelines. Eligible studies included ≥ 5 patients with intracranial wide-necked bifurcation aneurysms treated with Y-stent-assisted coiling using low-profile stents, providing angiographic and clinical outcomes. Two authors independently handled the search and selection. Primary outcomes were immediate and follow-up aneurysm occlusion, procedure-related complications, aneurysm recanalization, and retreatment. Secondary outcomes included technical success, procedure-related morbidity, procedure-related mortality, procedure-related stroke, and in-stent stenosis at follow-up. We analyzed the data using random-effects meta-analysis. In total, 19 studies including 507 patients with 509 aneurysms were included. 95% of the treated aneurysms were managed using the crossing Y-configuration. Technical success rate was 99%. Immediate adequate aneurysm occlusion was 90%. Follow-up angiographies were available for 443 aneurysms. The mean angiographic follow-up duration was 15.6 ± 1.9 months. The rates for follow-up adequate aneurysm occlusion and complete occlusion were 98% and 89%, respectively. After a mean clinical follow-up of 15 ± 2.4 months, a good clinical outcome was observed in 98% of patients. Overall, procedure-related morbidity and mortality rates were 1.3%, and 0.4%, respectively. Low-profile stents in Y-stent-assisted coiling outperform previous stent versions in terms of safety, efficacy, and technical success rates.

Vertebral Artery Access Considerations in Coil Embolization of Small Superior Cerebellar Artery Aneurysm

Coiling of small superior cerebellar artery aneurysms (sSCAAs) is challenging. We aimed to describe anatomic considerations in the vertebral and basilar artery (VA and BA) morphology for decision making in the coiling of sSCAAs. Eleven patients with sSCAAs (<5 mm) treated at our institution between April 2015 and February 2022 were included to show our concept of deciding access routes in the coiling of sSCAAs. The access route was decided on the basis of VA characteristics, BA curvature, and aneurysm laterality. Adequate aneurysm occlusion on angiography (Raymond-Roy grading scale I and II), good outcome (modified Rankin Score 0-2) at the last follow-up, and adverse outcomes were evaluated. Simple coiling (n= 2), a balloon-assisted technique (n= 3), and stent-assisted technique (n= 6) were selected. At the last follow-up (median 13.0 months), adequate aneurysm occlusion and good outcome were obtained in all 9 patients (n= 10). Adverse outcomes were not observed. When VA dominance was equal, in the straight BA, the microcatheter insertion into the ipsilateral VA to the aneurysm was favorable to form a "fulcrum" on the contralateral side and obtain microcatheter stability. When an aneurysm was on the concave aspect of the curved BA, microcatheter insertion into the ipsilateral VA was favorable. As for the convex aspect's aneurysm location, the microcatheter insertion into the contralateral VA can be favored. Further, we described the VA origin classification as it relates to ease of access from a transradial approach. Vertebrobasilar morphology may be important in deciding access routes in the coiling of sSCAAs.

Lateral Compression is the Strongest Independent Predictor of Aneurysm Occlusion After Endovascular Treatment of Intracranial Aneurysms With the Woven EndoBridge Device

BACKGROUND AND OBJECTIVES: The effect of lateral compression (LC) of the Woven EndoBridge (WEB) device on intracranial aneurysm (IA) occlusion and retreatment has not been studied in depth. This study aims to determine the effect of LC on aneurysm occlusion and retreatment after endovascular treatment with WEB. METHODS: We retrospectively reviewed IAs treated with WEB at our institution between February 5th, 2019, and March 31st, 2022. LC was determined in the immediate postdetachment angiogram by measuring the mean implanted WEB width at the equator in two orthogonal projections and subtracting it from the nominal WEB width. LC was then converted to the percentage of nominal WEB width (percent LC [%LC]). Independent predictors of complete and adequate aneurysm occlusion at follow-up and retreatment were determined using multivariate logistic regression analysis. Optimal %LC thresholds were determined using receiver operating characteristic analysis. RESULTS: One hundred and fifty-five IAs were included, with a mean size of 6.4 mm, a mean neck of 3.6 mm, and a mean time to last follow-up of 15.5 months. At last follow-up, complete and adequate aneurysm occlusion was present in 98 (63.2%) and 139 (89.7%) IAs, respectively. Twelve IAs were retreated (7.7%). %LC was the strongest independent predictor of complete and adequate aneurysm occlusion at first and last follow-up and an independent predictor of aneurysm retreatment. Optimal %LC thresholds for complete and adequate aneurysm occlusion at first follow-up were &gt;17.1% and &gt;15.7%, respectively. Compared with IAs in which these thresholds were not attained, IAs in which these thresholds were attained had significantly higher rates of complete (31% vs 68%, P-value &lt;.0001) and adequate occlusion (81% vs 96%, P-value .004) at first follow-up. The optimal %LC threshold for aneurysm retreatment was ≤15.6%. IAs with ≤15.6% LC had a significantly higher rate of retreatment (15%) than IAs with &gt;15.6% LC (4%, P-value .025). CONCLUSION: LC is the strongest independent predictor of aneurysm occlusion in IAs treated with WEB.

Impact of branch arteries on efficacy of endoluminal flow diverters: Insights from posterior communicating artery aneurysms.

Flow diverter treatment may inevitably require jailing of the branch vessels. While the patency of covered branch arteries and associated safety risks have been a topic of substantial interest, the question of whether the characteristics of branch vessels affect flow diversion's efficacy remains unanswered. In this study, we aimed to assess the impact of branch arteries on the efficacy of endoluminal flow diverters, specifically focusing on posterior communicating artery (Pcomm) aneurysms. Following PRISMA guidelines, we systematically searched the MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane databases with predefined keywords. Studies providing data for flow diversion outcomes in Pcomm aneurysms were included. Outcomes of interest included complete and adequate aneurysm obliteration, ischemic and hemorrhagic complications, and Pcomm occlusion in the follow-up period. A random or fixed effects model was used to calculate the odds ratios (ORs) and pooled event rates with their corresponding confidence intervals (CI). The overall complete and adequate aneurysm occlusion rates were 72.25% (95% CI: 64.46-78.88%) and 88.37% (95% CI: 84.33-92.6), respectively. Fetal-type Pcomm aneurysms had significantly lower complete aneurysm occlusion rates than the nonfetal-type Pcomm aneurysms (OR: 0.12, 95% CI: 0.05-0.29). Overall ischemic and hemorrhagic complication rates were 2.62% (95% CI = 0.71-5.32) and 0.71% (95% CI: 0-2.24), respectively. There were no significant associations between Pcomm morphology and complications (OR: 3.61, 95% CI = 0.42-31.06 for ischemic complications and OR: 2.31, 95% CI = 0.36-14.6 for hemorrhage). Overall Pcomm occlusion rate was 32.04% (95% CI = 19.96-47.13), and the Pcomm patency was significantly lower in nonfetal-type Pcomm aneurysms (OR: 0.10, 95% CI = 0.02-0.44). Our meta-analysis suggests that flow diversion is a safe treatment option for Pcomm aneurysms, regardless of fetal-type Pcomm morphology. However, on the other hand, our findings indicate that Pcomm anatomy or the presence of jailed large branches can affect the efficacy of flow diverter treatment.

Balloon assisted Woven endobridge deployment (BAWD): A safety and efficacy study.

Balloon-assisted deployment/remodelling is a proven adjunctive technique for coil embolization of intracranial aneurysms, and it may be a helpful adjunct in delivering the Woven EndoBridge (WEB) device. To evaluate the safety, efficacy and feasibility of balloon-assisted WEB deployment in both ruptured and unruptured intracranial aneurysms in both typical and atypical locations. Patients who underwent treatment of ruptured and unruptured intracranial aneurysms with the BAWD technique were retrospectively identified from a prospectively maintained database at two neurointerventional centres. Patient demographics, aneurysm characteristics, technical procedure details, clinical and imaging outcomes were reviewed. Thirty-three aneurysms (23 women) were identified with a median age of 58 years. There were 15 (45.5%) ruptured aneurysms, 25 (64.3%) in the anterior circulation and 12 (36.4%) aneurysms having an atypical location for WEB treatment. The average aneurysm size was 6.8 mm (greatest dimension), 4.6 mm (height) and 4.5 mm (width), and 25 (75.8%) aneurysms had a wide neck morphology. One patient died (3.0%) secondary to a procedure-related complication, and there was no procedure-related permanent morbidity. Complete and adequate aneurysm occlusion on mid-term follow-up DSA was 85.2% and 92%, respectively. Balloon-assisted WEB deployment appears to be a safe and effective technique that may increase the utility of the WEB device. Further prospective studies on BAWD should be considered.

Abstract Number ‐ 3: Large and Giant Aneurysms Outcome in the Multicenter Prospective Core Lab Adjudicated SMART Coils Registry

Introduction Endovascular coiling for intracerebral aneurysms has been evolving. Yet, large, and giant aneurysms (LAGA) remain a significant challenge for treatment and carry a high rate of morbidity and mortality. Previous studies have demonstrated 72–76% long‐term adequate occlusion and up to 34% retreatment rate in patients undergoing reconstructive treatment for LAGA. Methods The SMART registry, a prospective, multicenter outcome trial was used to identify patients with LAGA (Sac 10–24mm for large and ≥ 25mm for giant aneurysms) treated with the Penumbra SMART COIL® (SMART) system in the US and Canada. Patients’ characteristics and outcomes were then compared to patients with smaller aneurysms (SA) (Sac≤10mm). Primary effectiveness endpoint was aneurysm occlusion using Raymond‐Roy (RR) scale and safety endpoints included mortality and stroke outcomes. Fisher exact test and T‐test were used to compare categorical and continuous variables, respectively. P‐value &lt; 0.05 was considered significant. Results A total of 131/903 (14.5%) patients had LAGA and 42 (32.1%) of those were ruptured. Patients with LAGA were older than SA (mean age: 61.9 vs 59.4, p = 0.04). Large aneurysms were mainly saccular in 75.6% of the cases (vs 87.7% of the ≤ 10 mm ones, p &lt; 0.001). Fusiform LAGA were 8.4% (vs 1.4% of the ≤ 10 mm ones, p &lt; 0.001). Furthermore, they are more likely to have wide neck (69.5% vs 59.7%, p = 0.042). They are less likely to have A‐Com aneurysm (10.7% vs 28%, p &lt; 0.001), and more likely to have basilar tip aneurysms (3.1% vs 0.8%, p = 0.044) and cavernous aneurysms (4.6% vs 0.6%, p = 0.002) compared to patients with SA. Primary coiling was the main treatment modality for both SA and LAGA (43.3% vs 43.5%, respectively, p = 1.0). However, LAGA were more likely to be treated with flow diversion in addition to coiling (6.1% vs 1.0%, p &lt; 0.001). Packing density was significantly lower in LAGA (mean (SD) = 21.2(13.1) vs 34.1(18.3), p &lt; 0.001). Surprisingly, long‐term aneurysm RR occlusion Class I‐II on follow‐up imaging was 82.5% in LAGA vs 91.2% in SA, p = 0.016. Retreatment rates was 11.7% in LAGA vs 6.4% in SA, p = 0.063. mRS0‐2 score was 73.6% in LAGA vs 86.4% in SA, p = 0.007. All‐cause 1‐year mortality was 9.2% in LAGA vs 4.7% in SA, p = 0.054. Conclusions Despite challenges with treating Large and giant aneurysms, SMART coiling registry demonstrated high adequate aneurysm occlusion rate on follow‐up imaging, as well as a good independent functional outcome.

A Systematic Literature Review and Meta-Analysis of the Treatment of Ruptured Intracranial Aneurysms with Hydrophilic Polymer and Phosphorylcholine-Coated Flow Diverters Under Single Antiplatelet Therapy

Flow diverters coated with antithrombogenic substances were recently introduced and have shown encouraging results in the preclinical setting. Our aim was to analyze their clinical application in patients with ruptured intracranial aneurysms using single antiplatelet therapy (SAPT). We performed a PRISMA-compliant systematic review and meta-analysis covering 3 major data bases until March 2022.Two reviewers independently reviewed clinical studies for eligibility.Random-effects analysis of proportions was used to pool safety outcomes (hemorrhagic, thrombembolic, and overall complications). Studies were tested for publication bias and heterogeneity. Five studies reporting 43 patients with 46 aneurysms were identified. More than 1 stent was implanted in 16%, and additional coil embolization was performed in 53.8% of patients. SAPT with one of various acetylsalicylic acid regimens was used in 86%, altogether antiplatelet protocols were variable. The pooled risks of thromboembolic (23.9%; 95% confidence interval [CI], 9.6-47.9), hemorrhagic (9.4%; 95% CI, 3.6-22.6), and overall complications (28.3%; 95% CI, 12.4-52.5) were calculated in the absence of publication bias with low to moderate study heterogeneity measures. All complications occurred in patients under acetylsalicylic acid SAPT. Adequate aneurysm occlusion was described in 65.5% of patients.few retrospective observational studies with moderate heterogeneity, encompassing a limited number of patients treated with variable SAPT regimens. Flow diversion for ruptured aneurysms under SAPT with coated stents is feasible. Although the risk of hemorrhagic complications was low, thromboembolic complications occurred in a significant number of patients, all under ASA SAPT.

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

BackgroundTo report the 3-year safety and effectiveness of the Surpass Streamline flow diverter in the SCENT trial (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck...

Treatment of Wide-Necked Cerebral Aneurysms Using the WEB Device Including Flow Alteration Assessment With Color-Coded Imaging: A Single Center Experience

The Woven EndoBridge (WEB) device (MicroVention, Tustin, CA) has extended the treatment of cerebral aneurysms. Despite the fact that the WEB device has shown promising clinical results, little is known about the caused intra-aneurysmal flow alterations. Here we present our clinical experience with the WEB, including examining various syngo iFlow (Siemens AG, Erlangen, Germany) parameters to predict aneurysm occlusion. We reviewed the data from patients with unruptured cerebral aneurysms treated with a WEB device between 2016 and 2020. Aneurysm occlusion and complications were assessed. Furthermore, different quantitative criteria were evaluated using syngo iFlow after digital subtraction angiography. A total of 26 patients hosting 26 cerebral aneurysms met the inclusion criteria. Follow-up was available for 21 patients, with a mean of 7.3 ± 6.3 months. A total of 71.4% (n= 15) of the aneurysms included were located in the anterior and 28.6% (n= 6) in the posterior circulation. Adequate aneurysm occlusion was achieved in 85.7% (n= 18). The iFlow parameters for reduced aneurysm outflow (ID-R) differed significantly from the parameters for reduced inflow (PI-R and PI-D) (P < 0.001). The parameters did not differ significantly between adequately and insufficiently occluded aneurysms. Only a trend towards a lower ID-R of insufficiently occluded aneurysms was observed (P= 0.063), indicating a potential predictive value for insufficient aneurysmal outflow. There was no treatment-related morbidity or mortality. The applied syngo iFlow parameters confirmed that flow changes induced by the WEB device significantly affect outflow compared to inflow and have potential predictive value for adequate aneurysm occlusion.

Intracranial aneurysm treatment with intrasaccular flow disruption: comparison of WEB-21 and WEB-17 systems

BackgroundNew generations of Woven EndoBridge (WEB) devices (WEB-21 and WEB-17) are available to treat aneurysms with a width <6.5 mm. Limited comparisons between both systems exist in the literature, but...

Endovascular treatment of unruptured intracranial aneurysms with flow diverters: A retrospective long-term single center analysis.

The introduction of flow diverters (FDs) in 2007 greatly enhanced the treatment of intracranial aneurysms. Here, we present our long-term clinical experience in treating unruptured intracranial aneurysms with FDs. 107 patients with unruptured aneurysms and treated with an FD between 2010 and 2019 were retrospectively reviewed. Aneurysm occlusion, procedural complications, and clinical outcome were evaluated. Angiographic follow-up was available for 93 patients with a mean long-term follow-up time of 28.4 ± 21.6months. Additional coiling was performed in 15.1% of patients (n = 14). Adequate aneurysm occlusion (Kamran grades 3 and 4) at long-term follow-up was achieved in 94.6% of patients (n = 88). 3.2% (n = 3) required endovascular retreatment since the last follow-up showed a lack of aneurysm occlusion (Kamran grade 0) due to a foreshortening of the FD. Incomplete opening of the FD and parent vessel occlusion was seen in 1.1% (n = 1) and 3.2% (n = 3) of patients, respectively. In-stent stenosis was observed in 57% (n = 53) of cases at short-term follow-up and 22.6% (n = 21) at long-term, which were moderate and asymptomatic overall. In-stent stenosis decreased significantly between short- and long-term follow-ups (31.4 ± 17.0% vs 9.7 ± 13.6%, respectively; p ≤ 0.001). Thromboembolic and hemorrhagic events occurred in 7.5% (n = 7) and 1.1% (n = 1) of patients, respectively. Good clinical outcome (modified Rankin scale: 0-2) was obtained in 97.8% (n = 91) leading to an overall treatment-related morbidity of 2.2% (n = 2). There was no procedural mortality. Our study shows that FD treatment of unruptured intracranial aneurysms is effective and safe with high occlusion rates and low rates of permanent morbidity at long-term follow-up.

Flow Diversion vs. Stent-Assisted Coiling in the Treatment of Intradural Large Vertebrobasilar Artery Aneurysms.

ObjectiveTo compare the safety, angiographic, and long-term clinical outcomes of intradural large vertebrobasilar artery (VBA) aneurysms following flow diversion (FD) or conventional stent-assisted coiling (SAC).MethodsWe performed a retrospective study of 66 consecutive patients with intradural large VBA aneurysms between 2014 and 2021 who underwent FD or SAC. Patients' characteristics, postprocedural complications, and clinical and angiographic outcome details were reviewed.ResultsA total of 66 intradural large VBA aneurysms were included, including 42 (63.6%), which were treated with SAC (SAC group) and 24 (36.4%), which were treated with FD (FD group). Clinical follow-up was obtained at the median of 24.0 [interquartile range (IQR) 12.0–45.0] months, with 34 (81.0%) patients achieved the modified Rankin Scale (mRS) ≤ 2 in the SAC group and 21 (87.5%) patients in the FD group. Thirteen (19.7%) patients experienced neurological complications, of which 9 (13.6%) patients first occurred during the periprocedural phase and 4 (6.1%) patients first occurred during follow-up. The overall complication rate and periprocedural complication rate were both higher in the SAC group, but did not reach statistical significance (23.8 vs. 12.5%, P = 0.430; 16.7 vs. 8.3%, P = 0.564). The mortality rates were similar between the groups (11.9 vs. 12.5%). Angiographic follow-up was available for 46 patients at the median of 7 (IQR 6–14) months, with a numerically higher complete occlusion rate in the SAC group (82.1 vs. 55.6%, P = 0.051) and similar adequate aneurysm occlusion rates between the groups (85.7 vs. 83.3%, P = 1.000). In the multivariate analysis, ischemic onset (P = 0.019), unilateral vertebral artery sacrifice (P = 0.008), and older age (≥60 years) (P = 0.031) were significantly associated with complications.ConclusionThere was a trend toward lower complication rate and lower complete occlusion rate for intradural large VBA aneurysms following FD as compared to SAC. FD and SAC have comparable mortality rates and favorable outcomes. Ischemic onset, unilateral vertebral artery sacrifice, and older age could increase the risk of complications.

Comparing treatment outcomes of various intracranial bifurcation aneurysms locations using the Woven EndoBridge (WEB) device

BackgroundThe Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in...

168 International Study of Intracranial Aneurysm Embolization Using the Woven EndoBridge (WEB) Device: Results of the WorldWideWEB Consortium

INTRODUCTION: Pooled data from several registries have shown satisfactory efficacy of the WEB device to treat wide-neck aneurysms. The present study is the most extensive multi-center collaboration that endeavors to investigate the angiographic and clinical outcomes of real-world treatment of intracranial aneurysms with the device. METHODS: The World-Wide-WEB consortium is a retrospective multicenter collaboration of international centers with no limitation on aneurysm location or rupture status. Both bifurcation and sidewall aneurysms were included. Angiographic and clinical outcomes and complications were assessed among all consecutive patients along with determinants of adequate aneurysm occlusion (i.e. complete occlusion or neck remnant). RESULTS: The cumulative population comprised 674 patients (median age 61.3 years; 71.3% female) with 686 intracranial aneurysms. MCA bifurcation (30.2%) was the most common location. Adequate occlusion was observed in 85.7% of aneurysms at the last follow-up. Aneurysm retreatment was required in 7.9% of aneurysms. Thromboembolic complications were encountered in 7.6% of patients, but only 2.0% had permanent neurological deficits, while 3.1% had hemorrhagic complications. We identified subarachnoid hemorrhage, immediate remnant aneurysm (as compared to complete occlusion), and minor compaction or major compaction (as compared to no compaction) as significant determinants for lower rates of adequate aneurysm occlusion on last follow up (p &lt; 0.01). CONCLUSION: This report suggests an adequate efficacy and safety profile of the WEB comparableto the currently availablesurgical andotherendovascular techniques fortreatment ofintracranial aneurysms.