X Armoiry1, F Turjman2, D J Hartmann3, R Sivan-Hoffmann4, R Riva5, P E Labeyrie6, G Aulagner7, B Gory8. 1. From the Délégation à la Recherche Clinique et à l'Innovation (X.A.), Hospices Civils de Lyon, Cellule Innovation, Lyon, France CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France. 2. Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France Centre de Neurosciences Cognitives (F.T., B.G.), CNRS, UMR 5229, Lyon, France. 3. CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France. 4. Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France. 5. Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Galilee Medical Center (R.S.-H.), Nahariya, Israel. 6. CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France Serine Proteases and Pathophysiology of the Neurovascular Unit (P.E.L.), INSERM UMR-S U919, Caen, France. 7. CNRS 5510/MATEIS (X.A., D.J.H., P.E.L., G.A.), Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France Service Pharmaceutique (G.A.), Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France. 8. Service de Neuroradiologie Interventionnelle (F.T., R.S-H., R.R., B.G.), DHU IRIS, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France Université Lyon 1 (F.T., D.J.H., G.A., B.G.), Lyon, France Centre de Neurosciences Cognitives (F.T., B.G.), CNRS, UMR 5229, Lyon, France benjamin.gory@chu-lyon.fr.
Abstract
BACKGROUND AND PURPOSE: Despite the improvement in technology, endovascular treatment of bifurcation intracranial wide-neck aneurysms remains challenging, mainly due to the difficulty of maintaining coils within the aneurysm sac without compromising the patency of bifurcation arteries. The Woven EndoBridge (WEB) device is a recent intrasaccular braided device specifically dedicated to treating such aneurysms with a wide neck by disrupting the flow in the aneurysmal neck and promoting progressive aneurysmal thrombosis. MATERIALS AND METHODS: Using several health data bases, we conducted a systematic review of all published studies of WEB endovascular treatment in intracranial aneurysms from 2010 onward to evaluate its efficacy and safety profile. RESULTS: The literature search identified 6 relevant studies (7 articles) including wide-neck bifurcation aneurysms in ≥80% of cases. Clinical data supporting the efficacy and safety of the WEB are limited to noncomparative cohort studies with large heterogeneity from a methodologic standpoint. The WEB deployment was feasible with a success rate of 93%-100%. Permanent morbidity (mRS of >1 at last follow-up) and mortality were measured at 2.2%-6.7% and 0%-17%, respectively. The adequate occlusion rate (total occlusion or neck remnant) varied between 65% and 85.4% at midterm follow-up (range, 3.3-27.4 months). CONCLUSIONS: Endovascular treatment of bifurcation wide-neck aneurysms with the WEB device is feasible and allows an acceptably adequate aneurysm occlusion rate; however, the rate of neck remnants is not negligible. The WEB device needs further clinical and anatomic evaluation with long-term prospective studies, especially of the risk of WEB compression. Prospective controlled studies should be encouraged.
BACKGROUND AND PURPOSE: Despite the improvement in technology, endovascular treatment of bifurcation intracranial wide-neck aneurysms remains challenging, mainly due to the difficulty of maintaining coils within the aneurysm sac without compromising the patency of bifurcation arteries. The Woven EndoBridge (WEB) device is a recent intrasaccular braided device specifically dedicated to treating such aneurysms with a wide neck by disrupting the flow in the aneurysmal neck and promoting progressive aneurysmal thrombosis. MATERIALS AND METHODS: Using several health data bases, we conducted a systematic review of all published studies of WEB endovascular treatment in intracranial aneurysms from 2010 onward to evaluate its efficacy and safety profile. RESULTS: The literature search identified 6 relevant studies (7 articles) including wide-neck bifurcation aneurysms in ≥80% of cases. Clinical data supporting the efficacy and safety of the WEB are limited to noncomparative cohort studies with large heterogeneity from a methodologic standpoint. The WEB deployment was feasible with a success rate of 93%-100%. Permanent morbidity (mRS of >1 at last follow-up) and mortality were measured at 2.2%-6.7% and 0%-17%, respectively. The adequate occlusion rate (total occlusion or neck remnant) varied between 65% and 85.4% at midterm follow-up (range, 3.3-27.4 months). CONCLUSIONS: Endovascular treatment of bifurcation wide-neck aneurysms with the WEB device is feasible and allows an acceptably adequate aneurysm occlusion rate; however, the rate of neck remnants is not negligible. The WEB device needs further clinical and anatomic evaluation with long-term prospective studies, especially of the risk of WEB compression. Prospective controlled studies should be encouraged.
Authors: Sbt van Rooij; M E Sprengers; J P Peluso; J Daams; D Verbaan; W J van Rooij; C B Majoie Journal: Interv Neuroradiol Date: 2020-02-06 Impact factor: 1.610
Authors: Jean Raymond; Anne-Christine Januel; Daniela Iancu; Daniel Roy; Alain Weill; Andrew Carlson; Tim E Darsaut Journal: Interv Neuroradiol Date: 2019-11-05 Impact factor: 1.610