L Goertz1, T Liebig2, E Siebert3, Y Özpeynirci2, L Pennig4, E Celik4, M Schlamann4, F Dorn5, C Kabbasch4. 1. From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany lukas.goertz@uk-koeln.de. 2. Department of Neuroradiology (T.L., Y.Ö.), University Hospital Munich, Munich, Germany. 3. Department of Neuroradiology (E.S.), University Hospital of Berlin (Charité), Berlin, Germany. 4. From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany. 5. Department of Neuroradiology (F.D.), University Hospital Bonn, Bonn, Germany.
Abstract
BACKGROUND AND PURPOSE: Treatment of PICA aneurysms can be technically challenging by either surgical or endovascular means. Our aim was to report our preliminary experience with intrasaccular flow disruption using the Woven EndoBridge (WEB) for the treatment of proximal PICA aneurysms. MATERIALS AND METHODS: Sixteen PICA aneurysms treated with the WEB at 3 institutions were retrospectively reviewed. Baseline patient and aneurysm characteristics, procedural specifics, clinical outcomes, and angiographic results were evaluated. RESULTS: All aneurysms were located at the proximal, anteromedullary segment of the PICA. Seven aneurysms were ruptured. The median aneurysm size was 3.9 mm (range, 2-12 mm), and all aneurysms were wide-neck. WEB deployment failed in 1 case due to WEB protrusion in a small PICA aneurysm. Additional stent implantation was required for 2 aneurysms to improve intra-aneurysmal WEB positioning. One patient developed a partial posterior cerebral artery territory infarction with transient hemianopsia. Intraoperative rerupture of a ruptured aneurysm could be immediately stopped by WEB deployment due to intrasaccular stasis; however, it might have contributed to a slight disability of the patient. At last angiographic follow-up, 12/15 aneurysms (80%) were completely occluded and 3/15 (20%) had a neck remnant. CONCLUSIONS: The preliminary results indicate that WEB treatment of proximal PICA aneurysms is feasible with a reasonable safety and efficacy profile. The advantages of intrasaccular flow disruption include preservation of the PICA, durable aneurysm occlusion, and omission of antiplatelet therapy. The low-profile WEB 17 delivery system might enable navigation to distal PICA aneurysms, which needs to be addressed further.
BACKGROUND AND PURPOSE: Treatment of PICA aneurysms can be technically challenging by either surgical or endovascular means. Our aim was to report our preliminary experience with intrasaccular flow disruption using the Woven EndoBridge (WEB) for the treatment of proximal PICA aneurysms. MATERIALS AND METHODS: Sixteen PICA aneurysms treated with the WEB at 3 institutions were retrospectively reviewed. Baseline patient and aneurysm characteristics, procedural specifics, clinical outcomes, and angiographic results were evaluated. RESULTS: All aneurysms were located at the proximal, anteromedullary segment of the PICA. Seven aneurysms were ruptured. The median aneurysm size was 3.9 mm (range, 2-12 mm), and all aneurysms were wide-neck. WEB deployment failed in 1 case due to WEB protrusion in a small PICA aneurysm. Additional stent implantation was required for 2 aneurysms to improve intra-aneurysmal WEB positioning. One patient developed a partial posterior cerebral artery territory infarction with transient hemianopsia. Intraoperative rerupture of a ruptured aneurysm could be immediately stopped by WEB deployment due to intrasaccular stasis; however, it might have contributed to a slight disability of the patient. At last angiographic follow-up, 12/15 aneurysms (80%) were completely occluded and 3/15 (20%) had a neck remnant. CONCLUSIONS: The preliminary results indicate that WEB treatment of proximal PICA aneurysms is feasible with a reasonable safety and efficacy profile. The advantages of intrasaccular flow disruption include preservation of the PICA, durable aneurysm occlusion, and omission of antiplatelet therapy. The low-profile WEB 17 delivery system might enable navigation to distal PICA aneurysms, which needs to be addressed further.
Authors: Lukas Goertz; Thomas Liebig; Eberhard Siebert; Lenhard Pennig; Kai Roman Laukamp; Erkan Celik; Marco Timmer; Gerrit Brinker; Marc Schlamann; Roland Goldbrunner; Franziska Dorn; Boris Krischek; Christoph Kabbasch Journal: Neurosurgery Date: 2021-03-15 Impact factor: 4.654
Authors: L Goertz; T Liebig; E Siebert; M Herzberg; L Pennig; M Schlamann; J Borggrefe; B Krischek; F Dorn; C Kabbasch Journal: AJNR Am J Neuroradiol Date: 2019-09-05 Impact factor: 3.825
Authors: Nohra Chalouhi; Pascal Jabbour; Robert M Starke; Stavropoula I Tjoumakaris; L Fernando Gonzalez; Samantha Witte; Robert H Rosenwasser; Aaron S Dumont Journal: J Neurosurg Date: 2013-01-25 Impact factor: 5.115