Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up

Cortese, Jonathan; Caroff, Jildaz; Chalumeau, Vanessa; Gallas, Sophie; Ikka, Léon; Moret, Jacques; Sabuzi, Federico; Popescu, Septimiu Daniel; Ozanne, Augustin; Grimaldi, Lamiae; Mihalea, Cristian; Spelle, Laurent

doi:10.1136/neurintsurg-2022-018780

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…In a smaller population but with 5 years of follow-up, Pierot et al 10 described an 11.7% retreatment rate with no observed difference dependent on aneurysm location, and with most procedures performed during the first 2 years post-treatment. In accordance with this, Cortese et al 5 demonstrated that recurrences mostly occur within the 17 months post-implantation, with a stable angiographic result after mid-term control.…”

Section: Discussionmentioning

confidence: 56%

“…The retreatment rate was significantly higher in the ruptured versus the unruptured group (13% vs 3.9%, respectively, P<0.0001). However, since multiple analysis5 18–20 found no statistical association between recurrence and ruptured aneurysm, we can hypothesize that operators were more prompt to treat initially ruptured recurrences, assuming a higher re-rupture risk. Similar observations have been made concerning aneurysms initially treated with coils in some series 15…”

Section: Discussionmentioning

confidence: 89%

“…The Woven EndoBridge (WEB) device (Microvention, CA) currently represents the most extensively studied intrasaccular device,1 2 and has proven to be a very safe option to treat wide-necked bifurcation aneurysms 3. Since its introduction, angiographic results have improved year on year, likely due to the sharing of operator experiences in device sizing,4 5 and yet 5–12% of patients still require retreatment 3 6–10…”

Section: Introductionmentioning

confidence: 99%

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Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment

Caroff

Janot

Soize

et al. 2022

J NeuroIntervent Surg

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BackgroundAround 10% of Woven EndoBridge device (WEB)-treated intracranial aneurysms will need retreatment, and it is generally believed to be more challenging than retreatment after an initial coiling. We aim to report retreatment strategies and outcomes after initial WEB embolizations.MethodsDatabases from four treatment centers, containing consecutive aneurysms treated with a WEB between 2013 and 2022, were reviewed. Demographics, aneurysm characteristics, retreatment strategies and outcomes were collected and analyzed.ResultsFrom a 756 WEB database, 57 aneurysms were included. The global retreatment rate was 7.5% (95% CI 5.6% to 9.4%). The retreatment rate was significantly higher in the ruptured compared with the unruptured population (13% vs 3.9%, respectively, P<0.0001). Aneurysms were retreated on average 21.2 months after the initial WEB treatment (range 4.8–70 months). Surgery was performed in 11% and endovascular treatment in 89% of cases, consisting of flow diversion (48%), stent-assisted coiling (30%), coiling (12%), and second WEB placement (10%). Imaging follow-up was available in 88% of all WEB retreatments (50/57) (average 17 months, 49% digital subtraction angiography), demonstrating complete occlusion in 56% and ‘adequate’ occlusion in 88%. Morbidity was 5.3% (95% CI 0% to 12.0%) and mortality 0%. No patient experienced rebleeding during the follow-up period.ConclusionThe retreatment rate after an initial WEB treatment seems to compare favorably with that of coiling. Endovascular treatment of recurrence following WEB implantation is feasible in most situations; it generally requires the use of a stent and leads to a high rate of satisfactory occlusion.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment

Caroff

Janot

Soize

et al. 2022

J NeuroIntervent Surg

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“…In addition, it is recommended to oversize the WEB's width to obtain better occlusion rates. 16,18 It seemed relevant to check if this strategy could be responsible for the TEE, using an "oversizing ratio" to quantitatively evaluate the WEB constraint inside the aneurysm, as previously described. 18 FIGURE 1.…”

Section: Imaging Analysismentioning

confidence: 99%

Thromboembolic Events With the Woven Endobridge Device: Incidence, Predictive Factors, and Management

Rodriguez-Erazú,

Cortese,

Mihalea

et al. 2023

Neurosurgery

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BACKGROUND and OBJECTIVES: The Woven EndoBridge (WEB) device has been increasingly used to treat wide-neck aneurysms showing a safe and effective profile, but a relatively high number of thromboembolic events (TEEs) have been reported with such treatment. We aimed to evaluate the incidence and management of TEEs and possible predictive factors related to WEB embolization of ruptured and unruptured intracranial aneurysms. METHODS: A single-center database with consecutive aneurysms treated with a WEB device between July 2012 and May 2022 was reviewed for intraoperative and delayed TEEs. Univariate and multivariable analyses were used to determine factors associated with TEEs. RESULTS: A total of 266 independent aneurysms were treated with WEB devices in 245 patients (mean age 55.78 ± 11.64 years, 169 (63.5%) females, 80 (30%) ruptured). The overall rate of TEEs is 13% (35/266), including 8.7% intraoperative. Symptomatic TEEs with clinical sequelae at a 3-month follow-up are reported to be 2.6% (7/266) with no TEE-related mortality. Both the replacement of a WEB device during the procedure (adjusted odds ratio = 2.61, 95% CI 1.24-5.49; P = .01) and ruptured aneurysms (adjusted odds ratio = 2.74, 95% CI 1.31-5.7; P = .007) were independent predictors of TEEs. A case-by-case management of intraprocedural TEE is also presented; tirofiban was successfully used in most cases of this cohort. CONCLUSION: In this study, we demonstrated that ruptured aneurysms and WEB device replacement during the procedure were independent predictive factors for TEEs. As a result, making the correct choice of WEB is crucial for improving treatment outcomes. Moreover, with proper medical management of TEEs, minimal morbidity and no mortality could be achieved, which reinforces the safety of the technique.

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“…With continuous progress in endovascular treatment technology and concept, as well as rapid development in new materials and equipment, endovascular treatment technology has been widely used in the treatment of intracranial aneurysms. Compared with surgical clipping, interventional embolization of aneurysms has the advantages of less trauma, faster recovery, and lower surgical risk, and has been accepted by the majority of patients as one of the first choices for the treatment of intracranial aneurysms (25,(27)(28)(29)(30)(31). However, the recurrence rate was significantly higher than that of surgical clipping (2, 19-21), with the recurrent ruptured hemorrhage of embolized aneurysms characterized by high mortality and disability, requiring repeated endovascular embolization.…”

Section: Major Findingsmentioning

confidence: 99%

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

Han

Jiang²,

Tian³

et al. 2022

Front. Neurol.

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PurposeTo explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision-making.Materials and methodsForty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization, and characteristics of recurrent refractory aneurysms were analyzed.ResultsAmong the 49 patients with the second embolization, 5 were lost to follow-up, 9 recurred, and 35 did not. Univariate analysis showed that aneurysm size (P = 0.022), aneurysm classification (P = 0.014), and Raymond-Roy grade after the second embolization (P = 0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for the recurrence of aneurysms after the second embolization (P = 0.042). The complication rate after the second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17 ± 10.45 mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices.ConclusionAneurysm occlusion status after the second embolization is an independent risk factor for the recurrence of intracranial aneurysms. Compared with near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatments with the use of multiple stents or flow diverting devices.

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Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up

Cited by 17 publications

References 27 publications

Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment

Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment

Thromboembolic Events With the Woven Endobridge Device: Incidence, Predictive Factors, and Management

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

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