Occlusion assessment of intracranial aneurysms treated with the WEB device

Caroff, Jildaz; Mihalea, Cristian; Tuilier, Titien; Barreau, Xavier; Cognard, Christophe; Desal, Hubert; Piérot, Laurent; Arnoux, Armelle; Moret, Jacques; Spelle, Laurent

doi:10.1007/s00234-016-1715-9

Cited by 36 publications

(36 citation statements)

References 16 publications

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“…Of the 74 patients with angiographic follow-up, 54 aneurysms (73%) were completely occluded, 6 of those with some proximal WEB recess filling. [26][27][28] Seventeen aneurysms (23%) had a small neck remnant. In 3 patients (4%), the aneurysm was incompletely occluded.…”

Section: Angiographic Follow-upmentioning

confidence: 99%

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

Rooij

Rooij²,

Peluso³

et al. 2017

AJNR Am J Neuroradiol

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Section: Angiographic Follow-upmentioning

confidence: 99%

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

Rooij

Rooij²,

Peluso³

et al. 2017

AJNR Am J Neuroradiol

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“…A number of case reports and registries of ISFD have been published from European and American centers. 4–24 A meta-analysis of WEB treatments up to October 2015, which included 15 case series with 588 aneurysms, of which 127 were ruptured, yielded a midterm adequate occlusion rate of 85% (95%CI 67–98%), with adequate occlusion defined as complete occlusion or neck remnant. 25 The rates of peri-operative morbidity and mortality were 4% (95%CI 1–8%) and 1% (95%CI 0–2%), respectively.…”

Section: Introductionmentioning

confidence: 99%

The RISE trial: A Randomized Trial on Intra-Saccular Endobridge devices

et al. 2019

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Background Wide-necked bifurcation aneurysms (WNBA) are a difficult subset of aneurysms to successfully repair endovascularly, and a number of treatment adjuncts have been designed to improve on the results of coiling, including stenting and flow diversion of the parent vessel. Surgical clipping is commonly performed for certain WNBAs, such as middle cerebral aneurysms, in some centres. Intra-saccular flow diversion (ISFD) using the Woven Endo-Bridge (WEB) or similar devices, has been developed as a new endovascular alternative to coiling for WNBAs. Meta-analyses of case series suggest satisfactory results, both in terms of safety and efficacy, but in the absence of randomized evidence, whether ISFD leads to better outcomes for patients with WNBA remains unknown. There is a need to offer ISFD within the context of a randomized care trial. Methods The proposed trial is a multicentre, randomized controlled care trial comparing ISFD and best conventional management option (surgical or endovascular), as determined by the treating physician prior to randomized allocation. At least 250 patients will be recruited in at least 10 centres over a four-year period, and followed for one year, to show that ISFD can increase the incidence of successful therapy from 75 to 90% of patients, defined as complete or near-complete occlusion of the aneurysm AND a good clinical outcome (mRS ≤ 2) at one year. The trial will be followed by an independent data safety monitoring committee to assure the safety of participants. Conclusion Introduction of intra-saccular flow diversion can be accomplished within a care trial context.

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“…First, because of electrically conductive nature of the WEB a Faraday cage effect occurs which hinders the visibility of inside of the WEB and second, because of susceptibility artifacts resulting from disturbance of homogeneity of the magnetic field inside and in the vicinity of the implant, the neck area of the aneurysm and the parent artery cannot be evaluated very well . We think that CTA is superior to MRA especially in detection of persistent contrast enhancement inside the WEB which is a peculiar phenomenon seen with this device in short‐ or mid‐term follow‐up . In our series, CTA could define such contrast enhancements in 5 cases with 100% agreement with DSA (Fig ).…”

Section: Discussionmentioning

confidence: 84%

CT Angiography in Occlusion Assessment of Intracranial Aneurysms Treated with the WEB Device

Özpeynirci

Braun

Schmitz

2019

Journal of Neuroimaging

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EndoBridge (WEB) system has not been thoroughly studied yet. Our aim is to compare the ability of CTA to that of DSA to depict the occlusion status of aneurysms treated with WEB device and present the level of reproducibility of results from CTA. METHODS:Patients with intracranial aneurysm treated only with the WEB device and having a CTA and a DSA during the same hospital stay were included. Aneurysm occlusion was evaluated by two methods: a simplified binomial system grading as either adequate occlusion (complete occlusion or neck remnant) or aneurysm remnant and a four-grade scale. Interobserver and intermodality agreement were determined using the κ statistic. Using DSA as a reference test, the diagnostic capabilities of CTA were calculated. RESULTS: Sixteen patients with 16 aneurysms were included. Interobserver agreement was fair for DSA (κ = .26) and good for CTA (κ = .78) using the four-grade scale, and moderate for DSA (κ = .44) and good for CTA (κ = .63) using the binomial scale. CTA and DSA were in agreement in 15 of 16 aneurysms (93.75%) using the binomial scale meaning good intermodality agreement for aneurysm remnant detection (κ = .63). Sensitivity of CTA for detection of an aneurysm remnant was 50%, specificity was 100%, positive prediction value was 100%, and negative prediction value was 93.33%. CONCLUSION: CTA is a reliable and reproducible method to evaluate the aneurysm occlusion status and could be implemented on the follow-up of aneurysms treated with WEB.

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Occlusion assessment of intracranial aneurysms treated with the WEB device

Cited by 36 publications

References 16 publications

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

The RISE trial: A Randomized Trial on Intra-Saccular Endobridge devices

CT Angiography in Occlusion Assessment of Intracranial Aneurysms Treated with the WEB Device

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