Cognard Christophe, Januel Anne Christine
Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France.
Neurosurgery. 2015 May;76(5):522-30;discussion 530. doi: 10.1227/NEU.0000000000000669.
Flow disruption with the WEB technique has been developed to treat large-neck bifurcation aneurysms.
To report our anatomic angiographic results at first (3-6 months) and second (18 ± 3 months) angiographic follow-up in a series of 15 patients.
Fifteen patients (15 aneurysms) were consecutively treated in our center by 2 operators for a large-neck bifurcation aneurysm between March 2012 and February 2014. Results were evaluated by assessing WEB cage position at the aneurysm neck on angiography and high-resolution contrast-enhanced flat-panel detector computed tomography, contrast medium stagnation within the WEB and aneurysm on intraprocedural angiography, and 1-day time-of-flight magnetic resonance angiography. All aneurysms were followed up by angiography. Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. The 2 operators compared postprocedural and follow-up images and classified them as better, same, or worse. Subtracted images were compared in different projections to assess any WEB device compression or shape changes.
A worsening was observed between the postprocedural and first follow-up angiography in 10 of 14 (71.5%) and in 4 of 7 (57.2%) between the first and second control angiography. Compression of the WEB cage was observed at first follow-up in 8 of 14 (57.2%) and in an additional 3 of 7 cases (42.8%) at second control. Last angiography showed complete occlusion in 1 of 14 (7.2%), neck remnant in 8 of 14 (57.2%), and residual aneurysm in 5 of 14 (35.7%) cases.
This article draws attention to the risk of WEB compression and aneurysm recanalization. Future prospective studies should evaluate delayed WEB shape changes with different types of WEB devices (dual layer, single layer, single layer spherical).
CO, complete occlusionNR, neck remnantRA, residual aneurysm.
WEB技术所造成的血流中断已被用于治疗大型颈内动脉分叉处动脉瘤。
报告我们对15例患者进行首次（3 - 6个月）和第二次（18±3个月）血管造影随访时的解剖血管造影结果。
2012年3月至2014年2月期间，我们中心的2名操作人员连续治疗了15例患者（15个动脉瘤）的大型颈内动脉分叉处动脉瘤。通过血管造影评估动脉瘤颈部的WEB网篮位置、高分辨率对比增强平板探测器计算机断层扫描技术、术中血管造影时WEB网篮和动脉瘤内的造影剂滞留情况以及1天时间飞跃磁共振血管造影技术来评估结果。所有动脉瘤均通过血管造影进行随访。随访结果分为完全闭塞、颈部残留或残留动脉瘤。2名操作人员比较了术后和随访图像，并将其分类为改善、相同或恶化。在不同投影中比较减影图像，以评估任何WEB装置的压缩或形状变化。
在14例中的10例（71.5%）患者中，术后血管造影与首次随访血管造影之间观察到病情恶化，在7例中的4例（57.2%）患者中，首次与第二次对照血管造影之间观察到病情恶化。在14例中的8例（57.2%）患者的首次随访中观察到WEB网篮受压，在7例中的另外3例（42.8%）患者的第二次对照中观察到WEB网篮受压。最后一次血管造影显示，14例中的1例（7.2%）完全闭塞，14例中的8例（57.2%）颈部残留，14例中的5例（35.7%）残留动脉瘤。
本文提请注意WEB网篮受压和动脉瘤再通的风险。未来的前瞻性研究应评估不同类型的WEB装置（双层、单层、单层球形）导致的WEB网篮形状延迟变化。
CO，完全闭塞；NR，颈部残留；RA，残留动脉瘤。
