Department of Neuroradiology, University of Erlangen- Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Department of Neurology, University of Erlangen- Nuremberg, Erlangen, Germany.
Neuroradiology. 2020 Aug;62(8):1043-1050. doi: 10.1007/s00234-020-02390-3. Epub 2020 Mar 13.
Using the Woven EndoBridge (WEB) for aneurysm treatment has emerged as endovascular approach aiming for flow disruption in aneurysm sac. Since quantifiable data confirming the hemodynamic effect are lacking, we investigated in vivo aneurysmal flow alterations using time-density curve (TDC) analysis. Additionally, we evaluated whether flow parameters could be identified as independent factor to predict aneurysm occlusion.
Forty cerebral aneurysm patients treated with WEB were enrolled. Pre- and postinterventional digital subtraction angiography series were postprocessed and TDCs generated. TDCs were quantified calculating the parameters aneurysmal inflow velocity, outflow velocity, mean flow velocity, and relative time-to-peak (rTTP) of aneurysm filling. Pre- and postinterventional values were compared and related to occlusion rate.
WEB implanting induced highly significant rTTP prolongation by 52% (p = 0.001) and highly significant decrease of aneurysmal inflow, outflow, and mean flow velocity (p < 0.001). While outflow velocity was reduced by 49%, inflow velocity was reduced by 33% only. No statistically significant difference between the occluded and the non-occluded group was observed. No flow parameter reached significance level concerning predicting aneurysm occlusion.
Flow quantification confirms a significant flow-disrupting effect of WEB reducing more the outflow than the inflow velocity. In our small cohort, no flow parameter reached statistical significance to show predictive value regarding complete aneurysm occlusion. The hemodynamic effect of WEB is on comparable level to flow-diverting stents meaning that aneurysm closure can be delayed. In case of only slight inflow changes and high aneurysmal hemodynamic stress, some aneurysms might not be adequately protected in the short term.
使用编织型腔内血管重建装置（WEB）治疗动脉瘤是一种旨在破坏动脉瘤囊内血流的血管内治疗方法。由于缺乏可量化的数据来证实其血流动力学效果，我们通过时间密度曲线（TDC）分析研究了体内动脉瘤血流的变化。此外，我们还评估了血流参数是否可以作为独立因素来预测动脉瘤闭塞。
共纳入 40 例接受 WEB 治疗的脑动脉瘤患者。对治疗前后的数字减影血管造影系列进行后处理并生成 TDC。通过计算动脉瘤充盈的流入速度、流出速度、平均速度和相对达峰时间（rTTP）等参数，对 TDC 进行定量分析。比较治疗前后的数值，并与闭塞率相关联。
WEB 植入后，rTTP 显著延长了 52%（p=0.001），同时动脉瘤的流入速度、流出速度和平均速度也显著降低（p<0.001）。尽管流出速度降低了 49%，但流入速度仅降低了 33%。在闭塞组和未闭塞组之间，没有观察到统计学上的显著差异。没有任何一个血流参数在预测动脉瘤闭塞方面达到统计学意义。
流量定量分析证实了 WEB 具有显著的血流阻断作用，它降低了流出速度，而不是流入速度。在我们的小队列中，没有任何一个血流参数达到统计学意义，无法显示与完全动脉瘤闭塞相关的预测价值。WEB 的血流动力学效果与血流导向支架相当，这意味着动脉瘤的闭塞可能会延迟。在仅有轻微的流入变化和高动脉瘤血流动力学压力的情况下，一些动脉瘤在短期内可能无法得到充分的保护。
