Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
Research Department, Jacksonville University, Jacksonville, Florida, USA.
J Neurointerv Surg. 2021 Nov;13(11):1012-1016. doi: 10.1136/neurintsurg-2020-017105. Epub 2021 Jan 22.
BACKGROUND: The Woven EndoBridge (WEB) device is approved in the USA for treatment of unruptured wide-neck bifurcation aneurysms. However, the safety and effectiveness of the WEB device in the treatment of ruptured intracranial aneurysms is not clear. We aim to evaluate the perioperative safety and effectiveness of the WEB device in patients with ruptured intracranial aneurysms. METHODS: This retrospective study, conducted at eight centers in the USA, included patients with ruptured intracranial aneurysms treated with the WEB device in the setting of subarachnoid hemorrhage (SAH). Safety outcomes included intraoperative complications such as vessel perforation, thromboembolic events, and postoperative hemorrhagic or thromboembolic complications based on radiologic imaging. The primary effectiveness outcome was adequate (complete and neck remnant) aneurysm occlusion, according to the Raymond-Roy classification. RESULTS: A total of 91 patients with 94 ruptured intracranial aneurysms were included (mean age 57.7±15.2 years; 68.1% women; 82.9% wide-necked). Aneurysms were located in the anterior communicating artery (42/94, 44.6%), middle cerebral artery (16/94, 17%), and basilar artery (15/94, 16%). Adequate occlusion was achieved in 48.8% (41/84) and 80.0% (40/50) at discharge and last follow-up (mean of 3.4 months), respectively. At discharge, procedural-related morbidity was 3.3% (3/91) and there was no procedure-related mortality. No re-rupture or delayed aneurysm rupture was observed. CONCLUSIONS: This study demonstrates the perioperative safety and effectiveness of the WEB device for the treatment of patients with ruptured intracranial aneurysms in the setting of SAH, with low periprocedural morbidity and mortality. Long-term follow-up is warranted.
背景:Woven EndoBridge(WEB)装置已获得美国批准,用于治疗未破裂的宽颈分叉部动脉瘤。然而,WEB 装置在破裂颅内动脉瘤治疗中的安全性和有效性尚不清楚。我们旨在评估 WEB 装置在蛛网膜下腔出血(SAH)患者中治疗破裂颅内动脉瘤的围手术期安全性和有效性。
方法:这是一项在美国 8 个中心进行的回顾性研究,纳入了接受 WEB 装置治疗的蛛网膜下腔出血患者的破裂颅内动脉瘤患者。安全性结果包括术中并发症,如血管穿孔、血栓栓塞事件,以及基于影像学的术后出血或血栓栓塞并发症。主要有效性结果是根据 Raymond-Roy 分类评估的充分(完全和瘤颈残留)动脉瘤闭塞。
结果:共纳入 91 例 94 个破裂颅内动脉瘤患者(平均年龄 57.7±15.2 岁;68.1%为女性;82.9%为宽颈)。动脉瘤位于前交通动脉(42/94,44.6%)、大脑中动脉(16/94,17%)和基底动脉(15/94,16%)。出院时和末次随访(平均 3.4 个月)时,达到充分闭塞的比例分别为 48.8%(41/84)和 80.0%(40/50)。出院时,与操作相关的发病率为 3.3%(3/91),无与操作相关的死亡率。未观察到再破裂或迟发性动脉瘤破裂。
结论:本研究表明,WEB 装置在 SAH 患者中治疗破裂颅内动脉瘤具有围手术期安全性和有效性,围手术期发病率和死亡率较低。需要长期随访。
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