Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France
Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris, France.
J Neurointerv Surg. 2022 Jan;14(1). doi: 10.1136/neurintsurg-2020-017232. Epub 2021 Mar 16.
The Woven EndoBridge (WEB) shape modification (WShM) during follow-up may be a potential cause of poor angiographic outcomes. WShM predisposing factors have not yet been determined. Our systematic use of rotational cone beam computed tomography (VasoCT) imaging during follow-up allowed us to perform the first quantitative analysis of the shape of WEBs over time. Our goal was to identify possible strategies to reduce the occurrence of this phenomenon.
All patients treated in our hospital with a WEB device between October 2015 and January 2019 were included. Using VasoCT acquisitions, systematically performed after implantation and during follow-up, we analyzed WEB morphology. WShM was defined as the percentage reduction in the distance between the two WEB markers.
Sixty-three aneurysms treated with a WEB device were finally included in this analysis. At the last follow-up (mean 15.5 months), mean WShM was 48%±24. The mean WShM was significantly higher in the aneurysm recurrence group than in the adequate occlusion group (51±6.5% vs 36±3.4%, difference 15% points (95% CI 0.7 to 30); p<0.05). Conversely, the extent of WShM did not directly correlate with occlusion rates. Indeed, 32% of completely occluded aneurysms presented severe WShM (≥50%). Importantly, the absence of WShM guaranteed complete occlusion in our study (n=12). We demonstrated that oversizing the width of the WEB significantly correlated with WShM reduction during follow-up (r=-0.38, p=0.002).
WShM can be partly overcome by use of an appropriate width oversizing strategy that could lead to improved angiographic results.
在随访过程中，编织型 EndoBridge（WEB）形状的改变（WShM）可能是血管造影结果不佳的潜在原因。WShM 的诱发因素尚未确定。我们在随访中系统地使用旋转锥形束计算机断层扫描（VasoCT）成像，使我们能够首次对 WEB 随时间的形状进行定量分析。我们的目标是确定可能的策略来减少这种现象的发生。
纳入 2015 年 10 月至 2019 年 1 月期间在我院接受 WEB 装置治疗的所有患者。使用 VasoCT 采集，在植入后和随访期间系统地进行，我们分析了 WEB 的形态。WShM 定义为两个 WEB 标记之间距离的减少百分比。
最终纳入 63 个接受 WEB 装置治疗的动脉瘤进行此分析。在最后一次随访（平均 15.5 个月）时，平均 WShM 为 48%±24%。在动脉瘤复发组中，WShM 明显高于充分闭塞组（51±6.5%比 36±3.4%，差异 15 个百分点（95%置信区间 0.7 至 30）；p<0.05）。相反，WShM 的程度与闭塞率没有直接关系。事实上，32%的完全闭塞的动脉瘤出现严重的 WShM（≥50%）。重要的是，在我们的研究中，WShM 的缺失保证了完全闭塞（n=12）。我们证明，WEB 宽度的适度放大与随访期间 WShM 的减少显著相关（r=-0.38，p=0.002）。
通过使用适当的宽度放大策略，可以部分克服 WShM，从而改善血管造影结果。
