Caroff Jildaz, Janot Kevin, Soize Sebastien, Marnat Gaultier, Cortese Jonathan, Mihalea Cristian, Popescu Septimiu Daniel, Ikka Léon, Chalumeau Vanessa, Gallas Sophie, Ozanne Augustin, Eltantawy Eman, Grimaldi Lamiae, Barreau Xavier, Herbreteau Denis, Pierot Laurent, Spelle Laurent
Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
Neuroradiology, CHU Tours, Tours, Centre, France.
J Neurointerv Surg. 2023 Oct;15(10):939-942. doi: 10.1136/jnis-2022-019645. Epub 2022 Oct 26.
Around 10% of Woven EndoBridge device (WEB)-treated intracranial aneurysms will need retreatment, and it is generally believed to be more challenging than retreatment after an initial coiling. We aim to report retreatment strategies and outcomes after initial WEB embolizations.
Databases from four treatment centers, containing consecutive aneurysms treated with a WEB between 2013 and 2022, were reviewed. Demographics, aneurysm characteristics, retreatment strategies and outcomes were collected and analyzed.
From a 756 WEB database, 57 aneurysms were included. The global retreatment rate was 7.5% (95% CI 5.6% to 9.4%). The retreatment rate was significantly higher in the ruptured compared with the unruptured population (13% vs 3.9%, respectively, P<0.0001). Aneurysms were retreated on average 21.2 months after the initial WEB treatment (range 4.8-70 months). Surgery was performed in 11% and endovascular treatment in 89% of cases, consisting of flow diversion (48%), stent-assisted coiling (30%), coiling (12%), and second WEB placement (10%). Imaging follow-up was available in 88% of all WEB retreatments (50/57) (average 17 months, 49% digital subtraction angiography), demonstrating complete occlusion in 56% and 'adequate' occlusion in 88%. Morbidity was 5.3% (95% CI 0% to 12.0%) and mortality 0%. No patient experienced rebleeding during the follow-up period.
The retreatment rate after an initial WEB treatment seems to compare favorably with that of coiling. Endovascular treatment of recurrence following WEB implantation is feasible in most situations; it generally requires the use of a stent and leads to a high rate of satisfactory occlusion.
约10%接受编织型血管内桥接装置（WEB）治疗的颅内动脉瘤需要再次治疗，人们普遍认为这比初次弹簧圈栓塞后的再次治疗更具挑战性。我们旨在报告初次WEB栓塞后的再次治疗策略及结果。
回顾了四个治疗中心的数据库，这些数据库包含2013年至2022年间连续接受WEB治疗的动脉瘤。收集并分析了人口统计学、动脉瘤特征、再次治疗策略及结果。
在一个756例WEB治疗的数据库中，纳入了57例动脉瘤。总体再次治疗率为7.5%（95%置信区间5.6%至9.4%）。破裂动脉瘤的再次治疗率显著高于未破裂动脉瘤（分别为13%和3.9%，P<0.0001）。动脉瘤在初次WEB治疗后平均21.2个月接受再次治疗（范围4.8 - 70个月）。11%的病例采用手术治疗，89%采用血管内治疗，血管内治疗包括血流导向（48%）、支架辅助弹簧圈栓塞（30%）、单纯弹簧圈栓塞（12%）和第二次WEB植入（10%）。88%（50/57）的WEB再次治疗有影像学随访（平均17个月，49%为数字减影血管造影），显示完全闭塞率为56%，“充分”闭塞率为88%。发病率为5.3%（95%置信区间0%至12.0%），死亡率为0%。随访期间无患者发生再出血。
初次WEB治疗后的再次治疗率似乎优于弹簧圈栓塞。在大多数情况下，WEB植入后复发的血管内治疗是可行的；通常需要使用支架，且闭塞满意率较高。
