1Institute of Neurointervention, Paracelsus Medical University, Salzburg; and.
Departments of2Neurosurgery.
J Neurosurg. 2023 Jan 27;139(2):563-572. doi: 10.3171/2022.12.JNS222268. Print 2023 Aug 1.
The authors compared the Contour Neurovascular System (Contour) with the Woven EndoBridge (WEB) device for the treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall.
Prospective clinical and radiological data were collected for all patients treated with either the Contour or WEB at a tertiary university hospital from May 2018 to June 2022.
In patients who had at least 3 months of follow-up data available (median patient age 60.0 [IQR 51.8-67.0] years, male/female ratio 1:1.4), the authors compared 40 aneurysms in 34 patients treated with the Contour and 30 aneurysms in 30 patients treated with the WEB. Overall, 26 middle cerebral artery, 24 anterior communicating artery, 9 basilar artery tip, 4 posterior communicating artery, 4 internal carotid artery, 1 anterior cerebral artery, 1 posterior inferior cerebellar artery, and 1 superior cerebellar artery aneurysm were treated. In the Contour cohort, complete occlusion at last follow-up was achieved for 30 aneurysms (75%) and a small neck remnant was seen in 6 aneurysms (15%), summing up to an adequate occlusion rate of 90%. One aneurysm (2.5%) had to be retreated, and 1 symptomatic thromboembolic event (2.5%) was observed with complete remission at discharge. Three adjunctive stents (10%) had to be used due to branch occlusion. In the WEB cohort, adequate occlusion was also seen in 90% of aneurysms (complete occlusion in 19 [63.3%] and remnant neck in 8 [26.7%], with a retreatment rate of 20%). Four WEBs (13.3%) needed additional stent placement due to device protrusion into a branch, 2 asymptomatic thromboembolic events (6.7%) were noted, and 1 major ischemic event (3.3%) due to M2 occlusion was noted. One patient treated with the WEB died between follow-ups of causes unrelated to the aneurysm, treatment, or device. Time from first measurement to deployment and thus total treatment time was significantly shorter in the Contour group (p = 0.004), regardless of whether a prior angiogram was available for aneurysm measurement and device sizing.
Results for the Contour were promising, although longer follow-up is necessary to draw more solid conclusions on the utility and risk profile of this new device compared with the already widely used WEB device. Adequate occlusion at last follow-up was the same for both devices, whereas the probability of complete occlusion at last follow-up was significantly higher for the Contour, and the WEB showed a significantly higher retreatment rate. Median deployment times were significantly shorter with the Contour than the WEB.
作者比较了 Contour Neurovascular System（Contour）与 Woven EndoBridge（WEB）装置在治疗分叉或侧壁宽颈脑动脉瘤方面的效果。
前瞻性收集了 2018 年 5 月至 2022 年 6 月期间在一所三级大学医院接受 Contour 或 WEB 治疗的所有患者的临床和影像学数据。
在至少有 3 个月随访数据的患者中（中位患者年龄 60.0 [IQR 51.8-67.0] 岁，男女比 1:1.4），作者比较了 34 名患者的 40 个动脉瘤接受 Contour 治疗，30 名患者的 30 个动脉瘤接受 WEB 治疗。总共治疗了 26 个大脑中动脉、24 个前交通动脉、9 个基底动脉顶端、4 个后交通动脉、4 个颈内动脉、1 个大脑前动脉、1 个后下小脑动脉和 1 个小脑上动脉动脉瘤。在 Contour 组中，最后一次随访时完全闭塞的动脉瘤有 30 个（75%），6 个动脉瘤有小的瘤颈残留（15%），总的闭塞率为 90%。1 个动脉瘤（2.5%）需要再次治疗，1 个症状性血栓栓塞事件（2.5%）在出院时完全缓解。由于分支闭塞，需要使用 3 个附加支架（10%）。在 WEB 组中，90%的动脉瘤也达到了充分的闭塞（完全闭塞 19 个[63.3%]，瘤颈残留 8 个[26.7%]，再治疗率为 20%）。由于 WEB 突入分支，需要额外放置 4 个支架（13.3%），有 2 个无症状性血栓栓塞事件（6.7%），1 个由于 M2 闭塞导致的主要缺血事件（3.3%）。1 名接受 WEB 治疗的患者在随访期间因与动脉瘤、治疗或装置无关的原因死亡。无论是否有先前的血管造影用于动脉瘤测量和装置尺寸，Contour 组从第一次测量到放置的时间（即总治疗时间）都明显更短（p = 0.004）。
Contour 的结果很有希望，尽管需要更长时间的随访，才能与已经广泛应用的 WEB 装置相比，得出关于这种新型装置的实用性和风险概况的更可靠结论。两种装置的最后随访时闭塞率相同，而 Contour 装置的完全闭塞率明显更高，WEB 装置的再治疗率明显更高。与 WEB 装置相比，Contour 的放置时间明显更短。
