El Naamani Kareem, Momin Arbaz A, Mouchtouris Nikolaos, Hunt Adam, Lawall Charles L, Ghanem Marc, Koorie Morena Paula, El-Hajj Jad, Vinjamuri Shreya, Alhussein Abdulaziz, AlHussein Ruyof, Tjoumakaris Stavropoula I, Gooch M Reid, Rosenwasser Robert H, Jabbour Pascal M
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
2Gilbert and Rose-Marie Chaghoury School of Medicine, Lebanese American University, Byblos, Lebanon.
J Neurosurg. 2024 Jul 12;142(1):110-115. doi: 10.3171/2024.4.JNS24436. Print 2025 Jan 1.
The paucity of literature comparing Woven EndoBridge (WEB) embolization to microsurgical clipping for anterior circulation wide-neck bifurcation aneurysms (WNBAs) underscores the need for further investigation into the optimal management of this patient subpopulation. The objective of this study was to compare the rate of endovascular and microsurgical treatment of WNBAs before and after the introduction of the WEB device. In addition, the authors performed a comparison of demographics, aneurysm characteristics, and treatment outcomes in patients before and after the introduction of the WEB device.
This study was a retrospective review of the usage rate of different treatment modalities for WNBAs before and after the WEB device was approved by the US FDA on September 27, 2018.
The study cohort comprised 235 patients with anterior circulation WNBAs treated at the authors' institution, including 127 aneurysms treated pre-WEB and 108 treated post-WEB. Generally, the rate of endovascular treatment of anterior circulation WNBAs was significantly higher post-WEB (86.1% vs 46.5%, p < 0.001), while the rate of clipping was significantly lower (13.9% vs 53.5%, p < 0.001). During follow-up, the rate of adequate aneurysm occlusion (Raymond-Roy occlusion classification [RROC] grades 1 and 2) was nonsignificantly higher in the post-WEB cohort (83.9% vs 78.5%, p = 0.34), while the rate of RROC grade 3 was nonsignificantly higher in the pre-WEB cohort (21.5% vs 16.1%, p = 0.34). Additionally, and although nonsignificant, the rates of recurrence (pre-WEB 25.3% vs post-WEB 14.9%, p = 0.12) and retreatment (pre-WEB 22.8% vs post-WEB 14.9%, p = 0.22) were higher in the pre-WEB cohort. Recurrence was assessed before retreatment.
After the introduction of the WEB device, the rate of endovascular treatment of WNBAs increased while the rate of microsurgical clipping decreased. It is essential for neurointerventionalists to become familiar with the indications, advantages, and shortcomings of all these different techniques to be able to match the right patient with the right technique to produce the best outcome.
比较编织型血管内桥接装置（WEB）栓塞术与显微手术夹闭术治疗前循环宽颈分叉动脉瘤（WNBA）的文献较少，这凸显了进一步研究该亚组患者最佳治疗方案的必要性。本研究的目的是比较WEB装置引入前后WNBA的血管内治疗和显微手术治疗率。此外，作者还对WEB装置引入前后患者的人口统计学、动脉瘤特征和治疗结果进行了比较。
本研究是对2018年9月27日美国食品药品监督管理局（FDA）批准WEB装置前后不同治疗方式治疗WNBA的使用率进行的回顾性研究。
研究队列包括在作者所在机构接受治疗的235例前循环WNBA患者，其中127例动脉瘤在WEB装置应用前接受治疗，108例在WEB装置应用后接受治疗。一般来说，WEB装置应用后前循环WNBA的血管内治疗率显著更高（86.1%对46.5%，p<0.001），而夹闭率显著更低（13.9%对53.5%，p<0.001）。在随访期间，WEB装置应用后队列中动脉瘤充分闭塞率（雷蒙德-罗伊闭塞分级[RROC]1级和2级）略高，但差异无统计学意义（83.9%对78.5%，p=0.34），而RROC 3级率在WEB装置应用前队列中略高，但差异无统计学意义（21.5%对16.1%，p=0.34）。此外，虽然差异无统计学意义，但WEB装置应用前队列的复发率（WEB装置应用前25.3%对WEB装置应用后14.9%，p=0.12）和再次治疗率（WEB装置应用前22.8%对WEB装置应用后14.9%，p=0.22）更高。复发率在再次治疗前进行评估。
WEB装置引入后，WNBA的血管内治疗率增加，而显微手术夹闭率降低。神经介入医生必须熟悉所有这些不同技术的适应证、优点和缺点，以便能够为合适的患者匹配合适的技术，从而获得最佳结果。
