Essibayi Muhammed Amir, Altschul David J
Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Interv Neuroradiol. 2024 Aug 22:15910199241273984. doi: 10.1177/15910199241273984.
The Woven EndoBridge (WEB) device is increasingly used for treatment of wide-neck bifurcation aneurysms. With the newer 17 system, WEB deployment has been associated with a phenomenon known as incomplete or "sticky" detachment from the delivery wire, which may lead to imprecise placement. Optimal techniques for WEB manipulation and delivery to avoid this problem are poorly defined. This study aimed to evaluate standard WEB deployment techniques and determine the impact of delivery techniques and WEB stickiness on procedural success.
An study using identical silicone middle cerebral artery aneurysm models ( = 32) assessed WEB (6 × 2 mm) deployment through a VIA 17 microcatheter via three techniques that involved: "loading," "neutral," and "tension" on the pusher wire. Microcatheter position was placed in varied positions from the WEB device. Woven EndoBridge stickiness was graded during detachment attempts. Primary outcomes were detachment stickiness and attempt number, compared between techniques using Fisher's exact test.
The tension technique resulted in significantly fewer sticky detachments and detachment attempts compared to forward load or neutral techniques (p < 0.001). Sticky detachment was lower with tension (0% sticky) versus forward load (42% sticky, 8% very sticky) (p < 0.001). Forward load had a 50% rate of stickiness versus 0% with tension and neutral (p < 0.001). Forward load required multiple attempts in 100%, compared to 57% with neutral and 8% with tension (p < 0.001). Higher stickiness grades increased the need for multiple attempts (p < 0.001).
The tension technique reduces incomplete WEB detachment and enables precise single-attempt detachment, optimizing delivery precision. confirmation is needed.
编织型血管内桥接（WEB）装置越来越多地用于治疗宽颈分叉动脉瘤。随着更新的17系统的出现，WEB的部署与一种被称为从输送导丝不完全或“粘性”分离的现象相关，这可能导致放置不准确。用于避免此问题的WEB操作和输送的最佳技术定义不明确。本研究旨在评估标准的WEB部署技术，并确定输送技术和WEB粘性对手术成功的影响。
一项使用相同硅胶大脑中动脉瘤模型（n = 32）的研究，通过VIA 17微导管，采用三种涉及推送导丝上“加载”“中性”和“张力”的技术评估WEB（6×2mm）的部署。微导管位置放置在距WEB装置的不同位置。在分离尝试过程中对编织型血管内桥接的粘性进行分级。主要结局是分离粘性和尝试次数，使用Fisher精确检验在不同技术之间进行比较。
与向前加载或中性技术相比，张力技术导致粘性分离和分离尝试显著减少（p < 0.001）。张力技术的粘性分离率较低（0%粘性），而向前加载技术为（42%粘性，8%非常粘性）（p < 0.001）。向前加载技术的粘性率为50%，而张力和中性技术为0%（p < 0.001）。向前加载技术100%需要多次尝试，相比之下，中性技术为57%，张力技术为8%（p < 0.001）。更高的粘性等级增加了多次尝试的必要性（p < 0.001）。
张力技术减少了WEB的不完全分离，并实现了精确的单次分离，优化了输送精度。尚需进一步证实。
