确定用于编织型血管内桥接器栓塞的大脑中动脉分叉部理想动脉瘤大小。
Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization.
作者信息
Adeeb Nimer, Musmar Basel, Salim Hamza Adel, Aslan Assala, Alla Anika, Cancelliere Nicole M, McLellan Rachel M, Algin Oktay, Ghozy Sherief, Dibas Mahmoud, Lay Sovann V, Guenego Adrien, Renieri Leonardo, Carnevale Joseph, Saliou Guillaume, Mastorakos Panagiotis, Naamani Kareem El, Shotar Eimad, Premat Kevin, Möhlenbruch Markus, Kral Michael, Doron Omer, Chung Charlotte, Salem Mohamed M, Lylyk Ivan, Foreman Paul M, Vachhani Jay A, Shaikh Hamza, Župančić Vedran, Hafeez Muhammad U, Catapano Joshua S, Waqas Muhammad, Tutino Vincent M, Ibrahim Mohamed K, Mohammed Marwa A, Ozates M Ozgur, Ayberk Giyas, Rabinov James D, Ren Yifan, Schirmer Clemens M, Piano Mariangela, Kühn Anna L, Michelozzi Caterina, Elens Stéphanie, Starke Robert M, Hassan Ameer, Ogilvie Mark, Nguyen Anh, Jones Jesse, Brinjikji Waleed, Nawka Marie T, Psychogios Marios, Ulfert Christian, Diestro Jose Danilo Bengzon, Pukenas Bryan, Burkhardt Jan-Karl, Domingo Ricardo A, Huynh Thien, Martinez-Gutierrez Juan Carlos, Essibayi Muhammed Amir, Sheth Sunil A, Spiegel Gary, Tawk Rabih G, Lubicz Boris, Panni Pietro, Puri Ajit S, Pero Guglielmo, Nossek Erez, Raz Eytan, Killer-Oberfalzer Monika, Griessenauer Christoph J, Asadi Hamed, Siddiqui Adnan, Brook Allan L, Altschul David, Ducruet Andrew F, Albuquerque Felipe C, Regenhardt Robert W, Stapleton Christopher J, Kan Peter, Kalousek Vladimir, Lylyk Pedro, Boddu Srikanth, Knopman Jared, Aziz-Sultan Mohammad A, Tjoumakaris Stavropoula I, Clarençon Frédéric, Limbucci Nicola, Cuellar-Saenz Hugo H, Jabbour Pascal M, Mendes Pereira Vitor, Patel Aman B, Dmytriw Adam A
机构信息
1Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana.
2Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
出版信息
J Neurosurg. 2024 Oct 11;142(3):647-657. doi: 10.3171/2024.5.JNS232204. Print 2025 Mar 1.
OBJECTIVE
The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment.
METHODS
The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size.
RESULTS
The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters.
CONCLUSIONS
This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.
目的
编织型血管内桥接器（WEB）装置已被批准用于治疗宽颈分叉动脉瘤。该装置设计为一种瘤内血流干扰装置，可覆盖宽度达10毫米的动脉瘤。尽管先前的研究将所有动脉瘤大小合并在一起，但众所周知，动脉瘤根据其大小对血管内治疗的反应有所不同。因此，作者的目的是确定最适合WEB治疗的理想大脑中动脉（MCA）动脉瘤宽度和颈部尺寸。
方法
WorldWideWEB联盟是一个大型多中心回顾性数据库，分析使用WEB装置治疗的颅内动脉瘤。在本研究中，纳入了所有有可用测量值的未破裂MCA分叉动脉瘤。使用受试者工作特征（ROC）曲线测量基于动脉瘤宽度和颈部与动脉瘤闭塞状态相关的截断值。然后使用倾向评分匹配（PSM）来比较宽度和颈部尺寸小于和大于截断值的动脉瘤之间的治疗结果。
结果
MCA分叉动脉瘤宽度和颈部的理想截断值分别为6.1毫米和4.6毫米。在PSM中，基于宽度大小（≤6.1毫米和>6.1毫米）比较了87对匹配对，基于颈部大小（≤4.6毫米和>4.6毫米）比较了77对匹配对。宽度小于和大于这些截断值的动脉瘤之间以及颈部尺寸小于和大于这些截断值的动脉瘤之间，在充分的动脉瘤闭塞方面存在显著差异（93%对76%，p = 0.0017）和（90%对70%，p = 0.0026）。在这两个参数中，较大动脉瘤的再治疗率也显著更高。
结论
本研究表明，宽度≤6.1毫米且颈部尺寸≤4.6毫米的MCA分叉动脉瘤是WEB治疗的明显更佳候选者，可导致更好的闭塞状态和更低的再治疗率，这是使用WEB装置时的重要考虑因素。
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