Hicks William H, Traylor Jeffrey I, Schmitt Kelsey, Trevino Haldo, Guidry Bradley S, Welch Babu G, White Jonathan A, De Oliveira Sillero Rafael
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Oper Neurosurg. 2025 May 7. doi: 10.1227/ons.0000000000001589.
Endosaccular flow disruption with the Woven EndoBridge (WEB) embolization device emerged as an alternative treatment for wide-necked bifurcation aneurysms (WNBAs). Previous studies used pooled aneurysm locations to conclude the efficacy of the WEB device, failing to account for locational differences in outcomes, most notably at the middle cerebral artery (MCA). Thus, we analyzed characteristics and outcomes among a cohort of WEB-eligible MCA bifurcation aneurysms treated surgically.
We retrospectively reviewed a prospectively maintained aneurysm database at UT Southwestern between 2002 and 2022. WEB-eligible aneurysms met the criteria of a dome-to-neck ratio ≥1, a neck diameter >4.0 mm or a dome-to-neck ratio of ≤2, and an aneurysm diameter of 3.0-11.0 mm. Both unruptured and ruptured aneurysms were included. The end points assessed were functional status changes (modified Rankin scale [mRS]), complication rates, aneurysm recurrence, residual, morbidity, and mortality.
One hundred two patients met radiographic inclusion criteria as WEB-eligible WNBA who underwent microsurgical clipping. Eighty-five (83.3%) aneurysms were unruptured. Patients with ruptured aneurysms presented with a worse mRS and experienced more significant improvements in functional status at the final follow-up. Regardless of rupture status, outcomes with open surgery were excellent, with a 99% treatment success rate, 4.9% morbidity rate, and 0% mortality rate. Among unruptured MCA WNBAs, functional outcomes showed a final mRS ≤2 in 94.1% of patients and an improved or stable functional status in 91.8%. Microsurgical treatment of unruptured MCA WNBA carried a 5.9% thromboembolic complication rate.
Outcomes of WEB-eligible MCA WNBAs are comparable with the high success rates in large, heterogeneous series of MCA aneurysms and superior to those in WEB cohorts. Functional outcomes remain excellent regardless of treatment strategy; however, surgical treatment may offer higher complete occlusion rates, lower retreatment rates, and lower complication rates than endovascular treatment with WEB.
采用编织型血管内桥接（WEB）栓塞装置进行囊内血流阻断已成为治疗宽颈分叉动脉瘤（WNBA）的一种替代方法。以往研究使用汇总的动脉瘤位置来总结WEB装置的疗效，未考虑结局的位置差异，最显著的是大脑中动脉（MCA）处的差异。因此，我们分析了一组接受手术治疗的适合使用WEB的MCA分叉动脉瘤的特征和结局。
我们回顾性分析了2002年至2022年期间德克萨斯大学西南医学中心前瞻性维护的动脉瘤数据库。适合使用WEB的动脉瘤符合以下标准：瘤顶与瘤颈比值≥1、瘤颈直径>4.0 mm或瘤顶与瘤颈比值≤2，且动脉瘤直径为3.0 - 11.0 mm。纳入未破裂和破裂的动脉瘤。评估的终点指标包括功能状态变化（改良Rankin量表[mRS]）、并发症发生率、动脉瘤复发、残留情况、发病率和死亡率。
102例患者符合影像学纳入标准，为适合使用WEB的WNBA并接受了显微手术夹闭。85例（83.3%）动脉瘤未破裂。破裂动脉瘤患者的mRS较差，在末次随访时功能状态有更显著改善。无论破裂状态如何，开放手术的结局良好，治疗成功率为99%，发病率为4.9%，死亡率为0%。在未破裂的MCA WNBA中，94.1%的患者功能结局最终mRS≤2，91.8%的患者功能状态改善或稳定。未破裂MCA WNBA的显微手术治疗血栓栓塞并发症发生率为5.9%。
适合使用WEB的MCA WNBA的结局与大型异质性MCA动脉瘤系列的高成功率相当，且优于WEB队列中的结局。无论治疗策略如何，功能结局均良好；然而，与使用WEB的血管内治疗相比，手术治疗可能具有更高的完全闭塞率、更低的再次治疗率和更低的并发症发生率。
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