Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study,Journal of Neurosurgery

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Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study
Journal of Neurosurgery ( IF 4.1 ) Pub Date : 2023-10-20 , DOI: 10.3171/2023.8.jns235
Jose Danilo Bengzon Diestro ₁ , Mahmoud Dibas ₂ , Nimer Adeeb ₃ , Robert W Regenhardt ₄ , Justin E Vranic ₄ , Adrien Guenego ₅ , Sovann V Lay ₆ , Leonardo Renieri ₇ , Ali Al Balushi ₈ , Eimad Shotar ₉ , Kévin Premat ₉ , Kareem El Namaani ₁₀ , Guillaume Saliou ₁₁ , Markus A Möhlenbruch ₁₂ , Ivan Lylyk ₁₃ , Paul M Foreman ₁₄ , Jay A Vachhani ₁₄ , Vedran Župančić ₁₅ , Muhammad U Hafeez ₁₆ , Caleb Rutledge ₁₇ , Hamid Rai ₁₈ , Vincent M Tutino ₁₈ , Shervin Mirshahi ₂ , Sherief Ghozy ₁₉ , Pablo Harker ₄ , Naif M Alotaibi ₄ , James D Rabinov ₄ , Yifan Ren ₂₀ , Clemens M Schirmer ₂₁ , Oded Goren ₂₂ , Mariangela Piano ₂₃ , Anna L Kühn ₂₄ , Caterina Michelozzi ₂₅ , Stéphanie Elens ₅ , Robert M Starke ₂₆ , Ameer E Hassan ₂₇ , Arsalaan Salehani ₂₈ , Anh Nguyen ₂₉ , Jesse Jones ₂₈ , Marios Psychogios ₂₉ , Julian Spears ₁ , Thomas Marotta ₁ , Vitor Pereira ₁ , Carmen Parra-Fariñas ₁ , Maria Bres-Bullrich ₃₀ , Michael Mayich ₃₁ , Mohamed M Salem ₃₂ , Jan-Karl Burkhardt ₃₂ , Brian T Jankowitz ₃₂ , Ricardo A Domingo ₃₃ , Thien Huynh ₃₃ , Rabih Tawk ₃₃ , Christian Ulfert ₁₂ , Boris Lubicz ₅ , Pietro Panni ₂₅ , Ajit S Puri ₂₄ , Guglielmo Pero ₃₄ , Christoph J Griessenauer _{35,

36} , Hamed Asadi ₂₀ , Adnan Siddiqui ₁₈ , Andrew F Ducruet ₁₇ , Felipe C Albuquerque ₁₇ , Nirav Patel ₂ , Peter Kan ₁₆ , Vladimir Kalousek ₁₅ , Pedro Lylyk ₁₃ , Srikanth Boddu ₈ , Christopher J Stapleton ₄ , Jared Knopman ₈ , Pascal Jabbour ₁₀ , Stavropoula Tjoumakaris ₁₀ , Frédéric Clarençon ₉ , Nicola Limbucci ₇ , Mohammad A Aziz-Sultan ₂ , Hugo H Cuellar-Saenz ₃ , Christophe Cognard ₆ , Aman B Patel ₄ , Adam A Dmytriw _{2,

4}

Affiliation

1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
3Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana.
4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium.
6Diagnostic and Therapeutic Neuroradiology Department, Toulouse Hospital Center, Purpan Hospital, Toulouse, France.
7Neurovascular Intervention, Careggi Hospital of Florence, Florence, Italy.
8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York.
9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France.
10Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
11Department of diagnostic Radiology and Interventional Radiology, Vaudois Hospital Center of Lausanne, Lausanne, Switzerland.
12Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
13Endovascular Neurosurgery and Interventional Radiology Team, La Sagrada Familia Clinic, Buenos Aires, Argentina.
14Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida.
15Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia.
16Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas.
17Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York.
19Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota.
20Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Australia.
21Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania.
22Department of Neurosurgery, Geisinger, Danville, Pennsylvania.
23Neuroradiology, ASST Great Metropolitan Hospital, Niguarda, Milan, Italy.
24Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts.
25Neurovascular Intervention, San Raffaele Hospital, Milan, Italy.
26Department of Neurosurgery, University of Miami, Florida.
27Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas.
28Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
29Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland.
30Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
31Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania.
33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida.
34Neurovascular Intervention, Niguarda Cà Granda Hospital, Milano, Italy.
35Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; and.
36Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.

OBJECTIVE

The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device.

METHODS

The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use.

RESULTS

The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use.

CONCLUSIONS

This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.

中文翻译：

用于治疗颅内动脉瘤的支架辅助编织 EndoBridge 装置：一项国际多中心研究

客观的

Woven EndoBridge (WEB) 装置是一种囊内血流干扰器，专为宽颈分叉动脉瘤而设计。这些动脉瘤可能需要同时使用支架。本研究的目的是确定接受支架辅助 WEB 治疗的患者的临床和放射学结果。此外，作者还试图确定 WEB 设备治疗动脉瘤中伴随支架的预测因素。

方法

本研究的数据来自 WorldWideWEB 联盟，这是一个国际多中心队列，其中包括使用 WEB 设备治疗的患者。根据治疗将动脉瘤分为两组：支架辅助 WEB 和单独 WEB 装置。作者比较了两组的临床和放射学结果。进行单变量和多变量二元逻辑回归分析以确定倾向于使用支架的因素。

结果

该研究包括用 WEB 设备治疗的 691 例颅内动脉瘤（31 例有支架，660 例没有支架）。在最近一次随访中，两组之间的充分闭塞状态没有差异（83.3% vs 85.6%，p = 0.915）。接受支架置入术的患者有更多的血栓栓塞（32.3% vs 6.5%，p < 0.001）和手术并发症（16.1% vs 3.0%，p < 0.001）。使用伴随支架治疗的动脉瘤具有更宽的颈部、更高的高度和更低的穹颈比。颈部尺寸的增加是支架使用的唯一重要预测因素。

结论

这项研究表明，两组之间的动脉瘤闭塞程度没有差异；然而，支架组的并发症更为常见。此外，对于经 WEB 治疗的动脉瘤，较宽的动脉瘤颈容易需要支架辅助。

更新日期：2023-10-20

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