Impact of Woven EndoBridge Shape Modification on Aneurysm Recanalization at Short-Term Follow-up Digital Subtraction Angiography

Abstract

BACKGROUND:Woven EndoBridge (WEB) shape modification (WSM) is a frequently observed phenomenon after aneurysm embolization.OBJECTIVE:To test our hypothesis that WSM is associated with worse aneurysm occlusion on short-term angiographic follow-up images.METHODS:Patients with short-term follow-up digital subtraction angiography (DSA) available were included. Baseline patient characteristics, aneurysm morphometrics, and WEB dimensions (“conventional” parameters) and height and width WSM (“WSM” parameters) in the initial and the follow-up examination were analyzed. For ordinal regression analyses, aneurysm occlusion was graded according to the Bicêtre Occlusion Scale Score (BOSS; grades 0, 0′, 1, 2, 3, and 1 + 3). Receiver operating characteristic curve analysis was used to distinguish adequately (BOSS 0, 0′, and 1) from incompletely (BOSS 2, 3, and 1 + 3) occluded aneurysms.RESULTS:We included 93 patients with 96 aneurysms. Adequate occlusion was observed in 72 cases (75.0%). In univariate ordinal regression analysis, width WSM in anteroposterior DSA (odds ratio = 0.96, 95% CI: 0.94-0.99, P = .010) and in lateral DSA (odds ratio = 0.98, 95% CI: 0.97-0.99, P = .049) were significantly associated with the BOSS after 6 months. In multivariate regression analysis, WSM was not independently associated with aneurysm occlusion. Based on receiver operating characteristic curve analysis, the area under the curve (AUC) of the “conventional” model (AUC = 0.83, 95% CI 0.74-0.90) was higher than the AUC of the “WSM” model (WSM; AUC = 0.70, 95% CI 0.60-0.79).CONCLUSION:WSM was not independently associated with angiographic aneurysm occlusion status after 6 months. However, the “conventional” parameters including sex, rupture state, WEB type, WEB width, aneurysm width, height, and volume were associated with partial aneurysm recanalization in WEB-treated patients at the short-term follow-up.

Woven Endo Bridge shape modification contributes to decrease in adequate occlusion rate after Woven Endo Bridge implantation for wide-neck bifurcation intracranial aneurysms

“…16 Many previous reports indicate that WSM does not contribute to AO. 12,14,15,17 The present study found the impact of WSM on AO was determined by measuring detailed device shortening. The average WEB shortening of 86% over the course of 6 months in this study suggests that this is a frequent phenomenon for the WEB as a whole.…”

“…16 Many previous reports indicate that WSM does not contribute to AO. 12,14,15,17 The present study found the impact of WSM on AO was determined by measuring detailed device shortening.…”

“…There are also reports of a factor related to recurrence called WEB shape modification (WSM), which is a change in the shape of the device after WEB implantation. [11][12][13][14][15][16][17] WSM is also described as WEB compression, and is often defined as vertical compression of the WEB device itself. The frequency is as high as 31.6%-75.0%, but studies as a factor involved in recurrence have not yet reached any conclusion.…”

Woven EndoBridge in Wide-Neck Bifurcation Aneurysms: Digital Subtraction Angiography at 3-Year Follow-Up

“…As a result, the neck partially retracts and the contrast medium leaks into the pouch, without WNBA sac reperfusion. However, according to Rosskopf et al and Nawka et al, the shape deformation does not seem to influence WBNA sac occlusion [ 16 , 17 ]. In contrast to the study by Alig et colleagues in which shape modification was found in 45% of aneurysmal remnants, “butterfly shape” did not result in aneurysm reperfusions in our study [ 9 ].…”

Endovascular Treatment of Bifurcation Aneurysms with the Woven EndoBridge: Product Features and Selected Results of Off-Label Use

“…Oversizing is generally recommended; however, it is important to note that achieving proper placement with the intended size of the WEB device may not always provide adequate stability, and the difficulty in size selection may continue to be an issue in the future. 11,[56][57][58][59] For aneurysms ≥10 mm, those with branches originating from the body of the aneurysm, or cases where there is significant misalignment between the parent vessel and the aneurysm's axis, the selection of WEB treatment can be challenging from both a size and technical perspective. In such cases, other treatment options may be more appropriate.…”