Aims and objectives
Aneurysm recanalization concomitant to endo-saccular device (WEB) compaction has been reported.
Association of compaction and aneurysm remnant is still discussed in literature.
Effect of WEB oversizing on compaction and recanalization rates remains unknown.
To assess the association of WEB compaction and risk of aneurysmal remnant.
To assess the association of oversized WEB with complete aneurysmal occlusion,
peri-procedural complication,
WEB compaction.
Methods and materials
We retrospectively included all patients treated with the WEB in our center between March 2012 and August 2018 from a prospectively maintained registry.
Review Board approval was obtained.
From February 2015 to August 2018,
we used the oversizing technique (increase of the WEB width of 1mm compared to aneurysmal width).
First we analyzed the association between compaction and occlusion rates.
We then compared patients before and after this technical shift,
as long as patients with and without “>1 oversized WEB” (oversizing >1mm) for peri-procedural complication,...
Results
We treated 78 aneurysms in 77 patients.
- In case of compaction,
patients had a lower rate of adequate (91% vs 52%,
p= 0.005) and complete occlusion (36% vs 16% p= 0.05).
- The oversizing technique led to improved rates of no-compaction (36 vs 18%),
complete occlusion (28 vs 13%) at last follow-up despite no statistical significance.
- For “>1 oversized WEB”,
per-procedure complication rate was 3 times higher despite being non-statistically significant (p=0.07).
At last follow-up,
no-compaction risk was improved (48 vs 21%,
p=...
Conclusion
WEB compaction is associated with increased rates of aneurysm remnants.
WEB oversizing may improve the complete occlusion rate whereas decreasing WEB compaction.
A too much oversizing may lead to increase the risk of per-procedure complication whereas no additional effect on aneurysmal occlusion.
Rate of adequate occlusions remains acceptable.
References
Pierot L,
Spelle L,
Molyneux A,
Byrne J,
WEBCAST and French Observatory Investigators.
Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device.
Neurosurgery.
2016;78(1):133-141.
doi:10.1227/NEU.0000000000001106.
8.
Pierot L,
Spelle L,
Costalat V,
et al.
E-029 WEB Flow Disruption: Preliminary Results from WEBCAST trial.
J Neurointerv Surg.
2014;6(Suppl 1):A51.1-A51.
doi:10.1136/neurintsurg-2014-011343.96.
9.
Pierot L,
Moret J,
Turjman F,
et al.
WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory.
Am J Neuroradiol.
2016;37(4):655-659.
doi:10.3174/ajnr.A4578.
10.
Pierot L,
Costalat V,...