Quantitative evaluation of WEB shape modification: A five-year follow-up study - 19/03/19

Doi : 10.1016/j.neurad.2019.02.010

Kevin Janot ^a,^⁎ , Denis Herbreteau ^a, Aymeric Amelot ^b, Guillaume Charbonnier ^c, Fakhreddine Boustia ^a, Ana Paula Narata ^a, Basile Kerleroux ^a, Richard Bibi ^a, Chrysanthi Papagiannaki ^d, Aymeric Rouchaud ^e, Laurent Pierot ^f
^a University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France
^b University Hospital of La Pitié-Salpétrière, Neurosurgery Department, 47-83, boulevard de l'hopital, 75013 Paris, France
^c University Hospital of Besançon, Neuroradiology Department, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
^d University Hospital of Rouen, Neuroradiology Department, 37, boulevard Gambetta, 76000 Rouen, France
^e University Hospital of Limoges, Neuroradiology Department, 2, avenue Martin Luther King, 87000 Limoges, France
^f University Hospital of Reims, Neuroradiology Department, 45, rue Cognacq-Jay, 51100 Reims, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 19 March 2019
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Abstract

Background and purpose

Web shape modification (WSM) has previously been associated with aneurysm recurrence. We report here our five-year experience of WEB device use with a quantitative approach of the WSM phenomenon.

Methods

From July 2012 to July 2017, 50 patients with 51 unruptured aneurysms treated with the WEB device have been prospectively enrolled in our data base and retrospectively analyzed. An independent “core lab” evaluated anatomical results and potential WSM in DSA follow-up. We defined the WSM ratio (WSMr) as a relative index between the height and the width of the device in working projections which gave an evaluation of the device deformation over the time.

Results

During the total follow-up period, WSM was observed in 35/48 aneurysms (72.9%). Adequate occlusion rates were 87.0% and 92.6% with and without WSM respectively (P = 0.65). 30 out the 35 (85.7%) shape modifications were already noticed at short-term follow-up (6-month DSA). 33 patients had 2 DSA controls and WSMr measurements were available in 24 patients: 18 (75%) with WSM and 6 (25%) without WSM. In the group with WSM, WSMr values were 0.80 in post-embolization, 0.52 at the first DSA angiogram and 0.42 at the second DSA angiogram.

Conclusion

WEB shape modification was observed in more than half of cases but with no influence regarding adequate occlusion rate. This quantitative approach of WSM highlights that this phenomenon appears to be early and progressive over time. This supports the hypothesis that WSM could be more probably related to aneurysm healing rather than external compression.

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Keywords : Aneurysm, WEB

Abbreviations : AcomA, BA, CT, DSA, ICA, MCA, MRI, PcomA, TOF, WEB