Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization

动脉瘤 医学 大脑中动脉 闭塞 接收机工作特性 切断 放射科 栓塞 核医学 外科 内科学 缺血 量子力学 物理
作者
Nimer Adeeb,Basel Musmar,Hamza Salim,Assala Aslan,Anika Alla,Nicole M Cancelliere,Rachel M. McLellan,Oktay Algın,Sherief Ghozy,Mahmoud Dibas,Sovann Lay,Adrien Guenego,Leonardo Renieri,Joseph A. Carnevale,Guillaume Saliou,Panagiotis Mastorakos,Kareem El Naamani,Eimad Shotar,Kévin Premat,Markus Möhlenbruch
出处
期刊:Journal of Neurosurgery [American Association of Neurological Surgeons]
卷期号:: 1-11
标识
DOI:10.3171/2024.5.jns232204
摘要

OBJECTIVE The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors’ objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment. METHODS The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size. RESULTS The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters. CONCLUSIONS This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.
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