Treatment of Wide-Necked Cerebral Aneurysms Using the WEB Device Including Flow Alteration Assessment With Color-Coded Imaging: A Single Center Experience

Andreas Simgen; Annabelle Weyrich; Philipp Dietrich; Safwan Roumia; Ruben Mühl-Benninghaus; Umut Yilmaz; Wolfgang Reith; Michael Kettner

doi:10.1016/j.wnsx.2022.100143

Treatment of Wide-Necked Cerebral Aneurysms Using the WEB Device Including Flow Alteration Assessment With Color-Coded Imaging: A Single Center Experience

World Neurosurg X. 2022 Oct 8:17:100143. doi: 10.1016/j.wnsx.2022.100143. eCollection 2023 Jan.

Authors

Andreas Simgen¹, Annabelle Weyrich¹, Philipp Dietrich¹, Safwan Roumia¹, Ruben Mühl-Benninghaus¹, Umut Yilmaz¹, Wolfgang Reith¹, Michael Kettner¹

Affiliation

¹ Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany.

Abstract

Objective: The Woven EndoBridge (WEB) device (MicroVention, Tustin, CA) has extended the treatment of cerebral aneurysms. Despite the fact that the WEB device has shown promising clinical results, little is known about the caused intra-aneurysmal flow alterations. Here we present our clinical experience with the WEB, including examining various syngo iFlow (Siemens AG, Erlangen, Germany) parameters to predict aneurysm occlusion.

Methods: We reviewed the data from patients with unruptured cerebral aneurysms treated with a WEB device between 2016 and 2020. Aneurysm occlusion and complications were assessed. Furthermore, different quantitative criteria were evaluated using syngo iFlow after digital subtraction angiography.

Results: A total of 26 patients hosting 26 cerebral aneurysms met the inclusion criteria. Follow-up was available for 21 patients, with a mean of 7.3 ± 6.3 months. A total of 71.4% (n = 15) of the aneurysms included were located in the anterior and 28.6% (n = 6) in the posterior circulation. Adequate aneurysm occlusion was achieved in 85.7% (n = 18). The iFlow parameters for reduced aneurysm outflow (ID-R) differed significantly from the parameters for reduced inflow (PI-R and PI-D) (P < 0.001). The parameters did not differ significantly between adequately and insufficiently occluded aneurysms. Only a trend towards a lower ID-R of insufficiently occluded aneurysms was observed (P = 0.063), indicating a potential predictive value for insufficient aneurysmal outflow. There was no treatment-related morbidity or mortality.

Conclusions: The applied syngo iFlow parameters confirmed that flow changes induced by the WEB device significantly affect outflow compared to inflow and have potential predictive value for adequate aneurysm occlusion.

Keywords: 2D, 2-dimensional; BOSS, Beaujon Occlusion Scale Score; CFD, Computational fluid dynamics; Cerebral aneurysm; DSA, Digital subtraction angiography; ID, Intensity decrease; ID-R, Intensity decrease ratio; PI, Peak intensity; PI-D, Peak intensity delay; PI-R, Peak intensity ratio; ROI, Region of interest; Syngo iFlow; TDC, Time density curve; TTP, Time to peak; WEB; WEB, Woven EndoBridge; mRS, Modified Rankin scale.