WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Short- and Midterm Results in a European Study
WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Short- and Midterm Results in a European Study
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DOI：
10.3174/ajnr.a3869
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发表时间：
2014-03-01
影响因子：
3.5
通讯作者：
Pierot, L.
中科院分区：
文献类型：
--
作者：
Lubicz, B.;Klisch, J.;Pierot, L.
在来自12家欧洲中心的45例患者中评估了使用新型WEB-DL器械进行动脉瘤血管内治疗的短期和中期结果。其中，42个动脉瘤未破裂，大多数位于MCA分叉或后循环。在6个月和13个月时，分别在81%和90%的动脉瘤中观察到充分闭塞。结果表明，WEB-DL血管内治疗宽颈分叉部动脉瘤可为历史上不稳定的一类动脉瘤提供稳定的闭塞。背景和目的：WEB-DL器械的血流中断已安全用于治疗宽颈分叉部动脉瘤，但该治疗后动脉瘤闭塞的稳定性尚不清楚。这项回顾性多中心欧洲研究分析了短期和中期数据的患者治疗WEB-DL.MATERIALS和METHODS：12个欧洲神经介入中心参加了这项研究。收集临床数据以及术前和术后短期和中期图像。经验丰富的介入神经放射科医生独立分析了图像。动脉瘤闭塞分为4个等级：完全闭塞、器械近端隐窝混浊、瘤颈残留和动脉瘤残留。结果：纳入45例患者（34例女性和11例男性），年龄35-74岁（平均56.3 +/- 9.6岁），45个动脉瘤接受WEB器械治疗。动脉瘤位于大脑中动脉26例，后循环13例，前交通动脉5例，颈内动脉终末1例。42个动脉瘤未破裂。末次随访时，93.3%的患者临床结局良好（mRS < 2）。在短期随访（中位数，6个月）和中期随访（中位数，13个月）中，分别在30/37例患者（81.1%）和26/29例患者（89.7%）中观察到充分闭塞（完全闭塞、近端隐窝混浊或瘤颈残留）。在中期随访时，2/28例患者（7.1%）的动脉瘤闭塞情况恶化。结论：结果表明，宽颈分叉部动脉瘤的WEB血管内治疗为一类历史上不稳定的动脉瘤提供了稳定的闭塞。此外，我们的数据显示WEB隐窝的混浊可以从真实的瘤颈或动脉瘤残留物中描绘出来。
Short- and midterm results of endovascular aneurysm treatment with the new WEB-DL device were assessed in 45 patients from 12 European centers. Of these, 42 aneurysms were unruptured and most were located either in the MCA bifurcation or the posterior circulation. Adequate occlusion was observed in 81% and 90% of aneurysms at 6 and 13 months, respectively. Results suggest that WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable.BACKGROUND AND PURPOSE:Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL.MATERIALS AND METHODS:Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant.RESULTS:Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 +/- 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations were the middle cerebral artery in 26 patients, the posterior circulation in 13 patients, the anterior communicating artery in 5 patients, and the internal carotid artery terminus in 1 patient. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion was observed in 2/28 patients (7.1%) at midterm follow-up.CONCLUSIONS:The results suggest that the WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnants.