Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device

J-B Girot; J Caroff; J Cortese; C Mihalea; A Rouchaud; V Da Ros; J V Martinez; L Contreras; L Ikka; V Chalumeau; A Ozanne; G B D Aguiar; S Gallas; J Moret; L Spelle

doi:10.3174/ajnr.A7115

Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device

AJNR Am J Neuroradiol. 2021 Jul;42(7):1276-1281. doi: 10.3174/ajnr.A7115. Epub 2021 Apr 29.

Authors

J-B Girot^{1

2}, J Caroff³, J Cortese¹, C Mihalea¹, A Rouchaud⁴, V Da Ros⁵, J V Martinez¹, L Contreras^{1

6}, L Ikka¹, V Chalumeau¹, A Ozanne¹, G B D Aguiar^{1

7}, S Gallas¹, J Moret^{1

8}, L Spelle^{1

8}

Affiliations

¹ From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France.
² Radiology Department (J.-B.G.), Angers University Hospital, Angers, France.
³ From the Department of Interventional Neuroradiology-NEURI Brain Vascular Center (J.-B.G., J. Caroff, J. Cortese, C.M., J.V.M., L.C., L.I., V.C., A.O., G.B.D.A., S.G., J.M., LS.), Bicêtre Hospital, Le Kremlin-Bicêtre, France Jildaz.caroff@aphp.fr.
⁴ Department of Radiology (A.R.), Centre Hospitalier et Universitaire Dupuytren, Centre National de la Recherche Scientifique, XLIM, Unité Mixte de Recherche Limoges, France.
⁵ Department of Biomedicine and Prevention (V.D.R.), University Hospital of Rome Tor Vergata, Rome, Italy.
⁶ Department of Neurosurgery (L.C.), Hospital Clínico Universidad de Chile, Santiago, Chile.
⁷ Department of Surgery, Discipline Neurosurgery (G.B.D.A.), Santa Casa de Sao Paulo School of Medical Sciences. São Paulo, Brazil.
⁸ Université Paris Sud, faculté de Médecine (J.M., L.S.), Le Kremlin-Bicêtre, France.

Abstract

Background and purpose: The Woven EndoBridge has proved to be a safe and effective treatment, especially for wide-neck intracranial aneurysms. The recent fifth-generation Woven EndoBridge came with smaller devices. The purpose of this study was to assess the safety and efficiency of Woven EndoBridge treatment of small and very small aneurysms.

Materials and methods: Between September 2017 and March 2020, all consecutive patients treated with a 3- or 3.5 mm-width Woven EndoBridge device were included in this retrospective intention-to-treat study. Clinical and radiologic findings were evaluated at immediate and last-available follow-up. Angiographic outcome was assessed by an external expert reader.

Results: One hundred twenty-eight aneurysms were treated with a fifth-generation Woven EndoBridge device including 29 with a width of ≤3.5 mm. Ten aneurysms were ruptured (34%). In 3 cases (10%), Woven EndoBridge treatment could not be performed because the aneurysm was still too small for the smallest available Woven EndoBridge device and another endovascular strategy was chosen. The median follow-up time was 11.2 months. Complete and adequate occlusion was obtained in 71% and 90% of the treated aneurysms, respectively. Retreatment was needed in 2 cases (10%). Symptomatic ischemic complications leading to transient neurologic deficits occurred in 2 cases (7%) (1 procedure-related and 1 device-related) but with full spontaneous recovery at discharge.

Conclusions: The fifth-generation Woven EndoBridge device seems to be a safe and technically feasible treatment for both ruptured and unruptured small and very small intracranial aneurysms, with satisfactory occlusion rates on midterm follow-up. However, further study is needed to evaluate longer-term efficiency.

MeSH terms

Blood Vessel Prosthesis
Embolization, Therapeutic
Endovascular Procedures
Female
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / surgery
Male
Middle Aged
Retrospective Studies
Treatment Outcome