Intrasaccular flow disruption for brain aneurysms: a systematic review of long-term outcomes

View More View Less
  • 1 Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;
  • | 2 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;
  • | 3 Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts; and
  • | 4 Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

The long-term safety and efficacy of intrasaccular flow disruption (IFD) for the treatment of brain aneurysms remain unclear. With accumulating experience and increasing use of IFD devices, recent studies have provided additional data regarding their outcomes. This review summarizes the long-term outcomes of IFD-treated brain aneurysms.

METHODS

A systematic literature review was performed on May 23, 2021, in PubMed, Web of Science, and Ovid MEDLINE for aneurysm treatment outcomes with IFD devices. Procedural details, including use of adjunctive devices and complications, were collected. The quality of studies was assessed using the Downs and Black checklist. Angiographic outcomes were classified as complete occlusion, residual neck, and residual aneurysm. Other outcomes included need for retreatment, permanent neurological deficit, and mortality. Pooled analyses were performed.

RESULTS

The final analysis comprised 1217 patients with 1249 aneurysms from 22 studies. The mean aneurysm diameter and neck width were 6.9 and 4.5 mm, respectively, and 27.6% of aneurysms were ruptured. The complete occlusion rates at 12 months and final follow-up (pooled mean duration 15.7 months) were 50.1% and 58.2%, respectively. Adjunctive devices were used in 6.4% of cases. The rates of hemorrhage, symptomatic infarction, permanent neurological deficit, and mortality were 1.2%, 2.8%, 1.0%, and 2.6%, respectively.

CONCLUSIONS

IFD is a very safe treatment for appropriately selected brain aneurysms with low complication and neurological deterioration rates. However, complete occlusion is achieved in only half of IFD-treated aneurysms at 1 year with a modest increase beyond this time point. As the majority of the studies were single arm, the pooled data are subject to selection and reporting biases. Future device developments, increased operator experience, and direct comparisons with alternative endovascular strategies and surgical clipping may clarify the role of IFD in aneurysm management.

ABBREVIATIONS

IFD = intrasaccular flow disruption; SAC = stent-assisted coil embolization; WEB = Woven EndoBridge; WNBA = wide-necked bifurcation intracranial aneurysm.

Supplementary Materials

    • Supplemental Tables I-IX (PDF 767 KB)

Images from Minchev et al. (pp 479–488).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Crobeddu E, Lanzino G, Kallmes DF, Cloft HJ. Review of 2 decades of aneurysm-recurrence literature, part 2: managing recurrence after endovascular coiling. AJNR Am J Neuroradiol. 2013;34(3):481485.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Crobeddu E, Lanzino G, Kallmes DF, Cloft HJ. Review of 2 decades of aneurysm-recurrence literature, part 1: reducing recurrence after endovascular coiling. AJNR Am J Neuroradiol. 2013;34(2):266270.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Becske T, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology. 2013;267(3):858868.

    • Search Google Scholar
    • Export Citation
  • 4

    Dmytriw AA, Salem MM, Yang VXD, Krings T, Pereira VM, Moore JM, Thomas AJ. Endosaccular flow disruption: a new frontier in endovascular aneurysm management. Neurosurgery. 2020;86(2):170181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Arthur AS, Molyneux A, Coon AL, Saatci I, Szikora I, Baltacioglu F, et al. The safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal WEB Intrasaccular Therapy (WEB-IT) Study. J Neurointerv Surg. 2019;11(9):924930.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001;32(9):19982004.

  • 7

    Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

  • 8

    Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, et al. Aneurysm treatment with Woven EndoBridge in the cumulative population of 3 prospective, multicenter series: 2-year follow-up. Neurosurgery. 2020;87(2):357367.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kaya HE, Bakdık S, Keskin F, Erdi MF, Koç O. Endovascular treatment of intracranial aneurysms using the Woven EndoBridge (WEB) device: retrospective analysis of a single center experience. Clin Imaging. 2020;59(1):2529.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Sauvigny T, Nawka MT, Schweingruber N, Mader MM, Regelsberger J, Schmidt NO, et al. Early clinical course after aneurysmal subarachnoid hemorrhage: comparison of patients treated with Woven EndoBridge, microsurgical clipping, or endovascular coiling. Acta Neurochir (Wien). 2019;161(9):17631773.

    • Search Google Scholar
    • Export Citation
  • 11

    Raj R, Rautio R, Pekkola J, Rahi M, Sillanpää M, Numminen J. Treatment of ruptured intracranial aneurysms using the Woven EndoBridge device: a two-center experience. World Neurosurg. 2019;123:e709e716.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Ozpeynirci Y, Braun M, Pala A, Schick M, Schmitz B. WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms. Acta Neurochir (Wien). 2019;161(8):15071513.

    • Search Google Scholar
    • Export Citation
  • 13

    Kabbasch C, Goertz L, Siebert E, Herzberg M, Borggrefe J, Krischek B, et al. WEB embolization versus stent-assisted coiling: comparison of complication rates and angiographic outcomes. J Neurointerv Surg. 2019;11(8):812816.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Haffaf I, Clarençon F, Shotar E, Rolla-Bigliani C, Vande Perre S, Mathon B, et al. Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results. J Neurointerv Surg. 2019;11(5):516522.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Da Ros V, Bozzi A, Comelli C, Semeraro V, Comelli S, Lucarelli N, et al. Ruptured intracranial aneurysms treated with Woven Endobridge intrasaccular flow disruptor: a multicenter experience. World Neurosurg. 2019;122:e498e505.

    • Search Google Scholar
    • Export Citation
  • 16

    van Rooij SB, van Rooij WJ, Peluso JP, Sluzewski M. The Woven EndoBridge (WEB) as primary treatment for unruptured intracranial aneurysms. Interv Neuroradiol. 2018;24(5):475481.

    • Search Google Scholar
    • Export Citation
  • 17

    Piotin M, Biondi A, Sourour N, Mounayer C, Jaworski M, Mangiafico S, et al. The LUNA aneurysm embolization system for intracranial aneurysm treatment: short-term, mid-term and long-term clinical and angiographic results. J Neurointerv Surg. 2018;10(12):e34.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Mine B, Goutte A, Brisbois D, Lubicz B. Endovascular treatment of intracranial aneurysms with the Woven EndoBridge device: mid term and long term results. J Neurointerv Surg. 2018;10(2):127132.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Limbucci N, Leone G, Rosi A, Consoli A, Renieri L, Laiso A, et al. Endovascular treatment of unruptured intracranial aneurysms by the Woven EndoBridge Device (WEB): are there any aspects influencing aneurysm occlusion?. World Neurosurg. 2018;109:e183e193.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Lawson A, Molyneux A, Sellar R, Lamin S, Thomas A, Gholkar A, Patankar T. Safety results from the treatment of 109 cerebral aneurysms using the Woven EndoBridge technique: preliminary results in the United Kingdom. J Neurosurg. 2018;128(1):144153.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Bhogal P, Brouwer PA, Yeo L, Svensson M, Söderman M. The Medina Embolic Device: Karolinska experience. Interv Neuroradiol. 2018;24(1):413.

  • 22

    Pierot L, Biondi A, Narata AP, Mihalea C, Januel AC, Metaxas G, et al. Should indications for WEB aneurysm treatment be enlarged? Report of a series of 20 patients with aneurysms in "atypical" locations for WEB treatment. J Neuroradiol. 2017;44(3):203209.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Aguilar Perez M, Bhogal P, Martinez Moreno R, Bäzner H, Ganslandt O, Henkes H. The Medina Embolic Device: early clinical experience from a single center. J Neurointerv Surg. 2017;9(1):7787.

    • Search Google Scholar
    • Export Citation
  • 24

    Sivan-Hoffmann R, Gory B, Riva R, Labeyrie PE, Signorelli F, Eldesouky I, et al. One-year angiographic follow-up after WEB-SL endovascular treatment of wide-neck bifurcation intracranial aneurysms. AJNR Am J Neuroradiol. 2015;36(12):23202324.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Liebig T, Kabbasch C, Strasilla C, Berlis A, Weber W, Pierot L, et al. Intrasaccular flow disruption in acutely ruptured aneurysms: a multicenter retrospective review of the use of the WEB. AJNR Am J Neuroradiol. 2015;36(9):17211727.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Caroff J, Mihalea C, Klisch J, Strasilla C, Berlis A, Patankar T, et al. Single-layer WEBs: intrasaccular flow disrupters for aneurysm treatment—feasibility results from a European study. AJNR Am J Neuroradiol. 2015;36(10):19421946.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Zimmer S, Maus V, Maurer C, Berlis A, Weber W, Fischer S. Widening the indications for intrasaccular flow disruption: WEB 17 in the treatment of aneurysm locations different from those in the good clinical practice trials. AJNR Am J Neuroradiol. 2021;42(3):524529.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Cherian J, Chen SR, Puri A, Vakharia K, Levy E, Eshraghi S, et al. Postmarket American experience with Woven EndoBridge device: adjudicated multicenter case series. Neurosurgery. 2021;89(2):275282.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Essibayi MA, Lanzino G, Brinjikji W. Safety and efficacy of the Woven EndoBridge device for treatment of ruptured intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2021;42(9):16271632.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Monteiro A, Lazar AL, Waqas M, Rai HH, Baig AA, Cortez GM, et al. Treatment of ruptured intracranial aneurysms with the Woven EndoBridge device: a systematic review. J Neurointerv Surg. Published July 15, 2021.doi: 10.1136/neurintsurg-2021-017613

    • Search Google Scholar
    • Export Citation
  • 31

    Xie Y, Tian H, Xiang B, Liu J, Xiang H. Woven EndoBridge device for the treatment of ruptured intracranial aneurysms: a systematic review of clinical and angiographic results. Interv Neuroradiol. Published online June 23, 2021.doi: 10.1177/15910199211026712

    • Search Google Scholar
    • Export Citation
  • 32

    Caroff J, Mihalea C, Tuilier T, Barreau X, Cognard C, Desal H, et al. Occlusion assessment of intracranial aneurysms treated with the WEB device. Neuroradiology. 2016;58(9):887891.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Fiorella D, Arthur A, Byrne J, Pierot L, Molyneux A, Duckwiler G, et al. Interobserver variability in the assessment of aneurysm occlusion with the WEB aneurysm embolization system. J Neurointerv Surg. 2015;7(8):591595.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Starke RM, Turk A, Ding D, Crowley RW, Liu KC, Chalouhi N, et al. Technology developments in endovascular treatment of intracranial aneurysms. J Neurointerv Surg. 2016;8(2):135144.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Pressman E, De la Garza CA, Chin F, Fishbein J, Waqas M, Siddiqui A, et al. Nuisance bleeding complications in patients with cerebral aneurysm treated with Pipeline embolization device. J Neurointerv Surg. 2021;13(3):247250.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Youssef PP, Dornbos Iii D, Peterson J, Sweid A, Zakeri A, Nimjee SM, et al. Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms. J Neurointerv Surg. 2021;13(5):443446.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Stapleton CJ, Torok CM, Rabinov JD, Walcott BP, Mascitelli JR, Leslie-Mazwi TM, et al. Validation of the Modified Raymond-Roy classification for intracranial aneurysms treated with coil embolization. J Neurointerv Surg. 2016;8(9):927933.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Michelozzi C, Darcourt J, Guenego A, Januel AC, Tall P, Gawlitza M, et al. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up. J Neurosurg. 2018;131(6):17511762.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Saleme S, Iosif C, Ponomarjova S, Mendes G, Camilleri Y, Caire F, et al. Flow-diverting stents for intracranial bifurcation aneurysm treatment. Neurosurgery. 2014;75(6):623631.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Jankowitz BT, Jadhav AP, Gross B, Jovin TG, Alhajeri AA, Fraser JF, et al. Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes. J Neurointerv Surg. Published online March 15, 2021.doi: 10.1136/neurintsurg-2020-017115

    • Search Google Scholar
    • Export Citation
  • 41

    Jankowitz BT, Hanel R, Jadhav AP, Loy DN, Frei D, Siddiqui AH, et al. Neuroform Atlas Stent System for the treatment of intracranial aneurysm: primary results of the Atlas Humanitarian Device Exemption cohort. J Neurointerv Surg. 2019;11(8):801806.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Cagnazzo F, Limbucci N, Nappini S, Renieri L, Rosi A, Laiso A, et al. Y-stent-assisted coiling of wide-neck bifurcation intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2019;40(1):122128.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Phan K, Huo YR, Jia F, Phan S, Rao PJ, Mobbs RJ, Mortimer AM. Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms. J Clin Neurosci. 2016;31:1522.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Chung EJ, Shin YS, Lee CH, Song JH, Park JE. Comparison of clinical and radiologic outcomes among stent-assisted, double-catheter, and balloon-assisted coil embolization of wide neck aneurysms. Acta Neurochir (Wien). 2014;156(7):12891295.

    • Search Google Scholar
    • Export Citation
  • 45

    Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke. 2013;44(5):13481353.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke. 2008;39(1):120125.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Mine B, Tancredi I, Aljishi A, Alghamdi F, Beltran M, Herchuelz M, Lubicz B. Follow-up of intracranial aneurysms treated by a WEB flow disrupter: a comparative study of DSA and contrast-enhanced MR angiography. J Neurointerv Surg. 2016;8(6):615620.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    Raoult H, Eugène F, Le Bras A, Mineur G, Carsin-Nicol B, Ferré JC, Gauvrit JY. CT angiography for one-year follow-up of intracranial aneurysms treated with the WEB device: utility in evaluating aneurysm occlusion and WEB compression at one year. J Neuroradiol. 2018;45(6):343348.

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1102 1102 192
Full Text Views 160 160 58
PDF Downloads 238 238 91
EPUB Downloads 0 0 0