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

IF 3.5 2区医学 Q1 CLINICAL NEUROLOGY

Journal of neurosurgery Pub Date : 2024-10-11 DOI:10.3171/2024.5.JNS232204

Nimer Adeeb, Basel Musmar, Hamza Adel Salim, Assala Aslan, Anika Alla, Nicole M Cancelliere, Rachel M McLellan, Oktay Algin, Sherief Ghozy, Mahmoud Dibas, Sovann V Lay, Adrien Guenego, Leonardo Renieri, Joseph Carnevale, Guillaume Saliou, Panagiotis Mastorakos, Kareem El Naamani, Eimad Shotar, Kevin Premat, Markus Möhlenbruch, Michael Kral, Omer Doron, Charlotte Chung, Mohamed M Salem, Ivan Lylyk, Paul M Foreman, Jay A Vachhani, Hamza Shaikh, Vedran Župančić, Muhammad U Hafeez, Joshua S Catapano, Muhammad Waqas, Vincent M Tutino, Mohamed K Ibrahim, Marwa A Mohammed, M Ozgur Ozates, Giyas Ayberk, James D Rabinov, Yifan Ren, Clemens M Schirmer, Mariangela Piano, Anna L Kühn, Caterina Michelozzi, Stéphanie Elens, Robert M Starke, Ameer Hassan, Mark Ogilvie, Anh Nguyen, Jesse Jones, Waleed Brinjikji, Marie T Nawka, Marios Psychogios, Christian Ulfert, Jose Danilo Bengzon Diestro, Bryan Pukenas, Jan-Karl Burkhardt, Ricardo A Domingo, Thien Huynh, Juan Carlos Martinez-Gutierrez, Muhammed Amir Essibayi, Sunil A Sheth, Gary Spiegel, Rabih G Tawk, Boris Lubicz, Pietro Panni, Ajit S Puri, Guglielmo Pero, Erez Nossek, Eytan Raz, Monika Killer-Oberfalzer, Christoph J Griessenauer, Hamed Asadi, Adnan Siddiqui, Allan L Brook, David Altschul, Andrew F Ducruet, Felipe C Albuquerque, Robert W Regenhardt, Christopher J Stapleton, Peter Kan, Vladimir Kalousek, Pedro Lylyk, Srikanth Boddu, Jared Knopman, Mohammad A Aziz-Sultan, Stavropoula I Tjoumakaris, Frédéric Clarençon, Nicola Limbucci, Hugo H Cuellar-Saenz, Pascal M Jabbour, Vitor Mendes Pereira, Aman B Patel, Adam A Dmytriw

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引用次数: 0

Abstract

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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确定 Woven EndoBridge 栓塞术理想的大脑中动脉分叉动脉瘤大小。

目的：Woven EndoBridge（WEB）装置已被批准用于治疗宽颈分叉动脉瘤。该装置被设计为肌内血流阻断器，可覆盖宽度达 10 毫米的动脉瘤。虽然之前的研究结合了所有动脉瘤的大小，但众所周知，动脉瘤的大小不同，对血管内治疗的反应也不同。因此，作者的目标是确定最适合 WEB 治疗的理想大脑中动脉（MCA）动脉瘤宽度和瘤颈尺寸：方法：WorldWideWEB 联合会是一个大型多中心回顾性数据库，对使用 WEB 设备治疗的颅内动脉瘤进行分析。在这项研究中，纳入了所有可测量的未破裂 MCA 分叉动脉瘤。根据动脉瘤宽度和颈部与动脉瘤闭塞状态的关系，使用接收器操作特征曲线（ROC）测量了临界值。然后使用倾向评分匹配法（PSM）比较动脉瘤宽度和颈部大小小于和大于临界值的治疗结果：MCA分叉动脉瘤宽度和颈部的理想临界值分别为6.1毫米和4.6毫米。在 PSM 中，87 对匹配的动脉瘤根据宽度大小（≤ 6.1 毫米和大于 6.1 毫米）进行了比较，77 对匹配的动脉瘤根据颈部大小（≤ 4.6 毫米和大于 4.6 毫米）进行了比较。在宽度（93% vs 76%，p = 0.0017）和颈部大小（90% vs 70%，p = 0.0026）方面，小于和大于上述临界值的动脉瘤在充分闭塞方面存在明显差异。在两个参数上，较大动脉瘤的再治疗率也明显更高：本研究表明，宽度小于 6.1 毫米、颈部大小小于 4.6 毫米的 MCA 分叉动脉瘤明显更适合 WEB 治疗，从而改善闭塞状况并降低再治疗率，而这正是使用 WEB 设备时需要考虑的重要因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.