Neurointervention.  2024 Nov;19(3):148-155. 10.5469/neuroint.2024.00143.

Assessing Radiation Exposure and Contrast Agent Utilization: A Comparative Analysis of the Woven EndoBridge Device and Stent-Assisted Coil Embolization for Managing Unruptured Wide-Neck Bifurcation Aneurysms

• Baek J
• Jeong HW
• Han JY
• Heo YJ
• Yun S
• Lee WH
• Kim ST

• KMID: 2560218
• DOI: http://doi.org/10.5469/neuroint.2024.00143

Abstract

Purpose
In this study, we determined whether there were significant differences in procedure time, radiation dose, fluoroscopy time, and total contrast media dose when unruptured wideneck bifurcation aneurysms (WNBAs) were treated with the Woven EndoBridge (WEB) device and stent-assisted coil (SAC) embolization.
Materials and Methods
The WEB device and SAC embolization (14:17) were used to treat 31 cases of internal carotid artery bifurcation, anterior communicating artery, middle cerebral artery bifurcation, and basilar bifurcation aneurysms between August 2021 and December 2022. The procedure time, radiation dose, fluoroscopy time, and total contrast medium dose between the 2 treatment groups were compared and analyzed. In the WEB device group, the results between operators were compared, and the follow-up radiologic outcomes were investigated.
Results
The procedure and fluoroscopy times were significantly shorter in the WEB device group. Radiation and total contrast media dose were also significantly smaller in the WEB device, but there was no significant difference in results between operators. The follow-up radiological outcome showed adequate occlusion in 83.3% (10/12) of cases.
Conclusion
The WEB device can be used as an alternative treatment method among the available endovascular treatment methods for WNBAs to reduce radiation exposure and the dose of contrast media when used adequately with appropriate indications.

Keyword

Intracranial aneurysm; Endovascular procedures; Contrast media; Fluoroscopy

Figure

• 

  Fig. 1. (A–C) A patient in their 60s patient with an anterior communicating artery (AcomA) aneurysm treated using the Woven EndoBridge (WEB; MicroVention/Terumo) device. (A) Anteroposterior view of the working projection. (B) Superselected state of the WEB device delivery microcatheter. (C) Final anteroposterior working projection after the procedure. Radiation dose, fluoroscopy time, procedural time, and amount of contrast agent used are as follows. 907 mGy, 20.9 minutes, 84 minutes, 86 mL. (D–F) A patient in their 70s with an AcomA aneurysm treated with stent-assisted coil embolization. (D) Anteroposterior view showing the working projection. (E) Placement of coil and stent delivery microcatheter at the appropriate location. (F) Final anteroposterior working projection after the procedure. Radiation dose, fluoroscopy time, procedural time, and amount of contrast agent used are as follows. 4,151 mGy, 110.1 minutes, 141 minutes, 151 mL.

Reference

1. Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke. 1999; 30:470–476.

2. Fiorella D, Arthur AS, Chiacchierini R, Emery E, Molyneux A, Pierot L. How safe and effective are existing treatments for wide-necked bifurcation aneurysms? Literature-based objective performance criteria for safety and effectiveness. J Neurointerv Surg. 2017; 9:1197–1201.

3. Muskens IS, Senders JT, Dasenbrock HH, Smith TR, Broekman ML. The Woven Endobridge device for treatment of intracranial aneurysms: a systematic review. World Neurosurg. 2017; 98:809–817.e1.

4. Goyal N, Hoit D, DiNitto J, Elijovich L, Fiorella D, Pierot L, et al. How to WEB: a practical review of methodology for the use of the Woven EndoBridge. J Neurointerv Surg. 2020; 12:512–520.

5. Pierot L, Liebig T, Sychra V, Kadziolka K, Dorn F, Strasilla C, et al. Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol. 2012; 33:1232–1238.

6. Pierot L, Spelle L, Molyneux A, Byrne J; WEBCAST and French Observatory Investigators. Clinical and anatomical follow-up in patients with aneurysms treated with the WEB device: 1-year follow-up report in the cumulated population of 2 prospective, multicenter series (WEBCAST and French Observatory). Neurosurgery. 2016; 78:133–141.

7. Arthur AS, Molyneux A, Coon AL, Saatci I, Szikora I, Baltacioglu F, WEB-IT Study Investigators, 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; 11:924–930.

8. Asnafi S, Rouchaud A, Pierot L, Brinjikji W, Murad MH, Kallmes DF. Efficacy and safety of the Woven EndoBridge (WEB) device for the treatment of intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2016; 37:2287–2292.

9. Kabbasch C, Goertz L, Siebert E, Herzberg M, Borggrefe J, Mpotsaris A, et al. Comparison of WEB embolization and coiling in unruptured intracranial aneurysms: safety and efficacy based on a propensity score analysis. World Neurosurg. 2019; 126:e937–e943.

10. Pierot L, Costalat V, Moret J, Szikora I, Klisch J, Herbreteau D, et al. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study. J Neurosurg. 2016; 124:1250–1256.

11. Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, et al. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol. 2017; 38:1151–1155.

12. Rai AT, Turner RC, Brotman RG, Boo S. Comparison of operating room variables, radiation exposure and implant costs for WEB versus stent assisted coiling for treatment of wide neck bifurcation aneurysms. Interv Neuroradiol. 2021; 27:465–472.

13. Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, et al. An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg. 2015; 7:496–502.

14. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, International Study of Unruptured Intracranial Aneurysms Investigators, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003; 362:103–110.

15. Bonneville F, Sourour N, Biondi A. Intracranial aneurysms: an overview. Neuroimaging Clin N Am. 2006; 16:371–382. vii.

16. Fargen KM, Soriano-Baron HE, Rushing JT, Mack W, Mocco J, Albuquerque F, et al. A survey of intracranial aneurysm treatment practices among United States physicians. J Neurointerv Surg. 2018; 10:44–49.

17. Toccaceli G, Diana F, Cagnazzo F, Cannizzaro D, Lanzino G, Barbagallo GMV, et al. Microsurgical clipping compared with new and most advanced endovascular techniques in the treatment of unruptured middle cerebral artery aneurysms: a meta-analysis in the modern era. World Neurosurg. 2020; 137:451–464.e1.

18. Pierot L, Szikora I, Barreau X, Holtmannspoetter M, Spelle L, Herbreteau D, et al. Aneurysm treatment with WEB in the cumulative population of two prospective, multicenter series: 3-year follow-up. J Neurointerv Surg. 2021; 13:363–368.

19. Lautin EM, Freeman NJ, Schoenfeld AH, Bakal CW, Haramati N, Friedman AC, et al. Radiocontrast-associated renal dysfunction: incidence and risk factors. AJR Am J Roentgenol. 1991; 157:49–58.

20. Doll R. Hazards of ionising radiation: 100 years of observations on man. Br J Cancer. 1995; 72:1339–1349.

21. Forbrig R, Ozpeynirci Y, Grasser M, Dorn F, Liebig T, Trumm CG. Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms. Eur Radiol. 2020; 30:4504–4513.

22. Ronco F, Tarantini G, McCullough PA. Contrast induced acute kidney injury in interventional cardiology: an update and key guidance for clinicians. Rev Cardiovasc Med. 2020; 21:9–23.

23. Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, et al. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series. J Neurointerv Surg. 2018; 10:553–559.