Purpose

Using the Woven EndoBridge (WEB) for aneurysm treatment has emerged as endovascular approach aiming for flow disruption in aneurysm sac. Since quantifiable data confirming the hemodynamic effect are lacking, we investigated in vivo aneurysmal flow alterations using time-density curve (TDC) analysis. Additionally, we evaluated whether flow parameters could be identified as independent factor to predict aneurysm occlusion.

Methods

Forty cerebral aneurysm patients treated with WEB were enrolled. Pre- and postinterventional digital subtraction angiography series were postprocessed and TDCs generated. TDCs were quantified calculating the parameters aneurysmal inflow velocity, outflow velocity, mean flow velocity, and relative time-to-peak (rTTP) of aneurysm filling. Pre- and postinterventional values were compared and related to occlusion rate.

Results

WEB implanting induced highly significant rTTP prolongation by 52% (p = 0.001) and highly significant decrease of aneurysmal inflow, outflow, and mean flow velocity (p < 0.001). While outflow velocity was reduced by 49%, inflow velocity was reduced by 33% only. No statistically significant difference between the occluded and the non-occluded group was observed. No flow parameter reached significance level concerning predicting aneurysm occlusion.

Conclusion

Flow quantification confirms a significant flow-disrupting effect of WEB reducing more the outflow than the inflow velocity. In our small cohort, no flow parameter reached statistical significance to show predictive value regarding complete aneurysm occlusion. The hemodynamic effect of WEB is on comparable level to flow-diverting stents meaning that aneurysm closure can be delayed. In case of only slight inflow changes and high aneurysmal hemodynamic stress, some aneurysms might not be adequately protected in the short term.

中文翻译：

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Woven EndoBridge的血液动力学作用是什么？使用时间密度曲线分析的体内定量。

目的

使用编织内膜桥（WEB）进行动脉瘤治疗已成为旨在破坏动脉瘤囊血流的血管内方法。由于缺乏可证实的血液动力学效应的可量化数据，我们使用时间密度曲线（TDC）分析了体内动脉瘤流量的变化。此外，我们评估了是否可以将血流参数确定为预测动脉瘤闭塞的独立因素。

方法

登记了40名接受WEB治疗的脑动脉瘤患者。对介入前和介入后数字减影血管造影系列进行后处理，并生成TDC。通过计算动脉瘤流入速度，流出速度，平均流速和动脉瘤充盈的相对峰时间（rTTP）参数来量化TDC。比较介入前和介入后的值，并与阻塞率相关。

结果

WEB植入导致rTTP延长52％（p  = 0.001），并显着降低动脉瘤流入，流出和平均流速（p  <0.001）。流出速度降低了49％，而流入速度仅降低了33％。在闭塞组和非闭塞组之间没有观察到统计学上的显着差异。没有流量参数达到有关预测动脉瘤闭塞的显着性水平。

结论

流量定量确认了WEB的显着扰流效果，与流入速度相比，流出量减少更多。在我们的小队列中，没有流量参数达到统计学意义，以显示出对完全动脉瘤闭塞的预测价值。WEB的血流动力学作用与分流支架相当，这意味着可以延迟动脉瘤的闭合。如果只有少量的流入变化和高的动脉瘤血流动力学压力，则短期内可能无法充分保护某些动脉瘤。