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Occlusion assessment of intracranial aneurysms treated with the WEB device

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The Woven EndoBridge (WEB) system is an innovative device under evaluation for its capacity to treat wide-neck bifurcation intracranial aneurysms. The purpose of this study is to evaluate the use of the different occlusion scales available in clinical practice.

Methods

Seven WEB-experienced neurointerventionalists were provided with 30 angiographic follow-up data sets and asked to grade each evaluation point according to the Bicêtre Occlusion Scale Score (BOSS), firstly based on DSA images only then using additional C-Arm VasoCT analysis. This BOSS evaluation was then converted into the WEB Occlusion Scale (WOS) and into a dichotomized scale (complete occlusion or not). To estimate the inter-rater agreement among the seven raters, an overall kappa coefficient [1] and its standard error (SE) were computed.

Results

Using the five-grade BOSS, raters showed “moderate” agreement (kappa = 0.56). Using the three-grade WOS, agreement appeared slightly better (kappa = 0.59). Strongest inter-rater agreement was observed with a dichotomized version of the scale (complete occlusion or not), which enabled an “almost perfect” agreement (kappa = 0.88). VasoCT consistently enhanced the agreement particularly with regards depicting intra-WEB residual filling.

Conclusion

The WOS is a consistent means to angiographically evaluate the WEB device efficiency. But the five-grade BOSS scale allows to identify aneurysm subgroups with differing risks of recurrence and/or rehemorrhage, which needs to be separated especially at the initial phase of evaluation of this innovative device. The additional use of VasoCT allows better inter-rater agreement in evaluating occlusion and specially in depicting intra-WEB persistent filling.

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Authors and Affiliations

  1. Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France

    Jildaz Caroff, Cristian Mihalea, Jacques Moret & Laurent Spelle

  2. Department of Neurosurgery, Piata Eftimie, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania

    Cristian Mihalea

  3. Interventional Neuroradiology, Hôpital Henri Mondor, Créteil, France

    Titien Tuilier

  4. Interventional Neuroradiology, CHU Hôpital Pellegrin, Bordeaux, France

    Xavier Barreau

  5. Interventional Neuroradiology, CHU Hôpital Purpan, Toulouse, France

    Christophe Cognard

  6. Interventional Neuroradiology, CHU Hôpital Nord Laennec, Nantes, France

    Hubert Desal

  7. Interventional Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France

    Laurent Pierot

  8. Statistics Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, France

    Armelle Arnoux

  9. Université Paris-Sud XI, Faculté de Médecine, Le Kremlin-Bicêtre, France

    Jacques Moret & Laurent Spelle

Authors
  1. Jildaz Caroff
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  2. Cristian Mihalea
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  3. Titien Tuilier
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  4. Xavier Barreau
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  5. Christophe Cognard
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  6. Hubert Desal
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  7. Laurent Pierot
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  8. Armelle Arnoux
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  9. Jacques Moret
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  10. Laurent Spelle
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Corresponding author

Correspondence to Jildaz Caroff.

Ethics declarations

We declare that all human and animal studies have been approved by the local ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

CC, LP, JM and LS consult for Sequent Medical.

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Caroff, J., Mihalea, C., Tuilier, T. et al. Occlusion assessment of intracranial aneurysms treated with the WEB device. Neuroradiology 58, 887–891 (2016). https://doi.org/10.1007/s00234-016-1715-9

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  • DOI: https://doi.org/10.1007/s00234-016-1715-9

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