Abstract：
OBJECTIVE: The paucity of literature comparing Woven EndoBridge (WEB) embolization to microsurgical clipping for anterior circulation wide-neck bifurcation aneurysms (WNBAs) underscores the need for further investigation into the optimal management of this patient subpopulation. The objective of this study was to compare the rate of endovascular and microsurgical treatment of WNBAs before and after the introduction of the WEB device. In addition, the authors performed a comparison of demographics, aneurysm characteristics, and treatment outcomes in patients before and after the introduction of the WEB device.
METHODS: This study was a retrospective review of the usage rate of different treatment modalities for WNBAs before and after the WEB device was approved by the US FDA on September 27, 2018.
RESULTS: The study cohort comprised 235 patients with anterior circulation WNBAs treated at the authors\' institution, including 127 aneurysms treated pre-WEB and 108 treated post-WEB. Generally, the rate of endovascular treatment of anterior circulation WNBAs was significantly higher post-WEB (86.1% vs 46.5%, p < 0.001), while the rate of clipping was significantly lower (13.9% vs 53.5%, p < 0.001). During follow-up, the rate of adequate aneurysm occlusion (Raymond-Roy occlusion classification [RROC] grades 1 and 2) was nonsignificantly higher in the post-WEB cohort (83.9% vs 78.5%, p = 0.34), while the rate of RROC grade 3 was nonsignificantly higher in the pre-WEB cohort (21.5% vs 16.1%, p = 0.34). Additionally, and although nonsignificant, the rates of recurrence (pre-WEB 25.3% vs post-WEB 14.9%, p = 0.12) and retreatment (pre-WEB 22.8% vs post-WEB 14.9%, p = 0.22) were higher in the pre-WEB cohort. Recurrence was assessed before retreatment.
CONCLUSIONS: After the introduction of the WEB device, the rate of endovascular treatment of WNBAs increased while the rate of microsurgical clipping decreased. It is essential for neurointerventionalists to become familiar with the indications, advantages, and shortcomings of all these different techniques to be able to match the right patient with the right technique to produce the best outcome.
METHODS: This study was a retrospective review of the usage rate of different treatment modalities for WNBAs before and after the WEB device was approved by the US FDA on September 27, 2018.
RESULTS: The study cohort comprised 235 patients with anterior circulation WNBAs treated at the authors\' institution, including 127 aneurysms treated pre-WEB and 108 treated post-WEB. Generally, the rate of endovascular treatment of anterior circulation WNBAs was significantly higher post-WEB (86.1% vs 46.5%, p < 0.001), while the rate of clipping was significantly lower (13.9% vs 53.5%, p < 0.001). During follow-up, the rate of adequate aneurysm occlusion (Raymond-Roy occlusion classification [RROC] grades 1 and 2) was nonsignificantly higher in the post-WEB cohort (83.9% vs 78.5%, p = 0.34), while the rate of RROC grade 3 was nonsignificantly higher in the pre-WEB cohort (21.5% vs 16.1%, p = 0.34). Additionally, and although nonsignificant, the rates of recurrence (pre-WEB 25.3% vs post-WEB 14.9%, p = 0.12) and retreatment (pre-WEB 22.8% vs post-WEB 14.9%, p = 0.22) were higher in the pre-WEB cohort. Recurrence was assessed before retreatment.
CONCLUSIONS: After the introduction of the WEB device, the rate of endovascular treatment of WNBAs increased while the rate of microsurgical clipping decreased. It is essential for neurointerventionalists to become familiar with the indications, advantages, and shortcomings of all these different techniques to be able to match the right patient with the right technique to produce the best outcome.
摘要：
目的：缺乏比较WovenEndoBridge(WEB)栓塞术与显微手术夹闭治疗前循环宽颈分叉动脉瘤(WNBA)的文献，强调需要进一步研究该患者亚群的最佳管理。这项研究的目的是比较引入WEB设备前后WNBAs的血管内和显微外科治疗的比率。此外,作者对人口统计进行了比较，动脉瘤特征，以及引入WEB设备前后患者的治疗结果。
方法：本研究是对2018年9月27日美国FDA批准WEB设备前后WNBAs不同治疗方式使用率的回顾性回顾。
结果：研究队列包括在作者机构接受治疗的235例前循环WNBA患者，包括127个前治疗的动脉瘤和108个后治疗的动脉瘤。一般来说,血管内治疗前循环WNBAs的比率明显高于术后(86.1%vs46.5%,p<0.001)，而剪裁率明显较低(13.9%vs53.5%，p<0.001)。随访期间,充分的动脉瘤闭塞率（Raymond-Roy闭塞分类[RROC]1级和2级）在后-WEB队列中没有显著提高（83.9%vs78.5%，p=0.34)，而RROC3级的比率在WEB前队列中没有显着提高(21.5%vs16.1%，p=0.34）。此外,虽然不重要，复发率(WEB前25.3%vsWEB后14.9%，p=0.12)和再治疗(前22.8%vs后14.9%，p=0.22）在WEB前队列中更高。再治疗前评估复发情况。
结论：在引入WEB设备之后，WNBAs的血管内治疗率增加，而显微手术夹闭率降低。神经干预学家必须熟悉适应症，优势,以及所有这些不同技术的缺点，以能够将正确的患者与正确的技术相匹配，以产生最佳的结果。
方法：本研究是对2018年9月27日美国FDA批准WEB设备前后WNBAs不同治疗方式使用率的回顾性回顾。
结果：研究队列包括在作者机构接受治疗的235例前循环WNBA患者，包括127个前治疗的动脉瘤和108个后治疗的动脉瘤。一般来说,血管内治疗前循环WNBAs的比率明显高于术后(86.1%vs46.5%,p<0.001)，而剪裁率明显较低(13.9%vs53.5%，p<0.001)。随访期间,充分的动脉瘤闭塞率（Raymond-Roy闭塞分类[RROC]1级和2级）在后-WEB队列中没有显著提高（83.9%vs78.5%，p=0.34)，而RROC3级的比率在WEB前队列中没有显着提高(21.5%vs16.1%，p=0.34）。此外,虽然不重要，复发率(WEB前25.3%vsWEB后14.9%，p=0.12)和再治疗(前22.8%vs后14.9%，p=0.22）在WEB前队列中更高。再治疗前评估复发情况。
结论：在引入WEB设备之后，WNBAs的血管内治疗率增加，而显微手术夹闭率降低。神经干预学家必须熟悉适应症，优势,以及所有这些不同技术的缺点，以能够将正确的患者与正确的技术相匹配，以产生最佳的结果。
