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Research ArticleNeurointervention
Open Access

Lateral Compression Manipulation: A Simple Approach for Sizing Taller-Than-Wide Intracranial Aneurysms with the Woven EndoBridge Device

Han Seng Chew, Ming Yao Chong, Waleed Butt, Samer Al-Ali, Benjamin Butler, Mohammad Al-Tibi, Swarupsinh Chavda and Saleh Lamin
American Journal of Neuroradiology May 2024, DOI: https://doi.org/10.3174/ajnr.A8172
Han Seng Chew
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Ming Yao Chong
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Waleed Butt
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Samer Al-Ali
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Benjamin Butler
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Mohammad Al-Tibi
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Swarupsinh Chavda
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Saleh Lamin
aFrom the Department of Neuroradiology Queen Elizabeth Hospital Birmingham, Birmingham, UK
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  • FIG 1.
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    FIG 1.

    The manufacturer’s sizing chart for the WEB device does not cover aneurysms with a height-to-dome ratio of >1. Our proposed approach expands the original range of treatable aneurysms to include those shown in the red zone, effectively doubling the spectrum of aneurysms without the need for additional fixed-sized WEB devices.

  • FIG 2.
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    FIG 2.

    Diagram depicting the proposed sizing strategy for aneurysms with a high height-to-dome ratio. The appropriate WEB size is determined by strategically swapping the height and width dimensions of the aneurysm. For an aneurysm measuring w × h, it is advisable to use a h × w WEB. When fully deployed, the device undergoes significant lateral compression, leading to a substantial increase in its vertical extension, which helps to achieve an optimal fit for the aneurysm.

  • FIG 3.
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    FIG 3.

    An elective embolization was performed on a right cylindrical MCA aneurysm, with measurements indicating a maximum width of 3.82 mm and a height of 8 mm. An 8 × 4 mm WEB SL device was successfully deployed without impeding the adjacent temporal branch. As a result of intense lateral compression, the base of the SL device assumed a cup-shaped configuration, leaving a small “dog ear” at the neck of the aneurysm. At the 6-month follow-up, the aneurysm continued to show satisfactory results (red arrow).

  • FIG 4.
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    FIG 4.

    When one deals with aneurysms of noncylindrical shapes, interobserver discrepancies in image interpretation and aneurysm measurement can result in inconsistent results. Aneurysms with noncylindrical shapes generally have smaller actual volumes than their cylindrical counterparts with the same maximum width and height. To ensure an adequate fit within the aneurysms, one must downsize the WEB device by reducing the device height. In this visual representation, all 3 aneurysms share the same maximum width and height dimensions of 5 × 8 mm, suggesting that they should be treated with an 8 × 5 mm WEB device according to the recommended sizing method. However, the actual volumes of the 2 noncylindrical aneurysms are smaller and would not provide sufficient room for an 8 × 5 mm device. The WEB device can be downsized by reducing the height by 1 mm, making an 8 × 4 mm device a more appropriate choice for these aneurysms to address this issue.

  • FIG 5.
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    FIG 5.

    WEB embolization of an acute anterior communicating artery aneurysm, characterized by a maximum width of 5.4 mm and a height of 8.5 mm. A strategic downsizing was performed due to the noncylindrical shape of the aneurysm. Instead of using an 8 × 5 mm device, an 8 × 4 mm WEB SL was selected for the procedure. A follow-up at 6 months showed that the aneurysm remained fully occluded (red arrow).

  • FIG 6.
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    FIG 6.

    When subjected to extreme, lateral compression, the WEB SL device tends to assume a characteristic hourglass shape, while the WEB SLS is more likely to take on a cylindrical configuration. As a result, the base of the WEB SL device frequently adopts a concave, cup-shaped appearance (open arrow), whereas the WEB SLS device tends to create a flat base (solid arrow). This inversion of configurations can potentially affect the neck coverage during the treatment of the aneurysm.

Tables

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  • Comparison of patient demographics and details of operative procedures between group A, which adhered to the proposed sizing method, and group B, which did not

    Group AGroup BP Value
    Patient demographics
     No. (total =25)205
     Age (mean) (yr)63.8 (SD, 11.2)58.6 (SD, 14.5)
     Sex (female/male)13:7 (65.0%)4:1 (80.0%).642
    Rupture status.289
     Acute SAH14 (70%)5 (100%)
     Elective6 (30%)
    Location of aneurysm
     MCA7 (35%)3 (60%)
     AcomA11 (55%)
     Ophthalmic ICA1 (5%)1 (20%)
     Pericallosal1 (20%)
     Anterior choroidal1 (5%)
    Morphology of aneurysm
     Cylindrical6 (30%)
     Teardrop1 (5%)1 (20%)
     Spindle2 (10%)
     Irregular11 (55%)4 (80%)
    Aneurysm dimensions (mean, range)
     Width 4.95 mm (3.32–8.40 mm)5.40 mm (3.55–7.73 mm)
     Height7.11 mm (5.24–10.60 mm)8.44 mm (6.60–11.39 mm)
     Neck3.70 mm (2.36–6.00 mm)3.81 mm (2.36–4.70 mm)
    Degree of lateral compression2.05 mm (1.4–4.0 mm)2.00 mm (0.03–3.27 mm)
    2-Year imaging follow-up10 (50%)5 (100%).061
    Occlusion rate.001 (<.05)
     WOS grade A14 (70%)1 (20%)a
     WOS grade B6 (30%)
     WOS grade C4 (80%)
    Operative procedure
     WEB sizes (width).822
      3–7 mm14 (70%)3 (60%)
      8–9 mm4 (20%)1 (20%)
      10–11 mm2 (10%)1 (20%)
    WEB models.012 (<.05)
     SL/SLS18 (90%)2 (40%)
     SL/SLS 172 (10%)3 (60%)
    • Note:—AcomA indicates anterior communicating artery.

    • ↵a Successful replacement of an oversized WEB device conducted during the same procedure resulted in complete angiographic occlusion on subsequent follow-up.

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Lateral Compression Manipulation: A Simple Approach for Sizing Taller-Than-Wide Intracranial Aneurysms with the Woven EndoBridge Device
Han Seng Chew, Ming Yao Chong, Waleed Butt, Samer Al-Ali, Benjamin Butler, Mohammad Al-Tibi, Swarupsinh Chavda, Saleh Lamin
American Journal of Neuroradiology May 2024, DOI: 10.3174/ajnr.A8172
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Cite this article
Han Seng Chew, Ming Yao Chong, Waleed Butt, Samer Al-Ali, Benjamin Butler, Mohammad Al-Tibi, Swarupsinh Chavda, Saleh Lamin
Lateral Compression Manipulation: A Simple Approach for Sizing Taller-Than-Wide Intracranial Aneurysms with the Woven EndoBridge Device
American Journal of Neuroradiology May 2024, DOI: 10.3174/ajnr.A8172

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