High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography
Department of Radiology; New England Center for Stroke Research
Bioimaging and Biomedical Optics | Biomedical Devices and Instrumentation | Cardiovascular Diseases | Radiology
BACKGROUND: High-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 microm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates.
METHODS: In a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition > 50%) were binary coded. A device was considered 'adequately deployed' by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM).
RESULTS: Adequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R(2)=0.96; P < 0.001). More neointimal coverage of 78%+/-32% was found on 'adequate deployment' cases versus 31%+/-24% for the 'inadequate deployment' cases (P=0.001).
CONCLUSION: HF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.
aneurysm, device, intervention, laser
DOI of Published Version
Vardar Z, King RM, Kraitem A, Langan ET, Peterson LM, Duncan BH, Raskett CM, Anagnostakou V, Gounis MJ, Puri AS, Ughi GJ. High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography. J Neurointerv Surg. 2020 Sep 28:neurintsurg-2020-016447. doi: 10.1136/neurintsurg-2020-016447. Epub ahead of print. PMID: 32989033. Link to article on publisher's site
Journal of neurointerventional surgery
Vardar Z, King RM, Kraitem A, Langan ET, Peterson LM, Duncan BH, Raskett CM, Anagnostakou V, Gounis MJ, Puri AS, Ughi GJ. (2020). High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography. Radiology Publications. https://doi.org/10.1136/neurintsurg-2020-016447. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/564