Modification of Woven Endo-Bridge After Intracranial Aneurysm Treatment: A Methodology for Three-Dimensional Analysis of Shape and Relative Position Changes.

Abstract

During follow-up of patients treated with WEB devices, shape changes have been observed. The quantitative three-dimensional measurement of the WEB shape modification (WSM) would offer useful information to be studied in association with the anatomical results and try to better understand mechanisms implicated in this modification phenomenon. We present a methodology to quantify the morphology and position of the WEB device in relation to the vascular anatomy. Three-dimensional rotational angiography (3DRA) images of seven aneurysms patients treated with WEBs were used, which also accompanied by a post-treatment 3DRA image and a follow-up 3DRA image. The device was manually segmented, obtaining the 3D models after treatment and at the follow-up. Volume, surface area, height, maximum diameter and WSM ratio of both surfaces were calculated. Position changes were evaluated measuring WEB axis and relative position between post-treatment and follow-up. Changes in WEB volume and surface area were observed with a mean modification of <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>-</mo> <mn>5.04</mn> <mo>%</mo> <mo>(</mo> <mo>±</mo> <mn>14.19</mn> <mo>)</mo></mrow> </math> and <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>-</mo> <mn>1.68</mn> <mo>%</mo> <mo>(</mo> <mo>±</mo> <mn>8.29</mn> <mo>)</mo></mrow> </math> , respectively. The positional variables also showed differences, mean change of device axis direction was <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mn>26.25</mn> <mo>%</mo> <mo>(</mo> <mo>±</mo> <mn>24.09</mn> <mo>)</mo></mrow> </math> and mean change of distance <math xmlns="http://www.w3.org/1998/Math/MathML"><msub><mi>l</mi> <mi>b</mi></msub> </math> was <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mn>5.87</mn> <mo>%</mo> <mo>(</mo> <mo>±</mo> <mn>10.59</mn> <mo>)</mo></mrow> </math> . Inter-observer and intra-observer variability analyses did not show differences (ANOVA <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mi>p</mi> <mo>></mo> <mn>0.05</mn></mrow> </math> ). This methodology allows quantifying the morphological and position changes suffered by the WEB device after treatment, offering new information to be studied in relation to the occurrence of WEB shape modification.