title: Angiographic C-arm CT visualization of the Woven EndoBridge cerebral aneurysm embolization device (WEB): first experience in an animal aneurysm model.
abstract: BACKGROUND
  Improvements in the imaging capabilities of angiographic C-arm computed tomography (CT) using flat detector angiographic (FD-CT) systems now provide a means for the in vivo visualization of devices used for the treatment of intracranial aneurysms. One such device, the WEB embolization device, is made of a braided mesh of nitinol wires, the size of which are near to the limits of visualization using conventional x-ray fluoroscopy. Our hypothesis was that the imaging of these implants C-arm CT would provide useful information regarding their positioning and deployment.
  
  
  METHODS
  In five New Zealand white rabbits elastase induced aneurysms were created and subsequently treated using a WEB. Imaging was performed using digital subtraction angiography (DSA), X-ray imaging and two different Angiographic C-arm CT protocols. The images were evaluated by two neuroradiologists using an evaluation scale.
  
  
  RESULTS
  The mesh of the WEB was barely visible on the DSA or x-ray fluoroscopy images. Volume rendering technique (VRT) reconstruction and multiplanar reconstruction (MPR) of images done using the C-arm CT protocols clearly delineated the shape and structure of the device. Contrast-enhanced MPR and VRT reconstructions allowed assessment of the status of blood flow in the aneurysms. Beam hardening artifacts caused by platinum markers on the WEB were present.
  
  
  CONCLUSIONS
  In vivo C-arm CT imaging of the WEB is feasible and allows precise determination of the position and deployment status of the device. On contrast-enhanced images the occlusion status of aneurysms and the positioning of the WEB in relationship to the parent artery can be evaluated. C-arm-CT may serve as a minimal-invasive follow-up imaging modality.
authors.affiliation: Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany, tobias.struffert@uk-erlangen.de.
authors.forename: T
authors.initials: T
authors.lastname: Struffert
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.forename: E
authors.initials: E
authors.lastname: Adamek
authors.forename: T
authors.initials: T
authors.lastname: Engelhorn
authors.forename: C M
authors.initials: CM
authors.lastname: Strother
authors.forename: A
authors.initials: A
authors.lastname: Doerfler
mesh_terms: D000818:Animals; D002533:Cerebral Angiography / Q000379:methods*; D019544:Equipment Failure Analysis; D002532:Intracranial Aneurysm / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000628:therapy*; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods; D010196:Pancreatic Elastase; D011474:Prosthesis Design; D011817:Rabbits; D015641:Radiography, Interventional / Q000379:methods*; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D010196:Pancreatic Elastase