Occlusion assessment of intracranial aneurysms treated with the WEB device.
BACKGROUND
The Woven EndoBridge (WEB) system is an innovative device under evaluation for its capacity to treat wide-neck bifurcation intracranial aneurysms. The purpose of this study is to evaluate the use of the different occlusion scales available in clinical practice.


METHODS
Seven WEB-experienced neurointerventionalists were provided with 30 angiographic follow-up data sets and asked to grade each evaluation point according to the Bicêtre Occlusion Scale Score (BOSS), firstly based on DSA images only then using additional C-Arm VasoCT analysis. This BOSS evaluation was then converted into the WEB Occlusion Scale (WOS) and into a dichotomized scale (complete occlusion or not). To estimate the inter-rater agreement among the seven raters, an overall kappa coefficient [1] and its standard error (SE) were computed.


RESULTS
Using the five-grade BOSS, raters showed "moderate" agreement (kappa = 0.56). Using the three-grade WOS, agreement appeared slightly better (kappa = 0.59). Strongest inter-rater agreement was observed with a dichotomized version of the scale (complete occlusion or not), which enabled an "almost perfect" agreement (kappa = 0.88). VasoCT consistently enhanced the agreement particularly with regards depicting intra-WEB residual filling.


CONCLUSIONS
The WOS is a consistent means to angiographically evaluate the WEB device efficiency. But the five-grade BOSS scale allows to identify aneurysm subgroups with differing risks of recurrence and/or rehemorrhage, which needs to be separated especially at the initial phase of evaluation of this innovative device. The additional use of VasoCT allows better inter-rater agreement in evaluating occlusion and specially in depicting intra-WEB persistent filling.
Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. Jildaz.caroff@aphp.fr.
Jildaz
http://orcid.org/0000-0002-0029-1835
J
Caroff
Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.|Department of Neurosurgery, Piata Eftimie, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
Cristian
C
Mihalea
Interventional Neuroradiology, Hôpital Henri Mondor, Créteil, France.
Titien
T
Tuilier
Interventional Neuroradiology, CHU Hôpital Pellegrin, Bordeaux, France.
Xavier
X
Barreau
Interventional Neuroradiology, CHU Hôpital Purpan, Toulouse, France.
Christophe
C
Cognard
Interventional Neuroradiology, CHU Hôpital Nord Laennec, Nantes, France.
Hubert
H
Desal
Interventional Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France.
Laurent
L
Pierot
Statistics Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Armelle
A
Arnoux
Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.|Université Paris-Sud XI, Faculté de Médecine, Le Kremlin-Bicêtre, France.
Jacques
J
Moret
Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.|Université Paris-Sud XI, Faculté de Médecine, Le Kremlin-Bicêtre, France.
Laurent
L
Spelle
D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation*; D019544:Equipment Failure Analysis; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
Endovascular treatment; Flow disruption; Intracranial aneurysms; WEB; Woven EndoBridge device