Impact of A1 Asymmetry on the Woven EndoBridge Device in Anterior Communicating Artery Aneurysms

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FIG 1.
Grading scale for A1 segments. A, Grade H1: A1 segments are symmetric. B, Grade H2: The A1 segment is smaller on 1 side, but opacification of the A2 segment on that side is observed following ipsilateral injection (ie, asymmetric A1s but both functional). C, Grade H3: The A1 segment is very hypoplastic on 1 side, the A2 segment is not opacified from the ipsilateral injection, and A2 segments are only opacified with injection from the dominant side (ie, asymmetric A1s and a nonfunctional hypoplastic side). D, Grade Y: The A1 segment is absent on 1 side (aplastic). Blue filling represents opacification after injection from the side with the blue arrow. Grade Y corresponds to unilateral A1, and grade H3 + Y, to unilateral functional A1.
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FIG 2.
Patient flow chart.
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FIG 3.
Illustrative case of a ACoA aneurysm treated with a WEB device (A and B). The contralateral A1 segment is absent, rendering a Y-shape to the ACoA anatomy. Last control angiogram at 1-year follow-up demonstrates complete occlusion (C and D).

Table 1:

Baseline characteristics and angiographic outcomes^{^a}

Baseline Aneurysm Characteristics	All (n = 48)
Age (mean) (yr)	58.4 (SD, 11.2)
Women	26 (54.2)
Cardiovascular risk factor	25 (52.1)
Current smoker	7 (14.6)
Acutely ruptured	16 (33.3)
Irregular aneurysm	19 (39.6)
Maximum diameter (mean) (mm)	6.5 (SD, 2.2)
Aneurysm height (mean) (mm)	5.0 (SD, 1.8)
Aneurysm neck (mean) (mm)	3.8 (SD, 1.1)
Aneurysm width (mean) (mm)	5.1 (SD, 1.7)
Aspect ratio (height/neck) (mean)	1.27 (SD, 0.39)
Width/neck ratio (mean)	1.28 (SD, 0.27)
Unilateral A1 (grade Y)	13 (27.1)
Unilateral functional A1 (grade H3+Y)	19 (39.6)
Baseline treatment characteristics
Type of WEB WEB-DL WEB-SL WEB-SLS	2 (4.2) 37 (77.1) 9 (18.8)
WEB device generation Fifth generation Previous generations	30 (62.5) 18 (37.5)
Additional stent	2 (4.7)
Angiographic outcomes
Adequate occlusion	33 (68.8)
Complete occlusion	30 (62.5)
Aneurysm remnant	15 (31.2)
WShM (median) (IQR) (%)	31 (11–51)

Table 2:

Univariate analysis and multivariable logistic regression for angiographic adequate occlusion of ACoA aneurysms treated with WEB^{^a}

Variables	Univariate Analysis			Multivariable Analysis
Variables	Adequate Occlusion (n = 33)	Aneurysm Remnant (n = 15)	P Value	ORa (95% CI)	P Value
Age (mean) (yr)	59.1 (SD, 12)	56.9 (SD, 8)	.45
Women	19 (58)	8 (53)	.78
Cardiovascular risk factors	17 (52)	8 (53)	.91
Current smoker	5 (15)	2 (13)	.87
Ruptured aneurysm	11 (33)	5 (33)	.99
Irregular aneurysm	11 (33)	8 (53)	.19	0.54 (0.13–2.17)	.38
Aspect ratio (mean)	1.32 (SD, 0.37)	1.15 (SD, 0.40)	.19	5.98 (0.84–64.79)	.10
Width/neck ratio (mean)	1.27 (SD, 0.27)	1.29 (SD, 0.28)	.84
Neck (mean) (mm)	3.77 (SD, 1.13)	3.79 (SD, 1.20)	.97
Unilateral A1	12 (36)	1 (7)	.03	10.6 (1.6–220.7)	.04
WEB-SL	27 (82)	10 (67)	.39
Fifth-generation WEB device	20 (61)	10 (67)	.69
WShM (median) (IQR) (%)	30 (11–48)	35 (19–52)	.40