Intravenous Cone-Beam CT for Follow-up of Intracranial Aneurysms Treated with the Woven EndoBridge Device

TL;DR

This study shows that intravenous cone-beam CT is a reliable non-invasive alternative to digital subtraction angiography for monitoring brain aneurysms treated with the WEB device.

Contribution

The study demonstrates that IVCBCT has excellent diagnostic agreement with DSA for WEB-treated aneurysms.

Findings

IVCBCT showed complete agreement with DSA in all 16 cases (κ = 1.0).

Interobserver agreement for IVCBCT was excellent (κ = 0.86).

IVCBCT provided consistent diagnostic performance across different occlusion grades.

Abstract

The Woven EndoBridge (WEB) device is an established endovascular treatment method for wide-neck intracranial aneurysms. Digital subtraction angiography (DSA) is the reference standard for posttreatment evaluation; however, its invasive nature limits its repeated use. This study aimed to compare the diagnostic accuracy and reproducibility of intravenous cone-beam computed tomography (IVCBCT) and DSA in the follow-up of aneurysms treated with the WEB device.

This prospective single-center study included 16 patients with unruptured intracranial aneurysms who were treated with the WEB device. All patients underwent both DSA and IVCBCT at the 6‑month follow-up, performed on the same day. Aneurysm occlusion status was independently evaluated by two experienced neuroradiologists using the 8‑point modified Bicêtre Occlusion Scale Score (BOSS). Intermodality and interobserver agreement were assessed using Cohen’s kappa statistics.

Complete agreement between IVCBCT and DSA was observed in all 16 cases (κ = 1.0 for both raters). Interobserver agreement for IVCBCT grading was also excellent (κ = 0.86). The BOSS distribution for IVCBCT was as follows: grade 0 or 0’ in eight cases (50.0%), grade 1 in five cases (31.3%), grade 2 in two cases (12.5%), and grade 3 in one case (6.2%). IVCBCT demonstrated consistent diagnostic performance across various occlusion grades.

IVCBCT offers a reliable, noninvasive alternative to DSA for the follow-up of WEB-treated aneurysms, providing excellent diagnostic concordance and reproducibility.

Figures