High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography

J Neurointerv Surg. 2021 Jul;13(7):669-673. doi: 10.1136/neurintsurg-2020-016447. Epub 2020 Sep 28.


Background: High-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 µm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates.

Methods: In a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition >50%) were binary coded. A device was considered 'adequately deployed' by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM).

Results: Adequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R²=0.96; P<0.001). More neointimal coverage of 78%±32% was found on 'adequate deployment' cases versus 31%±24% for the 'inadequate deployment' cases (P=0.001).

Conclusion: HF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.

Keywords: aneurysm; device; intervention; laser.

MeSH terms

  • Angiography, Digital Subtraction / methods*
  • Animals
  • Embolization, Therapeutic / instrumentation
  • Embolization, Therapeutic / methods*
  • Intracranial Aneurysm / chemically induced
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / therapy*
  • Male
  • Pancreatic Elastase / toxicity
  • Rabbits
  • Self Expandable Metallic Stents*
  • Tomography, Optical Coherence / methods*
  • Treatment Outcome


  • Pancreatic Elastase