Predictors of aneurysm occlusion following treatment with the WEB device: systematic review and case series

The dual-layer Woven EndoBridge (WEB) device (WEB II) is designed to improve the performance of the first-generation WEB device. This study was performed to evaluate the acute and chronic performance of WEB II for aneurysm occlusion in an elastase-induced aneurysm model in rabbits. We implanted WEB II devices in 36 elastase-induced aneurysms and followed up for one, three, six, and 12 months. Degree of aneurysm occlusion at follow-up was graded on the Web Occlusion Scale (WOS): Grade A, complete aneurysm occlusion; Grade B, complete occlusion with recess filling; Grade C, residual neck filling; and Grade D, residual aneurysm filling. Hematoxylin and eosin staining was performed for histological assessment of aneurysm healing. Grades A, B, C, and D aneurysm occlusion at one-month follow-up were noted in three (17%), three (17%), eight (44%), and four (22%) of 18 cases, respectively. At the three-month time point Grades A, B, C, and D were shown in two (33%), two (33%), one (17%), and one (17%) aneurysms. Six months after treatment, one (17%), two (33%), two (33%), and one (17%) cases demonstrated Grades A, B, C, and D occlusion. At the 12-month time point, Grades B, C, and D were shown in three (50%), two (33%), and one (17%) aneurysms. Histologic evaluation showed progressive thrombus organization within aneurysm lumen from one to 12 months. These results indicated that the WEB II device can achieve high rates of aneurysm occlusion over time in experimental aneurysms.

Download Full-text

Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

Interventional Neuroradiology ◽

10.1177/1591019915590083 ◽

2015 ◽

Vol 21 (4) ◽

pp. 462-469 ◽

Cited By ~ 20

Author(s):

Patricia Bozzetto Ambrosi ◽

Benjamin Gory ◽

Rotem Sivan-Hoffmann ◽

Roberto Riva ◽

Francesco Signorelli ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Single Layer ◽

Additional Treatment ◽

Anterior Communicating Artery ◽

Neck Size ◽

Aneurysm Occlusion ◽

Web Device ◽

The Web

Background The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Methods Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Results Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4–10.7 mm), and average neck size was 4.9 mm (range 2.6–6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. Conclusions From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

Download Full-text

Factors that determine aneurysm occlusion after embolization with the Woven EndoBridge (WEB)

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014361 ◽

2018 ◽

Vol 11 (5) ◽

pp. 503-510 ◽

Cited By ~ 9

Author(s):

Christoph Kabbasch ◽

Lukas Goertz ◽

Eberhard Siebert ◽

Moriz Herzberg ◽

Jan Borggrefe ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Tertiary Care ◽

High Rate ◽

Simultaneous Treatment ◽

Aneurysm Size ◽

Aneurysm Occlusion ◽

Aneurysm Thrombosis ◽

Woven Endobridge ◽

Web Device ◽

The Web

BackgroundThe Woven EndoBridge (WEB) device is a novel endovascular tool for the treatment of wide-necked intracranial aneurysms.ObjectiveTo evaluate factors influencing aneurysm occlusion and aneurysm recurrence after WEB embolization.MethodsA total of 113 patients (mean age 58.9±11.9 years) with 114 aneurysms (mean size 8.6±4.6 mm) were successfully treated with the WEB device at three German tertiary care centers between May 2011 and February 2018. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification. We retrospectively collected patient characteristics, anatomical details, and procedural aspects and evaluated their impact on aneurysm occlusion and recurrence.ResultsOf 98 patients available for a 6-month angiographic follow-up, complete occlusion was achieved in 62.2%, neck remnants in 21.4%, and aneurysm remnants in 16.3%. Aneurysm recurrence occurred in 15.3%. Initial partial aneurysm thrombosis, recurrent aneurysms, aneurysm size, and simultaneous treatment by WEB and coil were associated with aneurysm remnants (p<0.05). Initial partial aneurysm thrombosis, increasing aneurysm size, and treatment by WEB and coil also predicted aneurysm recurrence (p<0.05).In the subgroup analysis of 71 aneurysms treated with WEB only, initial incomplete occlusion and male sex were associated with aneurysm remnants (p<0.05), while aneurysm height correlated with aneurysm recurrence (p=0.008).ConclusionsThe WEB provides a high rate of adequate occlusion even in a subset of complex wide-necked intracranial aneurysms. Anatomic results tend to be less favourable in large and partially thrombosed aneurysms and after treatment with WEB and coil.

Download Full-text

Endovascular Treatment of Posterior Cerebral Artery Aneurysms With Flow Diversion: Case Series and Systematic Review

Neurosurgery ◽

10.1093/neuros/nyx561 ◽

2018 ◽

Vol 83 (4) ◽

pp. 790-799 ◽

Cited By ~ 16

Author(s):

Adam N Wallace ◽

Jonathan A Grossberg ◽

Josser E Delgado Almandoz ◽

Mudassar Kamran ◽

Anil K Roy ◽

...

Keyword(s):

Systematic Review ◽

Cerebral Artery ◽

Complication Rate ◽

Posterior Cerebral Artery ◽

Case Series ◽

Flow Diverter ◽

Flow Diversion ◽

Parent Vessel ◽

Vessel Preservation ◽

Aneurysm Occlusion

Abstract BACKGROUND Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. OBJECTIVE To examine the safety and effectiveness of PCA aneurysm flow diverter treatment. METHODS Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. Systematic review of the literature identified published reports of PCA aneurysms treated with flow diversion. Rates of aneurysm occlusion and complications were calculated, and outcomes of saccular and fusiform aneurysm treatments were compared. RESULTS Ten PCA aneurysms in 9 patients were treated with the PED. There were 2 intraprocedural thromboembolic events (20%), including 1 symptomatic infarction and 1 delayed PED thrombosis. Eight of 10 patients returned to or improved from their baseline functional status. Complete aneurysm occlusion with parent vessel preservation was achieved in 75% (6/8) of cases at mean follow-up of 16.7 mo. Eleven of 12 (92%) major branch vessels covered by a PED remained patent. Including the present study, systematic review of 15 studies found a complete aneurysm occlusion rate of 88% (30/34) and complication rate of 26% (10/38), including 5 symptomatic ischemic strokes (13%; 5/38). Fusiform aneurysms more frequently completely occluded compared with saccular aneurysms (100% vs 70%; P = .03) but were associated with a higher complication rate (43% vs 9%; P = .06). CONCLUSION The safety and effectiveness profile of flow diverter treatment of PCA aneurysms may be acceptable in select cases.

Download Full-text

The safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal WEB Intrasaccular Therapy (WEB-IT) Study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014815 ◽

2019 ◽

Vol 11 (9) ◽

pp. 924-930 ◽

Cited By ~ 44

Author(s):

Adam S Arthur ◽

Andy Molyneux ◽

Alexander L Coon ◽

Isil Saatci ◽

Istvan Szikora ◽

...

Keyword(s):

Data Monitoring Committee ◽

Clinical Events ◽

Safety Event ◽

Registration Number ◽

Aneurysm Occlusion ◽

Woven Endobridge ◽

Web Device ◽

Wide Neck ◽

The Web

IntroductionThe Woven EndoBridge Intrasaccular Therapy (WEB-IT) Study is a pivotal, prospective, single-arm, investigational device exemption study designed to evaluate the safety and effectiveness of the WEB device for the treatment of wide-neck bifurcation aneurysms.MethodsOne-hundred and fifty patients with wide-neck bifurcation aneurysms were enrolled at 21 US and six international centers. Angiograms from the index procedure, and 6-month and 1-year follow-up visits were all reviewed by a core laboratory. All adverse events were reviewed and adjudicated by a clinical events adjudicator. A data monitoring committee provided oversight during the trial to ensure subject safety.ResultsOne-hundred and forty-eight patients received the WEB implant. One (0.7%) primary safety event occurred during the study—a delayed ipsilateral parenchymal hemorrhage—on postoperative day 22. No primary safety events occurred after 30 days through 1 year. At the 12-month angiographic follow-up, 77/143 patients (53.8%) had complete aneurysm occlusion. Adequate occlusion was achieved in 121/143 (84.6%) subjects.ConclusionsThe prespecified safety and effectiveness endpoints for the aneurysms studied in the WEB-IT trial were met. The results of this trial suggest that the WEB device provides an option for patients with wide-neck bifurcation aneurysms that is as effective as currently available therapies and markedly safer.Trial registration numberNCT02191618

Download Full-text

CT angiography for one-year follow-up of intracranial aneurysms treated with the WEB device: Utility in evaluating aneurysm occlusion and WEB compression at one year

Journal of Neuroradiology ◽

10.1016/j.neurad.2018.02.010 ◽

2018 ◽

Vol 45 (6) ◽

pp. 343-348 ◽

Cited By ~ 5

Author(s):

Hélène Raoult ◽

François Eugène ◽

Anthony Le Bras ◽

Géraldine Mineur ◽

Béatrice Carsin-Nicol ◽

...

Keyword(s):

Ct Angiography ◽

Intracranial Aneurysms ◽

Aneurysm Occlusion ◽

One Year ◽

Web Device ◽

The Web

Download Full-text

Endovascular treatment of cerebral aneurysms using the Woven EndoBridge technique in a single center: preliminary results

Journal of Neurosurgery ◽

10.3171/2015.4.jns142456 ◽

2017 ◽

Vol 126 (1) ◽

pp. 17-28 ◽

Cited By ~ 13

Author(s):

Aimee Lawson ◽

Tony Goddard ◽

Stuart Ross ◽

Atul Tyagi ◽

Kenan Deniz ◽

...

Keyword(s):

Thromboembolic Event ◽

Cerebral Aneurysms ◽

Single Layer ◽

New Device ◽

Radiological Evidence ◽

Aneurysm Occlusion ◽

Woven Endobridge ◽

Web Device ◽

The Web

OBJECTIVE The Woven EndoBridge (WEB) is an innovative new technique for securing cerebral aneurysms. It is designed particularly for wide-necked bifurcation aneurysms that otherwise would be difficult to treat. There is a paucity of follow-up data in the literature due to the novelty of this technique. The authors reviewed their data from cases involving patients treated at Leeds General Infirmary with the WEB device. They assessed the safety and complication risk associated with the device and clinical and radiological follow-up outcomes in their patients. This is, to their knowledge, the first publication to include the new single-layer sphere device (WEB SLS) in addition to the original dual-layer (WEB DL) and the (nonsphere) single-layer (WEB SL) devices. METHODS Data from 22 patients who underwent 25 WEB treatments were analyzed. Of the 25 WEB procedures, 3 were performed on an acute basis, 1 was performed on a semiacute basis, and the remaining 21 were elective. A novel 6-point scoring system called the Leeds WEB aneurysm occlusion scale was created to ensure accurate assessment based on the morphology of the WEB device. Outcome was assessed at follow-up by MR angiography with or without digital subtraction angiography and the modified Rankin Scale (mRS). RESULTS Deployment of the WEB device was successful in 22 (88%) of 25 procedures; 3 (12%) of the attempts at WEB treatment were abandoned. One of the patients in whom treatment was abandoned underwent a successful second attempt. Immediately after the 22 procedures with successful deployment, 4 (18%) of the patients had a complete occlusion of the aneurysm and WEB device; 10 (45%) had varying degrees of occlusion within the WEB device but no aneurysm neck or remnant; 3 (14%) had a neck remnant; and 5 (23%) had an aneurysm remnant. Of the patients with an aneurysm remnant, 1 had a complete aneurysm occlusion at ≥ 3-months follow-up. In total, 6 (27%) patients had a residual aneurysm at ≥ 3-months radiological follow-up. One of these patients was admitted with hydrocephalus secondary to a recurrent aneurysm and later received a second WEB treatment with additional coiling. Only 1 patient developed new neurological symptoms. This patient went from an mRS score of 0 to a score of 1 and had radiological evidence of a thromboembolic event. Two patients showed radiological evidence of a new thromboembolic event on follow-up MRI but were clinically asymptomatic. CONCLUSIONS The WEB has shown itself to be a promising new device with the potential to increase the scope of treatment for difficult wide-necked bifurcation aneurysms. The technique is safe, and short-term results show effective occlusion of complex aneurysms with minimal complications associated with the procedure. Long-term efficacy, however, still needs to be assessed.

Download Full-text

Transradial access for embolization of cerebral aneurysms with the woven EndoBridge device: Case series and review of the literature

Interventional Neuroradiology ◽

10.1177/1591019920972216 ◽

2020 ◽

pp. 159101992097221

Author(s):

Colin Son ◽

Samon Tavakoli-Sabour

Keyword(s):

Case Series ◽

Cerebral Aneurysms ◽

Limited Data ◽

Patient Demographics ◽

Clinical Complications ◽

Transradial Access ◽

Aneurysm Embolization ◽

Woven Endobridge ◽

Web Device ◽

The Web

Background Transradial access is an increasingly utilized route for neurointerventions with benefits of lower rates of access site complications, earlier patient mobilization and increased patient satisfaction over transfemoral interventions. There is limited data on deployment of the Woven EndoBridge (WEB) via transradial access. We report a case series of consecutive patients undergoing cerebral aneurysm embolization with the WEB device via transradial biaxial access. Methods A database of neuroendovascular procedures was queried for consecutive aneurysm embolization procedures involving the WEB device and intended via the transradial approach between August 2019 and July 2020. Patient demographics, radiological aneurysm characteristics and procedure details were recorded and statistically evaluated. Google Scholar and Pubmed were searched for previous reports of transradial WEB embolization. Results Ten aneurysms were treated in ten patients. All aneurysms were treated with successful WEB deployment. Nine of the ten aneurysms were successfully treated via transradial biaxial access. One aneurysm required conversion to transfemoral access. There were no clinical complications and no morbidity or mortality. Conclusions Transradial embolization of cerebral aneurysms with the WEB device is safe and feasible with low rates of access failure or complications.

Download Full-text

Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device

Neurosurgery ◽

10.1227/neu.0000000000001106 ◽

2015 ◽

Vol 78 (1) ◽

pp. 133-141 ◽

Cited By ~ 78

Author(s):

◽

Laurent Pierot ◽

Laurent Spelle ◽

Andrew Molyneux ◽

James Byrne

Keyword(s):

Antiplatelet Agent ◽

Good Clinical Practice ◽

Anterior Communicating Artery ◽

Neck Size ◽

Significant Difference ◽

Grade Scale ◽

Aneurysm Occlusion ◽

Web Device ◽

Favorable Safety ◽

The Web

Abstract BACKGROUND: Flow disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Initial series have shown a low complication rate with good efficacy. OBJECTIVE: To report clinical and anatomical results of the WEB treatment in the cumulated population of WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm) and French Observatory series. METHODS: WEBCAST and French Observatory are single-arm, prospective, multicenter, Good Clinical Practice studies dedicated to the evaluation of WEB treatment. Ruptured and unruptured bifurcation aneurysms located in the basilar artery, middle cerebral artery, anterior communicating artery, and internal carotid artery terminus were included in both studies. Clinical data were independently evaluated. Postoperative, 6-month (in WEBCAST), and 1-year aneurysm occlusion was independently evaluated with a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS: The cumulated population was 113 patients (74 female, 65.5%) 33 to 74 years of age with 114 aneurysms with a mean neck size of 5.6 mm. There was no mortality at 1 month, and morbidity was 2.7%. A statistically significant difference in the rate of occurrence of thromboembolic events was observed between the use of any antiplatelet agent and the use of no antiplatelet agent (P < .001). At 1 year, complete aneurysm occlusion was observed in 56.0%, neck remnant in 26.0%, and aneurysm remnant in 18.0%. Worsening of aneurysm occlusion between the procedure and 12 months was observed in 2.0% and between 6 months and 1 year in 7.1%. CONCLUSION: The analysis in this large cumulated population of studies confirms favorable safety and efficacy of WEB treatment.

Download Full-text