scholarly journals Image- based computational hemodynamic analysis of an anterior communicating aneurysm treated with the woven endobridge device

2021 ◽  
pp. 101251
Author(s):  
Yasaman Aghli ◽  
Mojtaba Dayyani ◽  
Behzad Golparvar ◽  
Humain Baharvahdat ◽  
Raphael Blanc ◽  
...  
Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S3-S3
Author(s):  
Laurent Pierot ◽  
Jacques Moret ◽  
Xavier Barreau ◽  
Istvan Szikora ◽  
Denis Herbreteau ◽  
...  

2021 ◽  
Author(s):  
Daniel M Heiferman ◽  
Jeremy C Peterson ◽  
Kendrick D Johnson ◽  
Vincent N Nguyen ◽  
David Dornbos ◽  
...  

Abstract The Woven EndoBridge (WEB) device (MicroVention, Aliso Viejo, California) is an intrasaccular flow disruptor used for the treatment of both unruptured and ruptured intracranial aneurysms. WEB has been shown to have 54% complete and 85% adequate aneurysm occlusion rates at 1-yr follow-up.1 Residual and recurrent ruptured aneurysms have been shown to have a higher risk of re-rupture than completely occluded aneurysms.2 With increased utilization of WEB in the United States, optimizing treatment strategies of residual aneurysms previously treated with the WEB device is essential, including surgical clipping.3,4 Here, we present an operative video demonstrating the surgical clip occlusion of previously ruptured middle cerebral artery and anterior communicating artery aneurysms that had been treated with the WEB device and had sizable recurrence on follow-up angiography. Informed consent was obtained from both patients. Lessons learned include the following: (1) the WEB device is highly compressible, unlike coils; (2) proximal WEB marker may interfere with clip closure; (3) no evidence of WEB extrusion into the subarachnoid space; (4) no more scarring than expected in ruptured cases; and (5) clipping is a feasible option for treating WEB recurrent or residual aneurysms.


2021 ◽  
pp. neurintsurg-2021-017405
Author(s):  
Guilherme Aguiar ◽  
Jildaz Caroff ◽  
Cristian Mihalea ◽  
Jonathan Cortese ◽  
Jean-Baptiste Girot ◽  
...  

BackgroundWoven EndoBridge (WEB) device treatment of wide-neck bifurcation aneurysms has proved to be safe and effective, but the use of these devices in sidewall aneurysms has been reported only in a small number of case series.ObjectiveTo report our results in a cohort of consecutive patients in whom a WEB device was used as first-line treatment for posterior communicating artery (PComA) aneurysms.MethodsWe conducted a retrospective analysis of a prospectively maintained database of PComA aneurysms treated with a WEB device in our institution from June 1, 2012 to November 15, 2020. Clinical and radiological findings were evaluated at immediate and last follow-up.ResultsA total of 219 aneurysms were treated with a WEB device, including 15 PComA aneurysms in 15 patients, 10 of which were ruptured. Aneurysms were wide necked, with a mean aspect ratio of 1.6 (range 0.7–3.0) and a mean neck size of 4.2 mm (range 2.6–7.4 mm). No intraoperative rupture occurred and only one thromboembolic event was noted. Among the group with at least a 3-month digital subtraction angiography (DSA) follow-up, complete and adequate occlusion were obtained in 54% and 72%, respectively (average follow-up 13 months). Re-treatment was needed for two initially ruptured aneurysms. No procedure-related morbidity or mortality was reported.ConclusionThis series suggests the high safety profile of WEB devices even when used in off-label indications. Treatment with these devices seems to be a valuable strategy for ruptured wide-neck PComA aneurysms, avoiding the need for antiplatelet medication. However, occlusion rates should be investigated in further larger studies.


2020 ◽  
Vol 31 (05) ◽  
pp. 2050073
Author(s):  
Alireza Sharifi ◽  
Amin Deyranlou ◽  
Mohammad Charjouei Moghadam ◽  
Hamid Niazmand

Over the past few decades, different therapeutic methods for the treatment of intracranial aneurysms have been developed. During recent years, novel standalone intrasaccular Woven EndoBridge (WEB) technique has paved the way for efficient therapy and reduced some deficiencies in prior procedures. Blood hemodynamics plays a crucial role in occurrence and perpetuating of aneurysm; therefore, understanding of relevant parameters can lead to a better treatment and evolution of design. Objectively, this paper has established the first mathematical framework to explore hemodynamic parameters for WEB-treated saccular aneurysms by employing Computational Fluid Dynamics (CFD). Two ideal models of artery — one is suffered by a bifurcation aneurysm at Basilar Artery (BA) and another Posterior Cerebral Artery (PCA) aneurysm — are selected. Simulations are performed for an untreated and three WEB-treated aneurysms by Dual Layer (DL), Single Layer (SL) and Single Layer Sphere (SLS) WEBs. Results demonstrate that, generally, the WEB reduces flow intrusion and circulation inside the aneurysm sac, which leads to lowering WSS; however, the infiltrated flow to the WEB causes slight increase in intrasaccular pressure. Moreover, the numerical results show that the WEB DL reduces velocity and WSS, and elevates pressure inside the sac more than the WEBs SL and SLS. Among the explored WEB models (DL, SL and SLS), by assuming thorough binding at the aneurysm neck, the WEB DL demonstrates much efficient performance in flow diversion from the aneurysm, while despite the different structure of WEBs SL and SLS, they perform similarly.


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