P-046 Factors associated with incomplete occlusion of intracranial aneurysms at follow up after treatment with woven endobridge (WEB) device

BackgroundWide-necked bifurcation aneurysms (WNBAs) present unique challenges for endovascular treatment. The Woven EndoBridge (WEB) device is an intrasaccular braided device, recently approved by the FDA for treatment of WNBAs. While treatment of intracranial aneurysms with the WEB device has been shown to yield an adequate occlusion rate of 85% at 1 year, few data have been published for patients with ruptured aneurysms.ObjectiveTo present a multi-institutional series depicting the safety and efficacy of using the WEB device as the primary treatment modality in ruptured intracranial aneurysms.MethodsA multi-institutional retrospective analysis was conducted, assessing patients presenting with aneurysmal subarachnoid hemorrhage treated with the WEB between January 2014 and April 2020. Baseline demographics, aneurysm characteristics, adverse events, and long-term outcomes (occlusion, re-treatment, functional status) were collected. A descriptive analysis was performed, and variables potentially associated with aneurysm recurrence or re-treatment were assessed.ResultsForty-eight patients were included. Anterior communicating artery aneurysms were the most common (35.4%) location for treatment, followed by middle cerebral artery (20.8%) and basilar apex (16.7%). Procedural success was noted in 95.8% of patients, and clinically significant periprocedural adverse events occurred in 12.5%. After a median follow-up of 5.5 months, 54.2% of patients had follow-up angiographic imaging. Complete occlusion was seen in 61.5% of cases with adequate occlusion in 92.3%. Re-treatment was required in only 4.2% of patients during the study period. Tobacco use was significantly higher in patients with aneurysm recurrence (88.9% vs 35.7%; p=0.012). No other characteristics were associated with recurrence/re-treatment. At 30 days, 81.1% were functionally independent (modified Rankin Scale score ≤2).ConclusionTreatment of acutely ruptured aneurysms with the WEB device demonstrates both safety and efficacy on par with rates of conventional treatment strategies.

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Endovascular treatment of intracranial aneurysms with the Woven EndoBridge device: mid term and long term results

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012964 ◽

2017 ◽

Vol 10 (2) ◽

pp. 127-132 ◽

Cited By ~ 13

Author(s):

Benjamin Mine ◽

Alexandra Goutte ◽

Denis Brisbois ◽

Boris Lubicz

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Long Term Results ◽

Results Of Treatment ◽

Long Term Follow Up ◽

Device Placement ◽

Woven Endobridge ◽

Web Device

PurposeTo evaluate the clinical and anatomical results of treatment of intracranial aneurysms (IA) with the Woven EndoBridge (WEB) device, with emphasis on mid term and long term follow-up.MethodsBetween November 2010 and November 2015, we retrospectively identified, in our prospectively maintained database, all patients treated by WEB device placement for an IA at three institutions. Clinical charts, procedural data, and angiographic results were reviewed.Results48 patients with 49 IAs were identified. There were 35 women and 13 men with a mean age of 57 years (range 35–76 years). All IA were wide necked. Mean aneurysm size was 8.6 mm. There were 44 unruptured IA and 5 ruptured IA. During endovascular treatment (EVT), adjunctive devices were used in 22.4% of procedures. A good clinical outcome (modified Rankin Scale score ≤2) was achieved in 44/48 patients (92%). There was no mortality. Mean follow-up was 25 months (range 3–72 months; median 24 months). Between mid term and long term follow-up, occlusion was stable in 19/23 IA (82.6%), improved in 2/23 IA (8.7%), and worsened in 2/23 IA (8.7%). Retreatment was performed in 8/49 IA (16.3%). At the latest available follow-up, there were 34/47 (72.3%) complete occlusions and 13/47 (27.7%) neck remnants.ConclusionsOur study suggests that EVT of IA with the WEB device provides adequate and stable long term occlusion.

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Woven EndoBridge device for ruptured aneurysms: perioperative results of a US multicenter experience

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017105 ◽

2021 ◽

pp. neurintsurg-2020-017105

Author(s):

Gustavo M Cortez ◽

Erinc Akture ◽

Andre Monteiro ◽

Adam S Arthur ◽

Jeremy Peterson ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Intraoperative Complications ◽

Anterior Communicating Artery ◽

The Usa ◽

Perioperative Safety ◽

Woven Endobridge ◽

Web Device ◽

Ruptured Intracranial Aneurysms ◽

The Web

BackgroundThe Woven EndoBridge (WEB) device is approved in the USA for treatment of unruptured wide-neck bifurcation aneurysms. However, the safety and effectiveness of the WEB device in the treatment of ruptured intracranial aneurysms is not clear. We aim to evaluate the perioperative safety and effectiveness of the WEB device in patients with ruptured intracranial aneurysms.MethodsThis retrospective study, conducted at eight centers in the USA, included patients with ruptured intracranial aneurysms treated with the WEB device in the setting of subarachnoid hemorrhage (SAH). Safety outcomes included intraoperative complications such as vessel perforation, thromboembolic events, and postoperative hemorrhagic or thromboembolic complications based on radiologic imaging. The primary effectiveness outcome was adequate (complete and neck remnant) aneurysm occlusion, according to the Raymond–Roy classification.ResultsA total of 91 patients with 94 ruptured intracranial aneurysms were included (mean age 57.7±15.2 years; 68.1% women; 82.9% wide-necked). Aneurysms were located in the anterior communicating artery (42/94, 44.6%), middle cerebral artery (16/94, 17%), and basilar artery (15/94, 16%). Adequate occlusion was achieved in 48.8% (41/84) and 80.0% (40/50) at discharge and last follow-up (mean of 3.4 months), respectively. At discharge, procedural-related morbidity was 3.3% (3/91) and there was no procedure-related mortality. No re-rupture or delayed aneurysm rupture was observed.ConclusionsThis study demonstrates the perioperative safety and effectiveness of the WEB device for the treatment of patients with ruptured intracranial aneurysms in the setting of SAH, with low periprocedural morbidity and mortality. Long-term follow-up is warranted.

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Woven EndoBridge device for the treatment of ruptured intracranial aneurysms: A systematic review of clinical and angiographic results

Interventional Neuroradiology ◽

10.1177/15910199211026712 ◽

2021 ◽

pp. 159101992110267

Author(s):

Yong Xie ◽

Huan Tian ◽

Bin Xiang ◽

Jian Liu ◽

Hua Xiang

Keyword(s):

Success Rate ◽

Intracranial Aneurysms ◽

Perioperative Mortality ◽

Occlusion Rate ◽

Woven Endobridge ◽

Web Device ◽

Intraoperative Rupture ◽

Ruptured Intracranial Aneurysms ◽

The Web

Background and objective The clinical outcome and angiographic outcome data of Woven EndoBridge (WEB) device for the treatment of ruptured intracranial aneurysms (IAs) are limited. We conducted a meta-analysis of the latest literature on the WEB device in the treatment of ruptured IAs. Methods A comprehensive literature search of 4 databases (PubMed, Web of Science, Cochrane library, and Embase) was conducted for studies published from January 1, 2010 to December 31, 2020. Two reviewers independently extracted variables (aneurysm and patient characteristics) using a prespecified data-collection sheet. Outcomes studied included initial and latest follow-up angiographic outcomes, technical success rate, perioperative mortality, retreated rate, perioperative re-bleeding, complication, intraoperative rupture, favorable neurologic outcome at discharge. We used random-effects model to pool the data. Results We finally presented the results of 7 articles including 276 patients with 283 aneurysms. Initial complete and adequate occlusion rate were 38% (95% CI, 25%–50%) and 98% (95% CI, 95%–100%), respectively. Latest follow-up complete and adequate occlusion rate were 61% (95% CI, 46%–75%) and 91% (95% CI, 84%–98%), respectively.Technical success rate was 99% (95% CI, 98%–100%). Perioperative mortality rates and perioperative re-bleeding rate were 9% (95% CI, 3%–15%) and 1% (95% CI, 0%–2%), respectively. Retreated rate was 6% (95% CI, 3%–10%). Overall and WEB treatment-related thromboembolic complication was 10% (95% CI, 6%–13%) and 7% (95% CI, 2%–12%), respectively. Intraoperative rupture rate was 3% (95% CI, 0%–6%). Conclusion Endovascular treatment of ruptured IAs with the WEB device has a good safety profile and an acceptable aneurysm occlusion rate.

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Initial and mid-term results from 108 consecutive patients with cerebral aneurysms treated with the WEB device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012276 ◽

2016 ◽

Vol 9 (4) ◽

pp. 411-417 ◽

Cited By ~ 47

Author(s):

Christin Clajus ◽

Christoph Strasilla ◽

Tom Fiebig ◽

Vojtech Sychra ◽

David Fiorella ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Clinical Results ◽

Unruptured Aneurysms ◽

Novel Device ◽

High Level ◽

Woven Endobridge ◽

Web Device ◽

The Web

IntroductionThe Woven EndoBridge (WEB) is a novel device for the treatment of wide-necked intracranial bifurcation aneurysms. The present series demonstrates our ‘real-world experience’ in the use of all iterations of WEB devices (available in Europe) in ruptured and unruptured aneurysms.MethodsWe analyzed our all-inclusive cerebrovascular database for patients treated with the WEB device between October 2010 and May 2015. Anatomic and clinical results are reported for all patients.ResultsOne hundred and eight patients with 114 intracranial aneurysms were included in the series. Forty-seven aneurysms (41.2%) were ruptured. Eighty-six patients received angiographic and clinical follow-up after a mean of 13.4 months. One hundred and ten of 114 WEB devices (96.5%) were deployed successfully. Thromboembolic complications occurred in 11 of 110 interventions (10.0%), with a new permanent deficit in one patient. Re-rupture after WEB treatment was detected in two aneurysms (4.3%), which had both initially presented with subarachnoid hemorrhage. Angiographic follow-up revealed adequate occlusion in 68 of 90 aneurysms (75.6%). Fifteen aneurysms required retreatment.ConclusionsThis series confirms a high level of safety and efficacy of the WEB device for the treatment of wide-necked intracranial aneurysms.

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Treatment of recurrent aneurysms using the Woven EndoBridge (WEB): anatomical and clinical results

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013287 ◽

2017 ◽

Vol 10 (7) ◽

pp. 629-633 ◽

Cited By ~ 13

Author(s):

Matthias Gawlitza ◽

Sebastien Soize ◽

Anne-Christine Januel ◽

Cristian Mihalea ◽

Georgios-Emmanouil Metaxas ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Clinical Results ◽

Thromboembolic Complication ◽

Safety And Efficacy ◽

Complete Occlusion ◽

Permanent Morbidity ◽

Woven Endobridge ◽

Web Device ◽

The Web

BackgroundThe safety and efficacy of the Woven EndoBridge (WEB) for the treatment of naïve intracranial aneurysms has been confirmed.PurposeTo analyze the safety and efficacy of the WEB in the treatment of recurrent aneurysms.MethodsAnatomical and clinical results in consecutive patients with a recurrent aneurysm, who were treated using the WEB device in two French neurointerventional centers, were evaluated.ResultsSeventeen patients with 17 aneurysms were included. Treatment was feasible in 16 patients. In seven patients (41.2%), ancillary devices were used. Permanent morbidity due to a thromboembolic complication occurred in one patient (5.9%). There was no mortality. Follow-up angiographic studies were available for 15 patients after a mean of 12.1±6.1 months. Rates of complete occlusion, neck remnant, and aneurysm remnant were 33.3%, 40.0%, and 26.7%, respectively.ConclusionsTreatment of recurrent aneurysms using the WEB device may be reasonably safe and effective.

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Treatment strategies for recurrent and residual aneurysms after Woven Endobridge implantation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014230 ◽

2018 ◽

Vol 11 (4) ◽

pp. 390-395 ◽

Cited By ~ 22

Author(s):

Christoph Kabbasch ◽

Lukas Goertz ◽

Eberhard Siebert ◽

Moriz Herzberg ◽

Christina Hamisch ◽

...

Keyword(s):

Tertiary Care ◽

Treatment Strategies ◽

True Aneurysm ◽

Tertiary Care Centers ◽

Multimodality Approach ◽

Woven Endobridge ◽

Web Device ◽

Incomplete Occlusion ◽

The Web

BackgroundWoven Endobridge (WEB) embolization is a safe and efficient technique for endovascular treatment of intracranial aneurysms. However, the management of aneurysm recurrence after WEB placement has not been well described to date. We present our multicenter experience of endovascular retreatment of aneurysm recurrence after WEB implantation.MethodsThis is a multicenter study of patients who underwent endovascular retreatment after WEB implantation in three German tertiary care centers. Treatment strategies, complications, and angiographic outcome were retrospectively assessed.ResultsAmong 122 aneurysms treated with the WEB device, 15 were retreated. Of these, six were initially treated with the WEB only, two were pretreated by coiling, and seven large aneurysms were treated in a multimodality approach. Ten were true aneurysm remnants and five were neck remnants. The reasons for retreatment were WEB migration (n=6), initial incomplete occlusion (n=5), and WEB compression (n=4). Retreatment strategies included coiling (n=4), stent-assisted coiling (n=7), flow diversion (n=3), and placement of an additional WEB (n=1). All procedures were technically successful and there were no procedure-related complications. Among 11 patients available for follow-up after retreatment, three were retreated again. At last angiographic follow-up, available in 11/15 cases at a median of 23 months, complete occlusion was obtained in eight cases and neck remnants in three.ConclusionsThis pilot study shows that endovascular retreatment of recurrent or residual aneurysms after WEB implantation can be done safely and can achieve adequate occlusion rates.

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Detection of the Residual Lumen of Intracranial Aneurysms Immediately after Coil Embolization by Three-dimensional Digital Subtraction Angiographic Virtual Endoscopic Imaging

Neurosurgery ◽

10.1097/00006123-200203000-00008 ◽

2002 ◽

Vol 50 (3) ◽

pp. 476-485 ◽

Cited By ~ 1

Author(s):

Hiro Kiyosue ◽

Mika Okahara ◽

Shuichi Tanoue ◽

Takaharu Nakamura ◽

Hirofumi Nagatomi ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Cerebral Arteries ◽

Three Dimensional ◽

Digital Subtraction ◽

Aneurysm Volume ◽

Digital Subtraction Angiographic ◽

Incomplete Occlusion ◽

Coil Volume

Abstract OBJECTIVE: Detection of a small residual lumen after coil embolization is often difficult because of the coil mass and the overlap of the cerebral arteries. The purpose of this study was to assess the usefulness of virtual endoscopic (VE) analysis of three-dimensional digital subtraction angiographic (DSA) images for evaluation of aneurysmal occlusion immediately after the procedure. METHODS: Twenty-seven intracranial aneurysms were treated with coil embolization using a three-dimensional DSA system. Biplane and rotational DSA scanning was performed before and immediately after the procedures. VE images were obtained at a separate workstation, after transfer of the rotational images. Two-dimensional (2D) DSA images and VE images obtained after the procedure were assessed with respect to aneurysmal occlusion. Morphological outcomes and other factors, including location, size, volumetric ratio (coil volume/aneurysm volume), and residual sites, were also evaluated. RESULTS: Seven aneurysms were evaluated as complete occlusion (CO) on both 2D DSA images and VE images. Twelve aneurysms exhibited residual lumina on both 2D DSA images and VE images. Five aneurysms were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images. There were no recurrences among the aneurysms that were evaluated as CO on VE images. Two of five aneurysms that were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images demonstrated regrowth in follow-up examinations. Residual sites and volumetric ratios were correlated with aneurysmal regrowth. CONCLUSION: VE imaging can demonstrate a residual lumen more frequently than can 2D DSA imaging and is useful for evaluating aneurysmal occlusion after coil embolization.

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Woven EndoBridge Embolized Aneurysm Clippings: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab218 ◽

2021 ◽

Author(s):

Daniel M Heiferman ◽

Jeremy C Peterson ◽

Kendrick D Johnson ◽

Vincent N Nguyen ◽

David Dornbos ◽

...

Keyword(s):

Treatment Strategies ◽

The United States ◽

Lessons Learned ◽

Anterior Communicating Artery ◽

Surgical Clip ◽

Woven Endobridge ◽

Web Device ◽

Clip Occlusion ◽

The Web

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.

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WEB device for treatment of posterior communicating artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017405 ◽

2021 ◽

pp. neurintsurg-2021-017405

Author(s):

Guilherme Aguiar ◽

Jildaz Caroff ◽

Cristian Mihalea ◽

Jonathan Cortese ◽

Jean-Baptiste Girot ◽

...

Keyword(s):

Case Series ◽

Posterior Communicating Artery ◽

Neck Size ◽

Ruptured Aneurysms ◽

Antiplatelet Medication ◽

Woven Endobridge ◽

Web Device ◽

Intraoperative Rupture ◽

Wide Neck

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.

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