Numerical simulation of blood flow in intracranial aneurysms treated by endovascular Woven EndoBridge technique

2020 ◽  
Vol 31 (05) ◽  
pp. 2050073
Author(s):  
Alireza Sharifi ◽  
Amin Deyranlou ◽  
Mohammad Charjouei Moghadam ◽  
Hamid Niazmand
Keyword(s):  
Intracranial Aneurysms ◽  
Single Layer ◽  
Mathematical Framework ◽  
Aneurysm Neck ◽  
The Past ◽  
Bifurcation Aneurysm ◽  
Efficient Performance ◽  
Computational Fluid Dynamics Cfd ◽  
Woven Endobridge ◽  
The Web

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.

Remnants and Recurrences After the Use of the WEB Intrasaccular Device in Large-Neck Bifurcation Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 522-530 ◽  
Author(s):  
Christophe Cognard ◽  
Anne Christine Januel
Keyword(s):  
Single Layer ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm ◽  
Contrast Enhanced ◽  
Web Device ◽  
Large Neck ◽  
Shape Changes ◽  
The Web

Abstract BACKGROUND: Flow disruption with the WEB technique has been developed to treat large-neck bifurcation aneurysms. OBJECTIVE: To report our anatomic angiographic results at first (3-6 months) and second (18 ± 3 months) angiographic follow-up in a series of 15 patients. METHODS: Fifteen patients (15 aneurysms) were consecutively treated in our center by 2 operators for a large-neck bifurcation aneurysm between March 2012 and February 2014. Results were evaluated by assessing WEB cage position at the aneurysm neck on angiography and high-resolution contrast-enhanced flat-panel detector computed tomography, contrast medium stagnation within the WEB and aneurysm on intraprocedural angiography, and 1-day time-of-flight magnetic resonance angiography. All aneurysms were followed up by angiography. Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. The 2 operators compared postprocedural and follow-up images and classified them as better, same, or worse. Subtracted images were compared in different projections to assess any WEB device compression or shape changes. RESULTS: A worsening was observed between the postprocedural and first follow-up angiography in 10 of 14 (71.5%) and in 4 of 7 (57.2%) between the first and second control angiography. Compression of the WEB cage was observed at first follow-up in 8 of 14 (57.2%) and in an additional 3 of 7 cases (42.8%) at second control. Last angiography showed complete occlusion in 1 of 14 (7.2%), neck remnant in 8 of 14 (57.2%), and residual aneurysm in 5 of 14 (35.7%) cases. CONCLUSION: This article draws attention to the risk of WEB compression and aneurysm recanalization. Future prospective studies should evaluate delayed WEB shape changes with different types of WEB devices (dual layer, single layer, single layer spherical).

Multiparametric MRI of intracranial aneurysms treated with the Woven EndoBridge (WEB): a case of Faraday’s cage?

2018 ◽  
Vol 10 (10) ◽  
pp. 988-994 ◽  
Author(s):  
Marie Teresa Nawka ◽  
Jan Sedlacik ◽  
Andreas Frölich ◽  
Maxim Bester ◽  
Jens Fiehler ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Thrombus Formation ◽  
Single Layer ◽  
Region Of Interest ◽  
Multiparametric Mri ◽  
Signal Loss ◽  
Contrast Enhanced ◽  
Woven Endobridge ◽  
The Web

ObjectiveTo evaluate multiparametric MRI including non-contrast and contrast-enhanced morphological and angiographic techniques for intracranial aneurysms treated with the single-layer Woven EndoBridge (WEB) embolization system applying simultaneous digital subtraction angiography (DSA) as the reference of standard.Materials and methodsWe retrospectively identified all patients with incidental and acute ruptured intracranial aneurysms treated with a WEB device (WEB SL and WEB SLS) between March 2014 and June 2016 in our neurovascular center with early (within 7 days) postinterventional multiparametric MRI as well as mid-term (5–8 months) follow-up MRI and DSA available. Occlusion rates were recorded both in DSA and MR angiography (MRA). In MRI, signal intensities within the WEB as well as in the occluded dome distal to the WEB, if present, were measured by region-of-interest (ROI) analysis.ResultsTwenty-five patients fulfilled the inclusion criteria. Rates of complete/adequate occlusion at mid-term follow-up were 84% with both MRA and DSA. A strong signal loss within the WEB was observed in all MR sequences at initial and follow-up examinations. ROI analysis did not reveal significant differences in non-contrast (P=0.946) and contrast-enhanced imaging (P=0.377). A T1-hyperintense thrombus in the non-WEB-carrying dome was a frequent observation.ConclusionsSignal intensity measurements in multiparametric MRI suggest that neither contrast-enhanced MRA nor morphological sequences are capable of revealing reliable information on the WEB lumen, presumably due to radio frequency shielding. MRI is therefore not suitable for confirming complete thrombus formation within the WEB.

Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms

2020 ◽  
pp. neurintsurg-2020-016405 ◽  
Author(s):  
Patrick P Youssef ◽  
David Dornbos III ◽  
Jeremy Peterson ◽  
Ahmad Sweid ◽  
Amanda Zakeri ◽  
...  
Keyword(s):  
Adverse Events ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Safety And Efficacy ◽  
Ruptured Aneurysms ◽  
Primary Treatment Modality ◽  
Woven Endobridge ◽  
Web Device ◽  
The Web

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.

scholarly journals Ten Years of Clinical Evaluation of the Woven EndoBridge: A Safe and Effective Treatment for Wide-Neck Bifurcation Aneurysms

2021 ◽  
Author(s):  
Laurent Pierot
Keyword(s):  
Clinical Evaluation ◽  
Intracranial Aneurysms ◽  
Current Knowledge ◽  
Endovascular Technique ◽  
Multicenter Studies ◽  
Flow Disruption ◽  
Woven Endobridge ◽  
Web Device ◽  
Wide Neck ◽  
The Web

Intrasaccular flow disruption is an innovative approach for the endovascular treatment of intracranial aneurysms. As of now, only one device is currently available worldwide: the Woven EndoBridge (WEB) device (MicroVention, Aliso Viejo, CA, USA). After 10 years of clinical use and careful clinical evaluation of the WEB device by multiple prospective, multicenter studies, this article is summarizing the current knowledge regarding this endovascular technique; indications, modalities, safety and efficacy of the WEB procedure are described.

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

2015 ◽  
Vol 21 (4) ◽  
pp. 462-469 ◽  
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.

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

2018 ◽  
Vol 11 (5) ◽  
pp. 503-510 ◽  
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.

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

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.

scholarly journals Pulsatile tinnitus due to an aneurysmatic diverticulum of the jugular bulb treated with the Woven EndoBridge device

2019 ◽  
Vol 26 (2) ◽  
pp. 235-238
Author(s):  
F Drescher ◽  
V Maus ◽  
W Weber ◽  
S Fischer
Keyword(s):  
Layer Structure ◽  
Single Layer ◽  
Flow Diverter ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Common Symptom ◽  
Pulsatile Tinnitus ◽  
Glomus Tumors ◽  
Woven Endobridge ◽  
The Web

Tinnitus is a common symptom with an incidence of 4–20%. Pulsatile tinnitus represents a minor subgroup of less than 10% of all patients suffering from tinnitus. Pulsatile tinnitus – different from permanent mostly idiopathic tinnitus is mainly caused by physical sources related to vascular pathologies resulting in a change in blood volume and pressure or an alteration of the vessel lumen. Differential diagnosis for pulsatile tinnitus include dural arteriovenous fistulas, glomus tumors of the jugular foramen and the middle ear or atherosclerotic diseases of the carotid artery in the petrous or cavernous segment. Anomalies of the dural sinuses and the jugular bulb have been described as rare sources of synchronized tinnitus. The Woven EndoBridge (WEB, Microvention, Tustin, CA) is an intraaneurysmal flow diverter for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile. The initial version of the WEB with a dual layer structure evolved to a single layer structure in two different versions (WEB SL, WEB SLS). The WEB system does not require a concomitant antiplatelet therapy compared to other intraluminal devices as extra-aneurysmal flow-diverters or intracranial stents. Here we describe a case of an aneurysmatic diverticulum of the jugular bulb in a patient with ipsilateral pulsatile tinnitus treated with a WEB device.

scholarly journals A systematic review and meta-analysis of Woven EndoBridge single layer for treatment of intracranial aneurysms

2020 ◽  
Vol 26 (4) ◽  
pp. 455-460 ◽  
Author(s):  
SBT van Rooij ◽  
ME Sprengers ◽  
JP Peluso ◽  
J Daams ◽  
D Verbaan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Single Layer ◽  
Aneurysm Rupture ◽  
Antiplatelet Medication ◽  
Low Profile ◽  
Woven Endobridge ◽  
New Generation

Background and purpose The Woven EndoBridge is an intrasaccular device for the treatment of intracranial aneurysms. The first generation consisted of a high-profile double-layer braid. This review aims to evaluate the outcomes of the new generation low-profile Woven EndoBridge single layer device for intracranial aneurysm treatment. Methods A systematic review was conducted with Medline, Embase, and Web of Science Conference Proceedings databases. The search strategy provided 589 articles, 15 articles were included. Results Fifteen articles were identified reporting the use of Woven EndoBridge single-layer devices in 963 aneurysms, mostly wide-necked bifurcation aneurysms. Procedural aneurysm rupture was reported in 8 of 963 patients (0.83%; 95%CI 0.39–1.66%) and thromboembolic events in 54 of 963 patients (5.61%, 95CI 4.31–7.26%). Cumulative morbidity was 2.85% (27/949, 95%CI 1.95–4.12%) and mortality 0.93% (9/963, 95%CI 0.46–1.80%). The overall rate of adequate aneurysm occlusion at last follow-up was 83.3% (613/736; 95%CI 80.4–85.8%). Retreatment was reported in 38 aneurysms in eight studies with 450 aneurysms with follow-up (38/450; 8.4%, 95CI 6.2–11.4%). In 12 studies comprising 644 aneurysms with follow-up, rebleeds occurred in three patients in three studies with mean follow-up between 3.3 and 14.4 months (0.47%, 95%CI 0.09–1.43%) Conclusion Woven EndoBridge single-layer is a promising new low-profile device especially for wide-neck bifurcation aneurysms, both ruptured and unruptured. No antiplatelet medication is needed which is a great advantage, especially in ruptured aneurysms. Efficacy and safety compare favorably with (stent-assisted) coiling. However, no direct comparison with other treatments is available as yet.

scholarly journals Mid-term 3T MRA follow-up of intracranial aneurysms treated with the Woven EndoBridge

2018 ◽  
Vol 24 (6) ◽  
pp. 601-607 ◽  
Author(s):  
SBT van Rooij ◽  
JP Peluso ◽  
M Sluzewski ◽  
HG Kortman ◽  
I Boukrab ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Intracranial Aneurysms ◽  
Posterior Cerebral Artery ◽  
Signal Loss ◽  
Short Term ◽  
Complete Occlusion ◽  
Woven Endobridge ◽  
The Web

Introduction Angiography is the standard follow-up modality for treated aneurysms with the Woven EndoBridge (WEB), and magnetic resonance angiography (MRA) is useful for extended follow-up. We present the results of WEB-treated aneurysms with angiographic follow-up at three months and at least 18 months’ 3T MRA follow-up. Materials and methods Included were 52 patients with 53 aneurysms treated with the WEB between February 2015 and July 2016. There were 29 women and 23 men with a mean age of 60 years (median 62, range 23–76). Mean aneurysm size was 6.2 mm (median 6, range 3–16 mm). Results 3T MRA follow-up was mean 19.6 months (median 18, range 18–36 months). One patient had an aneurysm remnant at three-month angiography that was additionally coiled and with stable complete occlusion at 18 months’ 3T MRA follow-up. At three-month follow-up angiography, 44 aneurysms were completely occluded and eight had a neck remnant. At latest 3T MRA, stable complete occlusion was present in 43 aneurysms and stable neck remnant in eight. One posterior cerebral artery (PCA) dissection aneurysm was stable at three and six months but was enlarged and reopened at 18 months, confirmed with angiography. Focal signal loss by the proximal marker of the WEB was apparent in four patients without compromising diagnostic evaluation. Conclusion WEB-treated aneurysms with adequate occlusion at three-month angiography remained stable during serial 3T MRA follow-up of 18–36 months. One PCA aneurysm reopened during the 6- to 18-month interval. Once the WEB-treated aneurysm is adequately occluded in the short term, later reopening is uncommon.

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