scholarly journals Experience of WEB embolization device implantation for treatment of intracranial arterial aneurisms

2020 ◽  
Vol 31 (1) ◽  
pp. 75-82
Author(s):  
D.V. Shchehlov ◽  
O.A. Pastushyn ◽  
O.E. Svyrydiuk
Keyword(s):  
Light Transmission ◽  
Standard Dosage ◽  
Routine Manner ◽  
Satisfactory Condition ◽  
Device Implantation ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
Arterial Aneurysms ◽  
First Time ◽  
The Web

For the first time in Ukraine, Woven EndoBridge (WEB) (Microvention – Terumo) for the treatment of intracranial arterial aneurysms was applied at Scientific and Practical Centre of Endovascular Neuroradiology of NAMS of Ukraine on November 29, 2018. To the end of 2019 4 patients were treated with WEB. In all patients aneurysms were accidental findings, diagnosed by magnetic resonance imaging, and confirmed by angio-graphy. Men were 2 (50 %), women – 2 (50 %). The average age of patients was 49 years. All aneurysms were complex for endovascular treatment. In 3 (75 %) cases, the aneurysm was located on the anterior cerebral/anterior connective arteries, in 1 (25 %) case – on the middle cerebral artery. All patients received double disaggregated therapy at the standard dosage (75 mg of clopidogrel and 75 mg of acetylsalicylic acid) during 5 days before surgery in case of an additional intracranial stent implantation. The efficacy of dual disaggregation therapy was monitored by light transmission agrigometry. The size of the WEB depended on the angioarchitectonics of the aneurysm. All surgeries were performed in a routine manner, under general anesthesia. In all cases, the WEB was implanted successfully, there were no intra- and postoperative complications. The next day after surgery, double disaggregation therapy was canceled. All patients were discharged from the hospital in satisfactory condition, under the supervision of a neurologist at the place of residence. A control examination in the form of angiography after 6 months passed all patients. The efficacy of aneurysm occlusion using the WEB embolization device was evaluated on the WEB occlusion scale. Grade 0 and 0’ were achieved in 2 (50 %) patients, Grade 1 – 1 (25 %), Grade 2 – 1 (25 %).

scholarly journals Experimental testing of the dual-layer Woven EndoBridge device using an elastase-induced aneurysm model in rabbits

2016 ◽  
Vol 22 (3) ◽  
pp. 299-303 ◽  
Author(s):  
Yong-Hong Ding ◽  
Daying Dai ◽  
Dana Schroeder ◽  
Ramanathan Kadirvel ◽  
David F Kallmes
Keyword(s):  
First Generation ◽  
Experimental Testing ◽  
Histologic Evaluation ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
Web Device ◽  
Aneurysm Model ◽  
The Web ◽  
Time Point

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.

Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms: A Propensity Score Analysis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Lukas Goertz ◽  
Thomas Liebig ◽  
Eberhard Siebert ◽  
Lenhard Pennig ◽  
Kai Roman Laukamp ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Outcomes ◽  
Technical Success ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
Major Adverse Events ◽  
Anterior Circulation Aneurysms ◽  
The Web

Abstract BACKGROUND Intrasaccular flow-disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms. OBJECTIVE To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment. METHODS A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion. RESULTS The technical success rates were 83% for WEB and 100% for clipping. Procedure-related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P < .01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01). CONCLUSION Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in ≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient's preferences.

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.

scholarly journals Coiling after Treatment with the Woven EndoBridge Cerebral Aneurysm Embolization Device

2012 ◽  
Vol 18 (2) ◽  
pp. 208-212 ◽  
Author(s):  
A.K. Wallner ◽  
E. Broussalis ◽  
T. Hauser ◽  
E. Trinka ◽  
M. Killer-Oberpfalzer
Keyword(s):  
Cerebral Aneurysm ◽  
Female Patient ◽  
Aneurysm Embolization ◽  
Mca Aneurysm ◽  
Woven Endobridge ◽  
Time Standard ◽  
First Time ◽  
The Web

Retreatment options after the use of the newly launched Woven EndoBridge cerebral aneurysm embolization device (WEB II) are mostly unknown. Nine months after WEB II implantation, a 55-year-old female patient presented with regrowth of an MCA aneurysm. For the first time, standard balloon-assisted coiling was used to close the regrown aneurysm proximal to the WEB II implant. We report on the feasibility and safety of balloon-assisted coiling after implantation of the WEB II device.

scholarly journals 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

2019 ◽  
Vol 11 (9) ◽  
pp. 924-930 ◽  
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

scholarly journals Intracranial aneurysm treatment with intrasaccular flow disruption: comparison of WEB-21 and WEB-17 systems

2021 ◽  
pp. neurintsurg-2021-017876
Author(s):  
Paolo Pagano ◽  
Laurentiu Paiusan ◽  
Sebastien Soize ◽  
Laurent Pierot
Keyword(s):  
Flow Disruption ◽  
Ruptured Aneurysms ◽  
Aneurysm Treatment ◽  
Interventional Neuroradiologist ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
High Treatment ◽  
The Web ◽  
Prospective Database

BackgroundNew generations of Woven EndoBridge (WEB) devices (WEB-21 and WEB-17) are available to treat aneurysms with a width <6.5 mm. Limited comparisons between both systems exist in the literature, but mid-term efficacy has not been compared. Our study aimed to compare the indications, feasibility, and safety of both systems and to evaluate their efficacy at mid-term follow-up (12 months).MethodsAneurysms treated with WEB-21 and WEB-17 were extracted from a prospective database. Patient and aneurysm characteristics, complications, and anatomical results were analyzed by an interventional neuroradiologist, independent of the procedures.ResultsFrom June 2015 to November 2019, 87 patients with 92 aneurysms were treated with WEB-21 (38/92, 41.3%) and WEB-17 (54/92, 58.7%). WEB-21 and WEB-17 had high treatment feasibility (97.4% and 94.4%, respectively). A higher percentage of ruptured aneurysms were treated with WEB-17 (9.3%) than with WEB-21 (2.6%; p=0.03). Morbidity and mortality at 1 month were similar in both groups (no morbidity in either group, and mortality 2.7% in the WEB-21 group and 2.0% in the WEB-17 group). The rate of complete and adequate aneurysm occlusion was not significantly higher with the WEB-17 system (59.2% and 95.9%, respectively) compared with the WEB-21 (52.9% and 85.3%, respectively).ConclusionsThis study showed the high feasibility of aneurysm treatment with both the WEB-21 and WEB-17 systems. Indications were relatively similar with both devices except for ruptured aneurysms, which were more frequently treated with the WEB-17 device. Efficacy at 12 months (complete and adequate occlusions) was slightly, but not significantly, better with the WEB-17 device.

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

2017 ◽  
Vol 126 (1) ◽  
pp. 17-28 ◽  
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.

scholarly journals Woven EndoBridge (WEB) Width at the Aneurysm Neck Level Affects Early Angiographic Aneurysm Occlusion

2021 ◽  
Author(s):  
Marie Teresa Nawka ◽  
Gabriel Broocks ◽  
Rosalie McDonough ◽  
Jens Fiehler ◽  
Maxim Bester
Keyword(s):  
External Validation ◽  
Short Term ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
Web Device ◽  
Aneurysm Diameter ◽  
The Web ◽  
Web Size

Abstract Purpose Endovascular therapy with the Woven EndoBridge (WEB) device is a safe treatment approach, whereby neoendothelialization at the neck area is a crucial element for aneurysm occlusion. We hypothesized that WEB sizing at the aneurysmal neck level has an impact on early aneurysm occlusion. Methods Patients with short-term follow-up digital subtraction angiography following WEB treatment of unruptured aneurysms were included. Aneurysms were categorized according to the Bicêtre Occlusion Scale Score (BOSS) as adequately (BOSS 0, 0′, 1) or partially occluded (BOSS 2, 3, 1 + 3). The WEB device dimensions, including the average aneurysm diameter (AADi) and the average neck diameter (ANDi) as well as baseline patient characteristics were documented. Results In this study 75 patients with 76 aneurysms were included and 65 aneurysms showed adequate occlusion at short-term follow-up (86%). In univariable logistic regression analysis, smaller differences in WEB size to ANDi (D-ANDi) were significantly associated with adequate aneurysm occlusion (odds ratio, OR = 0.41, 95% confidence interval, CI 0.23–0.71, p = 0.002). Receiver operating characteristic (ROC) curve analyses displayed higher discriminative power for the D‑ANDi (AUC = 0.77, 95% CI 0.66–0.86, cut-off ≤2.9 mm) compared to the difference in WEB size to the average aneurysm diameter (D-AADi, AUC = 0.65, 95% CI 0.53–0.75, cut-off ≤1.0 mm). Conclusion Smaller differences between the WEB width and ANDi were associated with adequate early aneurysm occlusion and might thus have a higher impact on the results than the traditional device sizing considering the mean aneurysm diameter. D‑ANDi ≤2.9 mm served as an optimal cut-off to classify occlusion after WEB treatment at the short-term follow-up. Further external validation is warranted.

A Hybrid Coil/Polymer Device for Occlusion of Cerebral Aneurysms

2009 ◽  
Vol 3 (4) ◽  
Author(s):  
Fangmin Xu ◽  
Kevin Hart ◽  
Claire E. Flanagan ◽  
John C. Nacker ◽  
Roham Moftakhar ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
In Vitro Models ◽  
In Vivo Studies ◽  
Polymer Shell ◽  
Device Implantation ◽  
Occlusion Device ◽  
Aneurysm Occlusion ◽  
Aneurysm Model

The treatment of cerebral aneurysms is frequently accomplished via endovascular delivery of metal coils in order to occlude the aneurysm and prevent rupture. This procedure involves imprecise packing of large lengths of wire into the aneurysm and often results in high rates of aneurysm recanalization. Over time, this incomplete aneurysm occlusion can lead to aneurysm enlargement, which may have fatal consequences. This report describes the fabrication and preliminary testing of a novel aneurysm occlusion device composed of a single metal coil surrounded by a biocompatible polymer shell. These coil-in-shell devices were tested under flow conditions in synthetic in vitro models of saccular aneurysms and deployed in vivo in a short-term porcine aneurysm model to study occlusion efficacy. A single nickel titanium shape memory wire was used to deploy a biocompatible, elastic polymeric shell, leading to aneurysmal sac filling in both in vitro and in vivo aneurysm models. The deployment of this coil-in-shell device in synthetic aneurysm models in vitro resulted in varying degrees of aneurysm occlusion, with less than 2% of trials resulting in significant leakage of fluid into the aneurysm. Meanwhile, in vivo coil-in-shell device implantation in a porcine aneurysm model provided proof-of-concept for successful occlusion, as both aneurysms were completely occluded by the devices. Both in vitro and in vivo studies demonstrated that this coil-in-shell device may be attractive as an alternative to traditional coil embolization methods in some cases, allowing for a more precise and controlled aneurysm occlusion.

The NOVAC database of volcanic SO2 emissions

2021 ◽  
Author(s):  
Bo Galle ◽  
Keyword(s):  
Sulphur Dioxide ◽  
Meteorological Conditions ◽  
So2 Emissions ◽  
Volcanic Gas ◽  
Data Set ◽  
Gas Emissions ◽  
First Time ◽  
Global Data ◽  
Web Repository ◽  
The Web

&lt;p&gt;We present a detailed global data-set of volcanic sulphur dioxide (SO2) emissions during the period 2005-2017. Measurements were obtained by scanning-DOAS instruments of the NOVAC network at 32 volcanoes, and processed using a standardized procedure. We reveal the daily statistics of volcanic gas emissions under a variety of volcanological and meteorological conditions. Data from several volcanoes are presented for the first time. Our results&amp;#160; are compared with yearly averages derived from measurements from space by the Aura/OMI instrument and with historical inventories of GEIA. This comparison shows some interesting differences which reasons are briefly discussed. Data is openly available through the web repository at https://novac.chalmers.se/.&lt;/p&gt;

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