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Chew HS, Altibi M, Al-Ali S, Butler B, Butt W, Chavda S, Lamin S. Microsnare retrieval as a bail-out technique of Detached Woven EndoBridge device: Illustrative series. Interv Neuroradiol 2024:15910199241242170. [PMID: 38576409 DOI: 10.1177/15910199241242170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The Woven EndoBridge (WEB) device (MicroVention, Tustin, CA, USA) has an excellent safety profile. While major complications such as device malposition and migration are rare, they can have serious consequences if not addressed promptly. Our case series describes the safety and efficacy of Amplatz goose neck microsnare device (Medtronic in Irvine, CA, USA) in endovascular retrieval of a detached WEB device. METHODS We retrospectively reviewed six consecutive patients who underwent endovascular WEB retrieval using Amplatz microsnare device between March 2012 and December 2022. RESULTS All six WEB devices were successfully retrieved either directly from the aneurysm sac due to device malpositioning or from a distal branch following device migration. None of the patients experienced intra-operative aneurysm perforation, arterial dissection, or vasospasm attributable to the process of WEB extraction. Five out of six patients (83.3%) had a good functional outcome (mRS 0-1) upon discharge from the hospital and at 24 months. CONCLUSION Our experience suggests that detached WEB devices can be safely retrieved using an Amplatz microsnare. Apart from addressing device migration, direct removal of an undersized or malpositioned WEB from the aneurysm sac appears to be a safe option that can be considered when all other rescue techniques have been exhausted.
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Affiliation(s)
- Han Seng Chew
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mohammad Altibi
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Samer Al-Ali
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Benjamin Butler
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Waleed Butt
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Swarupsinh Chavda
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Saleh Lamin
- Interventional Neuroradiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Gravino G, Masri S, Chandran A, Puthuran M. Management of WEB device migration and mal-position in endovascular treatment of cerebral aneurysms. Interv Neuroradiol 2022:15910199221122857. [PMID: 36017541 DOI: 10.1177/15910199221122857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
With increasing advances in technology, the breadth of aneurysms that are treatable via an endovascular approach has increased. Wide necked aneurysms remain difficult to treat but the emergence of dedicated intrasaccular flow disruption devices such as the Woven EndoBridge (WEB, Micorvention) has increasingly seen previously ruptured and unruptured wide necked aneurysms successfully embolised and secured from the circulation using a single device.We are reporting two cases of WEB device treatment from the earliest experience with this device at our institution. These were complicated by partial extrusion in one case and remote migration of the WEB device in another case. Our initial cases highlight the importance of case selection and the need for accurate WEB sizing which are paramount to ensure complete occlusion of the aneurysm without complications of dislocation or extrusion into the parent vessel. Since then, we have performed over 170 cases with the WEB device. We also present a comprehensive review of the limited literature available on the management of mal-positioned and dislocated WEB devices. This allows us to reflect on how to avoid these complications and the different management options at the disposal of the neuro-interventionalist once such a complication has already occured. Rescue devices and manoeuvres that we reflect on include microcatheter manipulation, alligator retrieval device, stent retrievers, microsnares, aspiration, and stenting. Ultimately, each case needs to be individually evaluated and the best strategy selected depends on the context and specific circumstances.
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Affiliation(s)
- Gilbert Gravino
- Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Souhyb Masri
- Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Arun Chandran
- Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Mani Puthuran
- Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
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Radu RA, Gascou G, Derraz I, Cagnazzo F, Costalat V. Micro-snare retrieval as bail-out technique for a distally migrated WEB-device: A case report. Interv Neuroradiol 2022:15910199221118709. [PMID: 35929103 DOI: 10.1177/15910199221118709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intra-procedural intrasaccular device migration is an uncommon complication of endovascular treatment of wide-neck aneurysms. We report the case of a 52-years old Caucasian male who presented with a 3 × 3 mm posterior facing top of the basilar aneurysm in which treatment with WEB-SL (Woven EndoBridge-single layer) device was tempted. Inadvertent WEB migration in the right posterior cerebral artery occurred after detachment. Two retrieval attempts were performed using a combined technique with two different stent-retrievers and a 5-Fr distal access catheter. Upon WEBectomy attempt, the device rolled over the stents, and the passages were unsuccessful. The device was successfully removed using a microSnare, catching and retrieving it inside the 5-Fr distal access catheter. Micro-Snare is an effective bail-out technique to recover migrated intrasaccular WEB devices in cerebral arteries.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- 87267"Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Grégory Gascou
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, 56224Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Mathern N, Yousefian E, Ridwan H, Nikoubashman O, Wiesmann M. Comparison of porcine and human vascular diameters for the optimization of interventional stroke training and research. PLoS One 2022; 17:e0268005. [PMID: 35503785 PMCID: PMC9064086 DOI: 10.1371/journal.pone.0268005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
The branches of the porcine subclavian artery are frequently used in endovascular stroke training and research. This study aimed to determine a porcine weight group, in which the arterial diameters most closely match human cerebral artery diameters, and thus optimize the porcine in-vivo model for neuroendovascular purposes. A group of 42 German Landrace swine (45–74 kg) was divided into four subgroups according to their weight. Angiographic images of the swine were used to determine the arterial diameter of the main branches of the subclavian artery: axillary artery, brachial artery, external thoracic artery, subscapular artery (at two different segments), suprascapular artery, caudal circumflex humeral artery, thoracodorsal artery, and circumflex scapular artery. The porcine arterial diameters were correlated with animal weight and compared to luminal diameters of human arteries which are commonly involved in stroke: internal carotid artery, basilar artery, vertebral artery, middle cerebral artery and M2 branches of the middle cerebral artery. Swine weight was positively correlated with porcine arterial diameter. The most conformity with human arterial diameters was found within the two heavier porcine groups (55–74 kg). We suggest the use of swine with a weight between 55–59.7 kg, as lighter animals show less similarity with human arterial diameters and heavier animals could cause more problems with manipulation and handling.
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Affiliation(s)
- Nathalie Mathern
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Ehsan Yousefian
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
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Amuluru K, Al-Mufti F, Sahlein DH, Scott J, Denardo A. Adjustment of Malpositioned Woven EndoBridge Device Using Gooseneck Snare: Complication Management Technique. Neurointervention 2021; 16:275-279. [PMID: 34634856 PMCID: PMC8561038 DOI: 10.5469/neuroint.2021.00318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/29/2021] [Indexed: 12/25/2022] Open
Abstract
The Woven EndoBridge (WEB) is an intrasaccular flow-disrupting device for the treatment of wide-necked saccular cerebral aneurysms. As with any neuroendovascular device, complications in the form of malpositioning and migration must be managed quickly and safely. Few studies have reported complication management techniques in instances of dislocated or migrated WEB devices. We retrospectively describe a case of a malpositioned WEB device that was successfully adjusted with the use of a gooseneck snare. Multiple other intra-procedural bailout strategies for management of WEB malposition and migration were considered, and are herein discussed. Operators should be aware of the causes of WEB malposition and a variety of bailout strategies.
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Affiliation(s)
- Krishna Amuluru
- Division of Interventional Neuroradiology, Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Indianapolis, IN, USA
| | - Fawaz Al-Mufti
- Department of Endovascular Neurosurgery and Neurocritical Care, Westchester Medical Center, Valhalla, NY, USA
| | - Daniel H Sahlein
- Division of Interventional Neuroradiology, Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Indianapolis, IN, USA
| | - John Scott
- Division of Interventional Neuroradiology, Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Indianapolis, IN, USA
| | - Andrew Denardo
- Division of Interventional Neuroradiology, Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Indianapolis, IN, USA
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Simgen A, Yilmaz U, Dietrich P, Tomori T, Mühl-Benninghaus R, Laschke MW, Menger MD, Reith W, Kettner M. Rescue of migrated Woven Endobridge devices using a stent-retriever-technique in a porcine model. Interv Neuroradiol 2020; 26:772-778. [PMID: 32340514 DOI: 10.1177/1591019920920984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The Woven Endobridge device (WEB) has become widely applied for the treatment of intracranial aneurysms. Complications are rare, however, especially dislocations and migrations can potentially increase poor clinical outcome. The aim of this study was to assess the feasibility and effectiveness of rescuing migrated Woven Endobridges using different stent retrievers. METHODS In a porcine model, Woven Endobridges of different sizes (SLS 4, SLS 7, SL 5 × 3, SL 4 × 3) were placed into the axillary arteries. By means of two different stent retrievers (Solitaire Platinum and 3D Revascularization Device), a total of 20 rescue maneuvers were performed. For this purpose, the retrievers were deployed distally of the migrated Woven Endobridges. After retracting the stent retrievers partially, the Woven Endobridges were trapped within the microcatheter. Rescue rates, time, attempts and complications were assessed. RESULTS Successful rescue of the migrated Woven Endobridges was observed in all cases (100%). Rescue was slightly faster (177.8 ± 72.8 s vs. 223.4 ± 104.1 s) with fewer attempts (1.5 ± 0.8 vs. 1.8 ± 0.9) when using the 3D Revascularization Device compared to the Solitaire Platinum. However, there were no significant differences (p = 0.327; p = 0.554). Migration of the Woven Endobridges during rescue was seen with both stent retrievers in a comparable frequency (p = 0.642). Further complications, such as entrapment of the stent-retriever-WovenEndobridge-complex at the intermediate catheter, vasospasm, perforation or dissection, were not observed. CONCLUSIONS Rescue of migrated Woven Endobridges using stent retrievers is a feasible and effective method. Rescue rates, times and attempts with the Solitaire Platinum and 3D Revascularization Device are comparable with each other.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
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