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Abbas R, Bendok BR. Commentary: Clip Ligation of a Recurrent Middle Cerebral Artery Aneurysm After Treatment With Woven EndoBridge: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:230-231. [PMID: 37934930 DOI: 10.1227/ons.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023] Open
Affiliation(s)
- Rawad Abbas
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix , Arizona , USA
- Department of Radiology, Mayo Clinic, Phoenix , Arizona , USA
- Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix , Arizona , USA
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2
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Traylor JI, Venkatesh P, Fabiano AS, Beach C, de Oliveira Sillero R. Clip Ligation of a Recurrent Middle Cerebral Artery Aneurysm After Treatment With Woven EndoBridge: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:229. [PMID: 37729624 DOI: 10.1227/ons.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Jeffrey I Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas , Texas , USA
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3
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Caroff J, Janot K, Soize S, Marnat G, Cortese J, Mihalea C, Popescu SD, Ikka L, Chalumeau V, Gallas S, Ozanne A, Eltantawy E, Grimaldi L, Barreau X, Herbreteau D, Pierot L, Spelle L. Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment. J Neurointerv Surg 2023; 15:939-942. [PMID: 36288976 DOI: 10.1136/jnis-2022-019645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Around 10% of Woven EndoBridge device (WEB)-treated intracranial aneurysms will need retreatment, and it is generally believed to be more challenging than retreatment after an initial coiling. We aim to report retreatment strategies and outcomes after initial WEB embolizations. METHODS Databases from four treatment centers, containing consecutive aneurysms treated with a WEB between 2013 and 2022, were reviewed. Demographics, aneurysm characteristics, retreatment strategies and outcomes were collected and analyzed. RESULTS From a 756 WEB database, 57 aneurysms were included. The global retreatment rate was 7.5% (95% CI 5.6% to 9.4%). The retreatment rate was significantly higher in the ruptured compared with the unruptured population (13% vs 3.9%, respectively, P<0.0001). Aneurysms were retreated on average 21.2 months after the initial WEB treatment (range 4.8-70 months). Surgery was performed in 11% and endovascular treatment in 89% of cases, consisting of flow diversion (48%), stent-assisted coiling (30%), coiling (12%), and second WEB placement (10%). Imaging follow-up was available in 88% of all WEB retreatments (50/57) (average 17 months, 49% digital subtraction angiography), demonstrating complete occlusion in 56% and 'adequate' occlusion in 88%. Morbidity was 5.3% (95% CI 0% to 12.0%) and mortality 0%. No patient experienced rebleeding during the follow-up period. CONCLUSION The retreatment rate after an initial WEB treatment seems to compare favorably with that of coiling. Endovascular treatment of recurrence following WEB implantation is feasible in most situations; it generally requires the use of a stent and leads to a high rate of satisfactory occlusion.
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Affiliation(s)
- Jildaz Caroff
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Kevin Janot
- Neuroradiology, CHU Tours, Tours, Centre, France
| | - Sebastien Soize
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
- Neuroradiology, CHU Reims, Reims, France
- Champagne-Ardenne University, Reims, France
| | | | - Jonathan Cortese
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Cristian Mihalea
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Septimiu Daniel Popescu
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Léon Ikka
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Vanessa Chalumeau
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Sophie Gallas
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Augustin Ozanne
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Eman Eltantawy
- Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
- Neurology, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Lamiae Grimaldi
- Clinical Research Unit; University, Faculty of Medicine Simone Veil, Versailles Saint Quentin University ; INSERM, CESP, Hospital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Xavier Barreau
- Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | | | - Laurent Pierot
- Neuroradiology, CHU Reims, Reims, France
- Champagne-Ardenne University, Reims, France
| | - Laurent Spelle
- Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicetre, France
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4
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Kranawetter B, Hernández S, Mielke D, Ernst MS, Malinova V, Rohde V. Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05596-5. [PMID: 37178247 DOI: 10.1007/s00701-023-05596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping. METHODS A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified. RESULTS Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms. CONCLUSIONS Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.
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Affiliation(s)
- B Kranawetter
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
| | - S Hernández
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - D Mielke
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - M S Ernst
- Department of Neuroradiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - V Malinova
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - V Rohde
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
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5
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Alpay K, Lindgren A, Rautio R, Parkkola R. The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months. Neuroradiol J 2023; 36:206-212. [PMID: 36028945 PMCID: PMC10034693 DOI: 10.1177/19714009221122216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To identify factors influencing short- and mid-term radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB). METHODS A total of 112 patients were treated for IAs with the WEB in at our institution between 2013 and 2020. Patients with 6- and/or 24-months follow-up data were included in the study. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification (RR). RR 1 and RR 2 were considered as adequate outcomes, while RR 3 inadequate. RESULTS Data were available for 91 patients (56 females, 62%) at 6 months and 62 of those patients (39 females, 58%) at 24 months. The adequate occlusion (RR 1/RR 2) rate was 89% (n = 81/91) at the 6-months follow-up and 91% (n = 56/62) at the 24-months follow-up. The treatment-related morbidity rate was 4% (n = 4/91), and mortality rate was 1% (n = 1/91). The predictor for inadequate occlusion at the 6-months follow-up was the lobular shape of an aneurysm (p = .01). The aneurysm's height (p = .02), maximal diameter (p = .001), width (p = .002), aspect ratio (p = .03), dome-to-neck ratio (p = .04), and lobular shape (p= .03) were predictive factors for inadequate occlusion at 24 months. All the thrombosed aneurysms (n = 3) showed unfavorable radiological outcomes and required re-treatment within 24 months. None of the patient-related factors were significant. CONCLUSIONS The WEB provides favorable occlusion rates and low complications for both ruptured and unruptured wide-necked IAs. Unfavorable radiological outcomes after WEB treatment may be related to aneurysm morphology and size.
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Affiliation(s)
- Kemal Alpay
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Antti Lindgren
- Department of Clinical Radiology, 60650Kuopio University Hospital, Kuopio, Finland
| | - Riitta Rautio
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
- 60652Turku University, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
- 60652Turku University, Turku, Finland
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Pierot L, Szikora I, Barreau X, Holtmannspoetter M, Spelle L, Klisch J, Herbreteau D, Costalat V, Fiehler J, Januel AC, Liebig T, Stockx L, Weber W, Berkefeld J, Moret J, Molyneux A, Byrne J. Aneurysm treatment with the Woven EndoBridge (WEB) device in the combined population of two prospective, multicenter series: 5-year follow-up. J Neurointerv Surg 2022; 15:552-557. [PMID: 35803731 DOI: 10.1136/neurintsurg-2021-018414] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evaluating a new endovascular treatment for intracranial aneurysms must not only demonstrate short-term safety and efficacy, but also evaluate longer-term outcomes (eg, delayed complications, anatomical results, retreatment). The current analysis reports the 5-year clinical and anatomical results of Woven EndoBridge (WEB) treatment in two European combined trial populations (WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy) and WEBCAST-2). METHODS All adverse events occurring between the procedure and 5-year follow-up were independently evaluated by an expert. Aneurysm occlusion was evaluated by an independent core laboratory using a three-grade scale: complete occlusion, neck remnant, and aneurysm remnant. In cases where data were not available at 5-year follow-up, the last observation carry forward (LOCF) method was used. RESULTS The safety and efficacy populations comprised 100 patients and 95 aneurysms, respectively. No adverse event related to the device occurred after the procedure during the 5-year follow-up period. Mortality at 5 years was 7.0% (7/100 patients) including mortality related to the WEB (0/100, 0.0%), the procedure (1/100, 1.0%), and another condition (6/100, 6.0%). At 5 years, complete aneurysm occlusion was observed in 49/95 (51.6%) aneurysms, neck remnant in 25/95 (26.3%), and aneurysm remnant in 21/95 (22.1%). Retreatment rate at 5 years was 11.6% (11/95 aneurysms). CONCLUSIONS This analysis conducted in a population of patients with wide-neck bifurcation aneurysms confirms WEB's safety profile. Additional evidence demonstrates good stability of aneurysm occlusion with adequate occlusion (complete occlusion or neck remnant) at 5 years in 77.9% of aneurysms with a low retreatment rate (11.6%). CLINICAL TRIAL REGISTRATION WEBCAST and WEBCAST-2: Unique identifier: NCT01778322.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, CHU Reims, Reims, Champagne-Ardenne, France
| | - Istvan Szikora
- Neurointerventions, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Xavier Barreau
- Neuroradiology Department, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Markus Holtmannspoetter
- Interventional and Diagnostic Neuroradiology, Nuremberg Hospital Campus South, Nurnberg, Germany
| | - Laurent Spelle
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France.,Neuroradiology, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Joachim Klisch
- Neuroradiology, Helios Klinikum Erfurt, Erfurt, Thüringen, Germany
| | | | - Vincent Costalat
- Neuroradiology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich, Munchen, Bayern, Germany
| | - Luc Stockx
- Neuroradiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Werner Weber
- Radiology and Neuroradiology, Ruhr-Universität Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Hessen, Germany
| | - Jacques Moret
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France
| | - Andy Molyneux
- Neurovascular and Neuroradiology Research Unit, Oxford University, Oxford, UK
| | - James Byrne
- Department of Neuroradiology, Oxford University, Oxford, UK
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7
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Delayed rupture of an anterior communicating artery aneurysm after elective Woven EndoBridge embolization, re-treated with microsurgical clipping: operative technique and systematic review. World Neurosurg 2022; 165:188-197.e1. [PMID: 35697227 DOI: 10.1016/j.wneu.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is designed for intrasaccular flow disruption for embolization of intracranial aneurysms. In limited experience so far, the rate of rupture after adequate occlusion by embolization is low. TECHNICAL REPORT A 58-year-old man initially had an incidental, unruptured 10.4 mm anterior communicating artery (ACoA) aneurysm treated with WEB embolization. Although his 6-month follow-up angiogram showed adequate occlusion of the aneurysm, he presented to our facility with aneurysmal recurrence due to WEB compaction and rupture. This was treated with surgical clipping of the aneurysm. METHODS The literature was systematically reviewed for cases of delayed rupture after WEB embolization. Statistical analyses included studies with at least 20 patients and follow-up of 3 months. RESULTS We identified 36 studies, which were primarily retrospective observational studies. The rate of complete occlusion ranged from 33% to 89%, and the rate of re-treatment ranged from 1.5% to 27%. Across four studies, the rate of recanalization ranged from 8.7% to 13%. Two cases of delayed rupture were reported; an additional four cases were found in case reports and case series. In only one previous case, the aneurysm was reported as previously untreated. CONCLUSION Early retrospective data has begun to define the history of WEB-treated aneurysms. Rupture of a previously unruptured, WEB-treated aneurysm with adequate initial occlusion is rare. We describe such a case with techniques for management, demonstrating that aneurysm recurrence and delayed rupture is possible despite good interim angiographic result. This report raises questions about follow-up for WEB-treated aneurysms.
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8
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Srinivasan VM, Dmytriw AA, Regenhardt RW, Vicenty-Padilla J, Alotaibi NM, Levy E, Waqas M, Cherian J, Johnson JN, Jabbour P, Sweid A, Gross B, Starke RM, Puri A, Massari F, Griessenauer CJ, Catapano JS, Rutledge C, Tanweer O, Yashar P, Cortez GM, Aziz-Sultan MA, Patel AB, Ducruet AF, Albuquerque FC, Hanel RA, Lawton MT, Kan P. Retreatment of Residual and Recurrent Aneurysms After Embolization With the Woven EndoBridge Device: Multicenter Case Series. Neurosurgery 2022; 90:569-580. [PMID: 35244028 PMCID: PMC9524592 DOI: 10.1227/neu.0000000000001883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Woven EndoBridge (WEB) device (Terumno Corp. [parent company of Microvention]) was approved by the U.S. Food and Drug Administration as the first intrasaccular device for intracranial aneurysm treatment in December 2018. Its use has become more common since then, but both trial results and postmarket experiences have raised questions about the efficacy in achieving complete aneurysm obliteration. Retreatment after WEB embolization has not been extensively discussed. OBJECTIVE To discuss the incidence and retreatment of aneurysms after initial WEB embolization. METHODS Retrospective review across 13 institutions identified all occurrences of WEB retreatment within neurovascular databases. Details regarding demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed. RESULTS Thirty aneurysms were retreated in 30 patients in a cohort of 342 WEB-treated aneurysms. The retreatment rate was 8.8%. Endovascular methods were used for 23 cases, and 7 were treated surgically. Two aneurysms presented with rehemorrhage after initial WEB embolization. Endovascular treatments included stent-assisted coiling (12), flow diversion (7), coiling (2), PulseRider (Johnson & Johnson)-assisted coiling (1), and additional WEB placement (1). Surgical treatments included primary clipping (6) and Hunterian ligation (1). There were no major complications within the study group. CONCLUSION WEB retreatments were successfully performed by a variety of techniques, including stent-assisted coiling, clipping, and flow diversion as the most common. These procedures were performed safely with subsequent obliteration of most aneurysms. The potential need for retreatment of aneurysms should be considered during primary WEB treatments.
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Affiliation(s)
- Visish M. Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA;
| | - Adam A. Dmytriw
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - Robert W. Regenhardt
- NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Juan Vicenty-Padilla
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - Naif M. Alotaibi
- NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Elad Levy
- Department of Neurological Surgery, Jacobs School of Medicine at Biomedical Sciences, Buffalo, New York, USA;
| | - Muhammad Waqas
- Department of Neurological Surgery, Jacobs School of Medicine at Biomedical Sciences, Buffalo, New York, USA;
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA;
| | - Jeremiah N. Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA;
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA;
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA;
| | - Bradley Gross
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - Robert M. Starke
- Department of Neurosurgery, University of Miami, Miami, Florida, USA;
| | - Ajit Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA;
| | - Francesco Massari
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA;
| | - Christoph J. Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA;
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria, USA;
| | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA;
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA;
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA;
| | | | - Gustavo M. Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA;
| | - Mohammad A. Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - Aman B. Patel
- NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Andrew F. Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA;
| | | | - Ricardo A. Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA;
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA;
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
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9
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Abbas R, El Naamani K, Sweid A, Birkenstock L, Ruiz R, Tjoumakaris S, Gooch MR, Herial NA, Rosenwasser RH, Jabbour P. Retreatment Strategies in Aneurysm Woven Endobridge Recurrences: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:201-207. [PMID: 35240675 DOI: 10.1227/ons.0000000000000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of wide-necked and bifurcation aneurysms has become a common indication for the Woven Endobridge (WEB) device. In many instances, WEB embolization fails and retreatment strategies for the recanalized aneurysms have not been established and may be challenging. OBJECTIVE To report an experience with retreatment strategies after WEB failure in 7 cases involving various aneurysm shapes, sizes, and location using multiple strategies including endovascular modalities and microsurgical clip ligation. METHODS Data were retrospectively collected from 1 high-volume cerebrovascular center for 7 patients treated with a WEB device for an aneurysm who subsequently required retreatment for that same aneurysm from 2015 through January 2021. RESULTS We identified 7 patients with WEB recurrences over a period of 6 years. Four patients initially presented with incidental findings, whereas 3 patients presented with subarachnoid hemorrhage. One patient was lost to follow-up and presented with a rerupture, whereas the 6 other patients were diagnosed with routine follow-up. Two patients received clip ligation, 2 had simple coil embolization, 1 had stent-assisted coil embolization, 1 had a flow-diverting stent, and 1 patient required 2 retreatments; he received stent-assisted coil embolization for the first retreatment and a simple coil embolization for the second retreatment. All patients had excellent angiographic outcomes and no complications. CONCLUSION The authors conclude that aneurysm recurrence after WEB is very diverse, and no single modality can properly address all recurrences. Rather, an individualized approach based on aneurysm features, neurointerventionalist expertise, and patient preference should be implemented.
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Affiliation(s)
- Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Lyena Birkenstock
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramon Ruiz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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10
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Pierot L. Ten Years of Clinical Evaluation of the Woven EndoBridge: A Safe and Effective Treatment for Wide-Neck Bifurcation Aneurysms. Neurointervention 2021; 16:211-221. [PMID: 34674453 PMCID: PMC8561039 DOI: 10.5469/neuroint.2021.00395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
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11
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Heiferman DM, Peterson JC, Johnson KD, Nguyen VN, Dornbos D, Moore KA, Inoa V, Hoit DA, Arthur AS. Woven EndoBridge Embolized Aneurysm Clippings: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E365. [PMID: 34171908 DOI: 10.1093/ons/opab218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
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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Affiliation(s)
| | - Jeremy C Peterson
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | | | - Vincent N Nguyen
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - David Dornbos
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Kenneth A Moore
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Violiza Inoa
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurology, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Daniel A Hoit
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
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12
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Peterson C, Cord BJ. Recurrent and Residual Aneurysms After Woven EndoBridge (WEB) Therapy: What's Next? Cureus 2021; 13:e14404. [PMID: 33981516 PMCID: PMC8109841 DOI: 10.7759/cureus.14404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 01/23/2023] Open
Abstract
The prevalence of recurrent and residual aneurysms following Woven EndoBridge (WEB) treatment is not insignificant. The goal of this systematic review was to evaluate retreatment methods for such aneurysms and their outcomes. PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Original studies reporting on aneurysms that were retreated after WEB were included. Sixteen studies (n = 901 aneurysms), of which three were prospective, reported on retreated aneurysms following initial WEB treatment. Of those 901 aneurysms, on average 18.7 ± 11.5% were recurrent or residual at the last follow-up and 10.7 ± 11% required some form of retreatment. When compared to WEB-IT (WEB Intra-saccular Therapy) data, retreated aneurysms were more likely to be large in size (p < 0.0001) and more likely to have been initially treated with the WEB dual-layer configuration. The mean age of those with retreated aneurysms was 58 ± 5.7 years old, and the mean size of aneurysm dome was 11.1 ± 5.5 millimeters. Majority (34.1%) of the aneurysms were located at the basilar apex. Retreatment modalities included coiling (20%), stent-assisted coiling (38.7%), additional WEB device (13.3%), flow diversion (16%), and clipping (12%). Majority of retreated cases had favorable outcomes, with 96.4 ± 13.4% of the cases demonstrating technical success and 90.5 ± 18.2% having adequate occlusion at the last follow-up. Our systematic review suggests that retreatment of recurrent and residual aneurysms after initial WEB treatment is feasible. Future prospective studies would be helpful in validating these results.
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Affiliation(s)
| | - Branden J Cord
- Neurological Surgery, University of California Davis, Sacramento, USA
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13
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Pierot L, Szikora I, Barreau X, Holtmannspoetter M, Spelle L, Herbreteau D, Fiehler J, Costalat V, Klisch J, Januel AC, Weber W, Liebig T, Stockx L, Berkefeld J, Moret J, Molyneux A, Byrne J. Aneurysm treatment with WEB in the cumulative population of two prospective, multicenter series: 3-year follow-up. J Neurointerv Surg 2021; 13:363-368. [PMID: 32532858 PMCID: PMC7982938 DOI: 10.1136/neurintsurg-2020-016151] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND WEB treatment is an endovascular approach for wide-neck bifurcation aneurysms that has demonstrated high safety and good efficacy in mid-term follow-up. While evaluating safety in the long term is important to determine if delayed adverse events occur affecting late morbidity and mortality, the most important point to evaluate is the long-term stability of aneurysm occlusion. The current analysis reports the 3-year clinical and anatomical results of WEB treatment in the combined population of two European trials (WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy) and WEBCAST-2). METHODS Aneurysm occlusion was evaluated using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The safety population comprised 79 patients. The efficacy population comprised 61 aneurysms. Aneurysm locations were middle cerebral artery in 32/61 aneurysms (52.5%), anterior communicating artery in 13/61 (21.3%), basilar artery in 9/61 (14.8%), and internal carotid artery terminus in 7/61 (11.5%). No adverse events related to the device or procedure occurred between 2 and 3 years. At 3 years, complete occlusion was observed in 31/61 (50.8%) aneurysms, neck remnant in 20/61 (32.8%), and aneurysm remnant in 10/61 (16.4%). Between 1 year and 3 years, aneurysm occlusion was improved or stable in 53/61 (86.9%) aneurysms and worsened in 8/61 (13.1%). Worsening was mostly from complete occlusion to neck remnant in 6/61 (9.8%) aneurysms. The retreatment rate at 3 years was 11.4%. CONCLUSIONS This analysis confirms the high safety profile of WEB. Moreover, evidence demonstrates the great stability of aneurysm occlusion with adequate occlusion (complete occlusion or neck remnant) in 83.6% of aneurysms. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. WEBCAST and WEBCAST-2: Unique identifier: NCT01778322.
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Affiliation(s)
| | - Istvan Szikora
- Neurointerventions, National Institute of Clinical Neurosciences, Budapest, Budapest, Hungary
| | | | - Markus Holtmannspoetter
- Neuroradiology Department, Nuremberg General Hospital, Paracelsius Medical University, Nürnberg, Germany
| | - Laurent Spelle
- Interventional Neuroradiology, CHU Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
| | | | - Jens Fiehler
- Department of Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Vincent Costalat
- Neuroradiology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Joachim Klisch
- Institute of Diagnostic and Intervenional Radiology and Neuroradiology, HELIOS Klinikum Erfurt Klinik für Frauenheilkunde und Geburtshilfe, Erfurt, Thuringia, Germany
| | | | - Werner Weber
- Radiology and Neuroradiology, Ruhr-Universitat Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Thomas Liebig
- Neuroradiology, University Hospital Munich, Munchen, Bayern, Germany
| | - Luc Stockx
- Neuroradiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Joachim Berkefeld
- Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Jacques Moret
- Interventional Neuroradiology, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
| | - Andy Molyneux
- Neurovascular and Neuroradiology Research Unit, Oxford University, Oxford, Oxfordshire, UK
| | - James Byrne
- Department of Neuroradiology, Nuffield Department of Surgical Sciences, Oxford University, Oxford, Oxfordshire, UK
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14
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Spuentrup E, Spüntrup C, Bytyqi F, Kabbasch C, Walter J. Aneurysm Rupture 5.5 Years after Woven EndoBridge device (WEB) Implantation. Clin Neuroradiol 2021; 31:875-880. [PMID: 33687482 DOI: 10.1007/s00062-021-01004-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Elmar Spuentrup
- Institute of Radiology, Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Germany. .,Neurovascular Center, Klinikum Saarbrücken, Saarbrücken, Germany.
| | | | - Fortesa Bytyqi
- Neurovascular Center, Klinikum Saarbrücken, Saarbrücken, Germany.,Department of Neurosurgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | | | - Jan Walter
- Neurovascular Center, Klinikum Saarbrücken, Saarbrücken, Germany.,Department of Neurosurgery, Klinikum Saarbrücken, Saarbrücken, Germany
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15
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Moore KA, Goyal N, Arthur AS. The Woven EndoBridge embolization device for the treatment of intracranial wide-necked bifurcation aneurysms. Future Cardiol 2021; 17:953-961. [PMID: 33559501 DOI: 10.2217/fca-2020-0173] [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: 11/21/2022] Open
Abstract
Wide-necked bifurcation aneurysms are common when evaluating both ruptured and unruptured intracranial aneurysms and can pose unique challenges. The Woven EndoBridge device (recently approved in the US) is specifically designed for the treatment of these aneurysms. This article serves to introduce the device to a wider audience with a thorough review of the literature, device design, indications, pre-operative evaluation, procedural usage and potential pitfalls.
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Affiliation(s)
- Kenneth A Moore
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Nitin Goyal
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,Semmes-Murphey Clinic, Memphis, TN 38120, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA.,Semmes-Murphey Clinic, Memphis, TN 38120, USA
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16
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[Woven-EndoBridge (WEB) as an intrasaccular method of aneurysm occlusion]. Radiologe 2020; 60:310-316. [PMID: 32179958 DOI: 10.1007/s00117-020-00671-9] [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: 10/24/2022]
Abstract
CLINICAL PROBLEM The treatment of intracranial wide-necked bifurcation aneurysms-which account for approximately 26-36% of all brain aneurysms-can be challenging both endovascularly and surgically, as a complete cut-off of the blood flow into the aneurysm should be achieved without disruption of the flow into the bifurcation vessels. Intrasacular flow disruption with the Woven-EndoBridge (WEB) is an innovative technique for the treatment of such aneurysms. This review article discusses various aspects of the treatment of intracranial aneurysms with the WEB device, including indications, aneurysm/device selecting strategies, antiplatelet therapy requirements, procedural technique and potential complications. PRACTICAL RECOMMENDATIONS Intrasacular flow disruption with the WEB device is a safe and effective treatment method for intracranial wide-necked bifurcation aneurysms, especially for patients with ruptured aneurysms, in patients with contraindications for antiplatelet therapy, and for patients in whom clipping is associated with high risks.
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17
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Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, Holtmannspötter M, Januel AC, Costalat V, Fiehler J, Klisch J, Gauvrit JY, Weber W, Desal H, Velasco S, Liebig T, Stockx L, Berkefeld J, Molyneux A, Byrne JV, Spelle L. Aneurysm Treatment With Woven EndoBridge in the Cumulative Population of 3 Prospective, Multicenter Series: 2-Year Follow-Up. Neurosurgery 2020; 87:357-367. [PMID: 31960052 PMCID: PMC7534535 DOI: 10.1093/neuros/nyz557] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Woven EndoBridge (WEB; Sequent Medical) treatment is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown high safety with good efficacy at short term confirmed by trials conducted in United States (WEB-Intrasaccular Therapy) and in Europe (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy [WEBCAST], French Observatory, and WEBCAST-2). OBJECTIVE To report the 2-yr clinical and anatomical results of WEB treatment in the combined population of 3 European trials. METHODS In a French Observatory, 2-yr clinical and anatomical data were collected. In WEBCAST and WEBCAST-2, 2-yr follow-up was optional, and data were collected when follow-up was performed. Aneurysm occlusion was evaluated using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS The population for safety was 138/168 patients (82.1%), including 89 females (64.5%), with mean age of 55.5 ± 10.2 yr. The population for efficacy was 121/169 aneurysms (71.6%). Aneurysm locations were middle cerebral artery in 65/121 aneurysms (53.7%), anterior-communicating artery in 25/121 (20.7%), basilar artery in 17/121 (14.0%), and internal carotid artery terminus in 14/121 (11.6%). No clinically relevant adverse events occurred between years 1 and 2. At 2 yr, complete occlusion was observed in 62/121 (51.2%) aneurysms, neck remnant in 36/121 (29.8%) aneurysms, and aneurysm remnant in 23/121 (19.0%) aneurysms. The global retreatment rate at 2 yr was 9.3%. CONCLUSION This analysis confirms the high safety profile of WEB treatment at 2 yr. Aneurysm occlusion is generally stable at 2 yr, and the retreatment rate between 1 yr and 2 yr is low (2.0%).
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Jacques Moret
- Department of Neuroradiology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Barreau
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Istvan Szikora
- Department of Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | | | | | | | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Klisch
- Department of Neuroradiology, Helios General Hospital, Erfurt, Germany
| | | | - Werner Weber
- Department of Neuroradiology, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Hubert Desal
- Department of Neuroradiology, CHU Nantes, Nantes, France
| | | | - Thomas Liebig
- Institut of Neuroradiology, Ludwig-Maximilian University Hospital, Munich, Germany
| | - Luc Stockx
- Department of Neuroradiology, ZOL (Ziekenhuis Oost-Limburg) Genk, Genk, Belgium
| | - Joachim Berkefeld
- Department of Neuroradiology, Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt, Germany
| | - Andrew Molyneux
- Department of Neuroradiology, Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom
| | - James V Byrne
- Department of Neuroradiology, Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom
| | - Laurent Spelle
- Department of Neuroradiology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
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18
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Nguyen HA, Soize S, Manceau PF, Vudang L, Pierot L. Persistent Blood Flow inside the Woven EndoBridge Device More Than 6 Months after Intracranial Aneurysm Treatment: Frequency, Mechanisms, and Management-A Retrospective Single-Center Study. AJNR Am J Neuroradiol 2020; 41:1225-1231. [PMID: 32527839 DOI: 10.3174/ajnr.a6593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Due to its high safety and great efficacy, flow disruption with the Woven EndoBridge (WEB) device is increasingly used to treat intracranial aneurysms. We recently identified patients with intracranial aneurysm treated with the WEB who presented with residual blood flow inside the device ("contrast-in-WEB" phenomenon) more than 6 months posttreatment. This series reports the frequency and underlying mechanisms and discusses management of this phenomenon. MATERIALS AND METHODS All patients presenting with the contrast-in-WEB phenomenon in the prospectively collected data base of patients with aneurysm treated with the WEB were retrospectively collected and analyzed. RESULTS From June 2011 to February 2019, one hundred twenty-seven patients with 133 aneurysms were treated with the WEB and had DSA follow-up at 6 months or later. Eight patients (6.3%) presented with the phenomenon. All aneurysms were wide-neck bifurcation aneurysms, including 7 unruptured and 1 ruptured aneurysm located at the MCA (5 aneurysms), anterior communicating artery (2 aneurysms), and basilar artery (1 aneurysm). All except 1 patient received dual-antiplatelet therapy preprocedure. All except 1 patient received dual-antiplatelet therapy postoperatively for at least 1 month. The most likely mechanism of the phenomenon is the absence of intradevice thrombosis related to perioperative dual-antiplatelet medication. The phenomenon is also likely associated with a low risk of bleeding except when there is residual blood flow against the aneurysm wall or in the dome. CONCLUSIONS Contrast-in-WEB is a relatively rare phenomenon possibly induced by dual-antiplatelet therapy continued post-WEB procedure. In most cases, no additional treatment is required.
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Affiliation(s)
- H A Nguyen
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - S Soize
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - P-F Manceau
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - L Vudang
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
| | - L Pierot
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France.
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19
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Goyal N, Hoit D, DiNitto J, Elijovich L, Fiorella D, Pierot L, Lamin S, Spelle L, Saatci I, Cekirge S, Arthur AS. How to WEB: a practical review of methodology for the use of the Woven EndoBridge. J Neurointerv Surg 2020; 12:512-520. [PMID: 32005760 PMCID: PMC7231463 DOI: 10.1136/neurintsurg-2019-015506] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
Wide-necked bifurcation aneurysms (WNBAs) make up 26-36% of all brain aneurysms. Treatments for WNBAs pose unique challenges due to the need to preserve major bifurcation vessels while achieving a durable occlusion of the aneurysm. Intrasaccular flow disruption is an innovative technique for the treatment of WNBAs. The Woven EndoBridge (WEB) device is the only United States Food and Drug Administration approved intrasaccular flow disruption device. In this review article we discuss various aspects of treating WNBAs with the WEB device, including indications for use, aneurysm/device selection strategies, antiplatelet therapy requirement, procedural technique, potential complications and bailouts, and management strategies for residual/recurrent aneurysms after initial WEB treatment.
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Affiliation(s)
- Nitin Goyal
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel Hoit
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Julie DiNitto
- Department of Research Collaborations, Siemens Medical Solutions USA Inc, Hoffman Estates, Illinois, USA
| | - Lucas Elijovich
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neuroradiology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Laurent Pierot
- Neuroradiology, Reims Champagne-Ardenne University, Reims, France
| | - Saleh Lamin
- Department of Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laurent Spelle
- Neuroradiology, NEURI Center, Bicetre Hospital, APHP, Paris-Saclay University, Saint-Aubin, France
| | - Isil Saatci
- Radiology, Koru Hospital, Yuksek Ihtisas Universitesi, Ankara, Turkey
| | - Saru Cekirge
- Radiology, Bayindir Hastanesi Kavaklidere, Ankara, Turkey
| | - Adam S Arthur
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
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