Shape Modification is Common in Woven EndoBridge-Treated Intracranial Aneurysms: A Longitudinal Quantitative Analysis Study

Modification of Woven Endo-Bridge After Intracranial Aneurysm Treatment: A Methodology for Three-Dimensional Analysis of Shape and Relative Position Changes

During follow-up of patients treated with WEB devices, shape changes have been observed. The quantitative three-dimensional measurement of the WEB shape modification (WSM) would offer useful information to be studied in association with the anatomical results and try to better understand mechanisms implicated in this modification phenomenon. We present a methodology to quantify the morphology and position of the WEB device in relation to the vascular anatomy. Three-dimensional rotational angiography (3DRA) images of seven aneurysms patients treated with WEBs were used, which also accompanied by a post-treatment 3DRA image and a follow-up 3DRA image. The device was manually segmented, obtaining the 3D models after treatment and at the follow-up. Volume, surface area, height, maximum diameter and WSM ratio of both surfaces were calculated. Position changes were evaluated measuring WEB axis and relative position between post-treatment and follow-up. Changes in WEB volume and surface area were observed with a mean modification of - 5.04 % ( ± 14.19 ) and - 1.68 % ( ± 8.29 ) , respectively. The positional variables also showed differences, mean change of device axis direction was 26.25 % ( ± 24.09 ) and mean change of distance l b was 5.87 % ( ± 10.59 ) . Inter-observer and intra-observer variability analyses did not show differences (ANOVA p > 0.05 ). This methodology allows quantifying the morphological and position changes suffered by the WEB device after treatment, offering new information to be studied in relation to the occurrence of WEB shape modification.

WEB shape modifications: angiography-histopathology correlations in rabbits

BACKGROUND

WEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in rabbits treated with the Woven EndoBridge (WEB) procedure.

METHODS

Quantitative WSM was assessed using flat-panel computed tomography (FPCT) during follow-up by calculating height and width ratio (HR, WR), defined as the ratio between either measurement at an index time point and the measurement immediately after WEB implantation. The index time point varied from 1 day to 6 months. HR and WR were evaluated with angiographic and histopathological assessments of aneurysm healing.

RESULTS

Final HR of devices varied from 0.30 to 1.02 and final WR varied from 0.62 to 1.59. Altogether, at least 5% of HR and WR variations were observed in 37/40 (92.5%) and 28/40 (70%) WEB devices, respectively, at the time of final assessment. There was no significant correlation between complete or incomplete occlusion groups and HR or WR (p=0.15 and p=0.43). Histopathological analysis revealed a significant association between WR and aneurysm healing and fibrosis 1 month following aneurysm treatment (both p<0.05).

CONCLUSION

Using longitudinal FPCT assessment, we observed that WSM affects both the height and width of the WEB device. No significant association was found between WSM and aneurysm occlusion status. Although presumably a multifactorial phenomenon, the histopathological analysis highlighted a significant association between width variations, aneurysm healing and fibrosis in the first month following aneurysm treatment.

WEB Treatment of Ruptured Intracranial Aneurysms: Long-Term Follow-up of a Single-Center Cohort of 100 Patients

BACKGROUND AND PURPOSE

The Woven EndoBridge device (WEB) was introduced for the intrasaccular treatment of wide-neck aneurysms without the need for adjunctive devices. We used the WEB as a primary treatment for 100 ruptured aneurysms regardless of neck size or location. In this study, we present the long-term follow-up of 78 surviving patients.

MATERIALS AND METHODS

Between February 2015 and April 2017, one hundred ruptured aneurysms were treated with the WEB. For surviving patients, angiographic and clinical follow-up was scheduled at 3 months, and 3T MRA and clinical follow-up, at 6, 12, 36, and 60 months. Of 100 patients, 18 died during hospital admission, and in 4, the ruptured aneurysm was additionally treated. The remaining 78 patients had a mean follow-up of 51 months (median, 52 months; range, 5-84 months). There were 57 women and 21 men, with a mean age of 58.5 years (median, 59 years; range, 24-80 years). Of 78 aneurysms with long-term follow-up, 52 (66%) had a wide neck.

RESULTS

Of 78 ruptured aneurysms, 56 (72%) remained completely occluded and 17 (22%) had a stable small neck remnant. Five of 78 aneurysms (6%; 95% CI, 2.4%-14.5%) reopened during follow-up and were additionally treated. There were no rebleeds during follow-up.

CONCLUSIONS

Treatment of ruptured aneurysms with the WEB was safe and effective and has long-term results comparable with those of simple coiling of small-neck aneurysms. The WEB proved to be a valuable alternative to coils for both wide- and small-neck ruptured aneurysms without the need for stents, balloons, or antiplatelet therapy.

A mini-review of intrasaccular flow diverters

Treatment of wide-necked complex intracranial aneurysms continues to challenge neurointerventionalists. Intrasaccular flow diverters have expanded the armamentarium considerably and are now used extensively. While five types of devices have already obtained the CE mark for use within Europe, only the Woven EndoBridge (WEB) device is approved by the US Food and Drug Administration. Other intrasaccular devices are the Luna/Artisse Aneurysm Embolization System (Medtronic), the Medina Embolic Device (Medtronic), the Contour Neurovascular System (Cerus), and the Neqstent Coil Assisted Flow Diverter (Cerus). This mini review will provide a compact overview of these devices and a summary of the current literature.

Woven EndoBridge in Wide-Neck Bifurcation Aneurysms: Digital Subtraction Angiography at 3-Year Follow-Up

Introduction: The Woven EndoBridge (WEB) device is a self-expanding intrasaccular braided-wire device for the treatment of wide-neck bifurcation aneurysms (WNBAs). Even though this device has an excellent safety profile and a low risk of rebleeding, little is known about its long-term effects. Material and Methods: All patients treated with WEB due to ruptured WNBAs were subjected to follow-up digital subtraction angiography (DSA) at 2 and 3 years after device deployment. The degree of residual neck was assessed through BOSS, Lubicz, and WEBCAST scales. Data on modified Rankin scale (mRS), bleeding events, and ischemic events occurring during this time period were collected as well. Lastly, overall and procedure-related mortality rates were calculated. Results: A total of 21 patients were treated between 1 January 2016, and 31 December 2018. DSA demonstrated a patency grade of 57.1% and 61.1% at 2 and 3 years, respectively. The overall 2-year mortality rate due to causes unrelated to the aneurysm was 14.3%. None of the patients were retreated between the 2- and the 3-year follow-up. No rebleeding or stroke events occurred during the follow-up. Conclusions: WEB-treated ruptured aneurysms showed an excellent degree of stability over time. The overall mortality rate—unrelated to the procedure–observed in our sample was higher than what reported in the literature, a possible bias associated with the COVID-19 pandemic.

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

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.