Clipping of recanalized intracerebral aneurysms initially treated by the Woven EndoBridge device

Abstract

Background and purposeIntrasaccular flow disruption using the Woven EndoBridge (WEB) is a safe and effective method to treat intracranial aneurysms, particularly wide neck bifurcation aneurysms. However mid term and long term follow-up imaging can show aneurysm remnant or recanalization, and retreatment is therefore sometimes necessary. In most cases, retreatment is performed using an endovascular approach. The present series reports and analyzes aneurysm clipping of recanalized or incompletely occluded aneurysms following WEB treatment.MethodsAll patients treated with the WEB device since the beginning of our experience in June 2011 were prospectively collected in a local database. Among them, patients who were retreated by clipping for aneurysm remnants were included in the present series.ResultsIn the cumulative population of 130 patients with aneurysms treated by the WEB device from June 2011 to February 2019, 4 patients (3.1%) were retreated with surgical clipping due to incomplete occlusion (2 patients) and aneurysm recanalization (2 patients). Three of the four aneurysms retreated (75%) were located in the middle cerebral artery and one in the anterior communicating artery (25.0%). The aneurysm was ruptured in 1 of 4 patients (25%). Clipping was performed 10–54 months after initial treatment with the WEB. Surgical exposure showed that the WEB device was inside the aneurysm sac in all cases. Clipping was easily performed in all but 1 case. Control DSA showed complete occlusion in two aneurysms and a neck remnant in two.ConclusionClipping is a feasible option for treating aneurysm remnants following initial treatment with intrasaccular flow disruption using the WEB.

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

“…Potential additional treatments have been discussed previously in the literature. 24,25 Contrast-in-WEB Phenomenon and WEB Shape Modification An ancillary finding in this series is that in cases of the contrast-in-WEB phenomenon, there is no WEB shape modification. This phenomenon was initially reported by Cognard and Januel 15 and erroneously named "compression."…”

Aneurysm Treatment With Woven EndoBridge in the Cumulative Population of 3 Prospective, Multicenter Series: 2-Year Follow-Up

“…At 2 yr, the global rate of retreatment from initial procedure was 9.2% of aneurysms, with the majority of retreatment completed prior to 1 yr. Several treatment modalities were used, including stent-assisted coiling, flow diversion, and clipping, as reported in previous series. 24 , 25 Rates of retreatment are difficult to compare from one series to another given variable indications for retreatment. 26 However, the rate of retreatment in wide-neck aneurysms is 13.7% in aneurysms treated with coils and 14.1% in aneurysms treated by stent-assisted coiling in the MAPS trial.…”

How to WEB: a practical review of methodology for the use of the Woven EndoBridge

“…In these cases, conventional stent-assisted coiling remains feasible (figure 15). Early experience has also indicated that clipping residual or recurrent aneurysms after WEB treatment is also quite feasible 24…”