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

Abstract

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.

The New Low-Profile WEB 17 System for Treatment of Intracranial Aneurysms: First Clinical Experiences

“…Our first results with the WEB 17 are in line with other studies using previous generations of the WEB or coils to treat intracranial aneurysms. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] In a meta-analysis by Asnafi et al, 7 15 uncontrolled series were included, totaling 565 patients with 588 aneurysms treated with the WEB, of which 127 were ruptured. Initial complete and adequate occlusion rates were 27% and 59%, respectively.…”

“…Most of the published series comprised wideneck, unruptured aneurysms. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] The first-generation WEBs required 0.027-to 0.033-inch microcatheters for delivery. In 2015, the WEB was redesigned for a 0.021-inch delivery microcatheter (WEB 21) in sizes ranging from 4 to 7 mm.…”

Safety results from the treatment of 109 cerebral aneurysms using the Woven EndoBridge technique: preliminary results in the United Kingdom

“…The recently developed Leeds WEB aneurysm occlusion scale has been carefully developed to include the nuances of the WEB device and will be invaluable for future monitoring of the device. 13 This series has a wide selection of predominantly widenecked aneurysms, a range of aneurysm locations, and a significant proportion of acute cases. The data suggest that the WEB device is a useful treatment option that makes more complex, wide-necked bifurcation aneurysms good candidates for endovascular treatment.…”

What is the hemodynamic effect of the Woven EndoBridge? An in vivo quantification using time-density curve analysis

“…In the first presentation of the WEB, the intraaneurysmal flow modulation after implantation was assessed only by visual analysis of intraaneurysmal contrast stagnation on digital subtraction angiography (DSA) series based on a scale not previously validated [10]. Alternatively, visual assessment of DSA series according to the Raymond scale [11], the Leeds WEB aneurysm occlusion scale [12], or the WEB occlusion scale [13] has been described, but quantifiable in vivo data are lacking. Furthermore, aneurysm recurrence after WEB implantation can occur [14] and it is not yet fully understood which aneurysms are more likely to recanalize and which flow parameters might play a role.…”