Extending the Indication of Woven EndoBridge (WEB) Embolization to Internal Carotid Artery Aneurysms: A Multicenter Safety and Feasibility Study

Goertz, Lukas; Liebig, Thomas; Siebert, Eberhard; Herzberg, Moriz; Borggrefe, Jan; Lichtenstein, Thorsten; Dorn, Franziska; Kabbasch, Christoph

doi:10.1016/j.wneu.2019.02.198

Cited by 30 publications

(14 citation statements)

References 25 publications

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“…Flow disruption by WEB implanting has emerged as an innovative endovascular concept for aneurysm treatment [3][4][5][6][7][8], but quantifiable data concerning the hemodynamic effect of this treatment strategy are lacking. In our study, we investigated in vivo hemodynamic changes following WEB deployment using TDC analysis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Purpose Using the Woven EndoBridge (WEB) for aneurysm treatment has emerged as endovascular approach aiming for flow disruption in aneurysm sac. Since quantifiable data confirming the hemodynamic effect are lacking, we investigated in vivo aneurysmal flow alterations using time-density curve (TDC) analysis. Additionally, we evaluated whether flow parameters could be identified as independent factor to predict aneurysm occlusion. Methods Forty cerebral aneurysm patients treated with WEB were enrolled. Pre-and postinterventional digital subtraction angiography series were postprocessed and TDCs generated. TDCs were quantified calculating the parameters aneurysmal inflow velocity, outflow velocity, mean flow velocity, and relative time-to-peak (rTTP) of aneurysm filling. Pre-and postinterventional values were compared and related to occlusion rate. Results WEB implanting induced highly significant rTTP prolongation by 52% (p = 0.001) and highly significant decrease of aneurysmal inflow, outflow, and mean flow velocity (p < 0.001). While outflow velocity was reduced by 49%, inflow velocity was reduced by 33% only. No statistically significant difference between the occluded and the non-occluded group was observed. No flow parameter reached significance level concerning predicting aneurysm occlusion. Conclusion Flow quantification confirms a significant flow-disrupting effect of WEB reducing more the outflow than the inflow velocity. In our small cohort, no flow parameter reached statistical significance to show predictive value regarding complete aneurysm occlusion. The hemodynamic effect of WEB is on comparable level to flow-diverting stents meaning that aneurysm closure can be delayed. In case of only slight inflow changes and high aneurysmal hemodynamic stress, some aneurysms might not be adequately protected in the short term.

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Section: Discussionmentioning

confidence: 99%

“…Actually, the new fifth generation of the WEB (WEB 17) is available. Several studies have demonstrated the safety and efficiency of the WEB [3][4][5][6][7][8][9]. But less is known about the precise intraaneurysmal flow alterations induced by the WEB and its real hemodynamic efficiency.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…In a previous study on ICA sidewall aneurysms, we reported deployment failure due to malrotation of the device after delivery of the pWEB in 2 aneurysms with sharp aneurysm angles. 21 Because WEB positioning could not be improved, the WEBs were finally removed and the aneurysms were treated with standard coiling. We speculate that treatment of these aneurysms would have been possible with the low-profile WEB 17.…”

Section: Discussionmentioning

confidence: 99%

Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility

Goertz

Liebig²,

Siebert

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The Woven EndoBridge 17 has recently been introduced to the market for facilitated endovascular treatment of small bifurcation aneurysms (7 mm) with low-profile microcatheters. We compared the Woven EndoBridge 17 with its predecessor versions in terms of procedural safety and feasibility. MATERIALS AND METHODS: This was a multicenter review of aneurysms ranging from 3 to 7 mm treated with the Woven EndoBridge between 2011 and 2019. Aneurysm characteristics, procedural parameters, and complications were retrospectively compared between treatment with the Woven EndoBridge 17 and a control group that was treated with its predecessor versions, using inverse probability of treatment weighting. RESULTS: Thirty-eight aneurysms treated with a Woven EndoBridge 17 (mean size, 4.9 6 1.5 mm) and 70 treated with a predecessor version of the Woven EndoBridge 17 (mean size, 5.6 6 1.4 mm) were included. The predecessor version of the Woven EndoBridge 17 had a higher failure rate (10.3%) than the Woven EndoBridge 17 (0%, P = .05). Additional stent placement was performed more often with the predecessor version of the Woven EndoBridge 17 (10.0%) than with the Woven EndoBridge 17 (2.6%, adjusted P = .005). The predecessor version of the Woven EndoBridge 17 was associated with a higher thromboembolic event rate (14.3%) than the Woven EndoBridge 17 (5.3%, adjusted P = .002). Neurologic complications (Woven EndoBridge 17: 2.6%; predecessor version of the Woven EndoBridge 17: 2.9%, adjusted P = 1.0) and immediate complete aneurysm occlusion rates (Woven EndoBridge 17: 57.9%; predecessor version of the Woven EndoBridge 17: 54.3%, adjusted P = .21) did not differ significantly between groups. CONCLUSIONS: In the current study, the Woven EndoBridge 17 was associated with a potentially lower thromboembolic event rate than the predecessor version of the Woven EndoBridge 17, without compromising the immediate aneurysm occlusion rate. Long-term clinical and angiographic outcome analysis will be necessary to draw a definite conclusion. ABBREVIATIONS: AcomA ¼ anterior communicating artery; IPTW ¼ inverse probability of treatment weighting; pWEB ¼ predecessor version of the Woven EndoBridge 17; SL ¼ Single-Layer; WEB ¼ Woven EndoBridge

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“…A number of case reports and registries of ISFD have been published from European and American centers. 4–24 A meta-analysis of WEB treatments up to October 2015, which included 15 case series with 588 aneurysms, of which 127 were ruptured, yielded a midterm adequate occlusion rate of 85% (95%CI 67–98%), with adequate occlusion defined as complete occlusion or neck remnant. 25 The rates of peri-operative morbidity and mortality were 4% (95%CI 1–8%) and 1% (95%CI 0–2%), respectively.…”

Section: Introductionmentioning

confidence: 99%

The RISE trial: A Randomized Trial on Intra-Saccular Endobridge devices

et al. 2019

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Background Wide-necked bifurcation aneurysms (WNBA) are a difficult subset of aneurysms to successfully repair endovascularly, and a number of treatment adjuncts have been designed to improve on the results of coiling, including stenting and flow diversion of the parent vessel. Surgical clipping is commonly performed for certain WNBAs, such as middle cerebral aneurysms, in some centres. Intra-saccular flow diversion (ISFD) using the Woven Endo-Bridge (WEB) or similar devices, has been developed as a new endovascular alternative to coiling for WNBAs. Meta-analyses of case series suggest satisfactory results, both in terms of safety and efficacy, but in the absence of randomized evidence, whether ISFD leads to better outcomes for patients with WNBA remains unknown. There is a need to offer ISFD within the context of a randomized care trial. Methods The proposed trial is a multicentre, randomized controlled care trial comparing ISFD and best conventional management option (surgical or endovascular), as determined by the treating physician prior to randomized allocation. At least 250 patients will be recruited in at least 10 centres over a four-year period, and followed for one year, to show that ISFD can increase the incidence of successful therapy from 75 to 90% of patients, defined as complete or near-complete occlusion of the aneurysm AND a good clinical outcome (mRS ≤ 2) at one year. The trial will be followed by an independent data safety monitoring committee to assure the safety of participants. Conclusion Introduction of intra-saccular flow diversion can be accomplished within a care trial context.

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Extending the Indication of Woven EndoBridge (WEB) Embolization to Internal Carotid Artery Aneurysms: A Multicenter Safety and Feasibility Study

Cited by 30 publications

References 25 publications

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

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

Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility

The RISE trial: A Randomized Trial on Intra-Saccular Endobridge devices

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