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

Goyal, Nitin; Hoit, Daniel; DiNitto, Julie; Elijovich, Lucas; Fiorella, David; Piérot, Laurent; Lamin, Saleh; Spelle, Laurent; Saatçi, Işıl; Çekirge, S.; Arthur, Adam S

doi:10.1136/neurintsurg-2019-015506

Cited by 105 publications

(102 citation statements)

References 24 publications

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“…Transverse size of the aneurysm is important, because the WEB device requires lateral compression to prevent device compaction. 14 It was found that sizing the device was based partially on aneurysm width, but ultimately on aneurysm volume, which achieved optimal device selection in the majority of cases. It may be appropriate to slightly oversize the WEB device in cases that the intent is to endoluminally remodel the aneurysm, as the radial force of the stent can be used to prevent herniation of the WEB.…”

Section: Resultsmentioning

confidence: 99%

“…Because of its design, the WEB device should be deployed parallel to the axis of the aneurysm to achieve the greatest neck coverage. 14 The steep angulation at which nonbifurcation aneurysms arise from the parent vessel often increases the difficulty of achieving a stable orientation of the delivery microcatheter that is parallel to the aneurysm axis. Therefore, in all cases except one, the Via microcatheter required steam shaping to appropriately deploy the WEB device into the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

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Technical aspects of combined intrasaccular and endoluminal flow diversion

et al. 2020

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Introduction The concurrent use of endoluminal flow diversion with coils is a viable option when treating complex or large aneurysms. Alternatives to coil embolization as an adjunctive treatment are currently limited. The Food and Drug Administration recently approved the Woven EndoBridge (WEB) device (Microvention, Aliso Viejo, California) as an intrasaccular flow diverter for wide-neck bifurcation aneurysms. We present the technical aspects of combined WEB device plus endoluminal flow diversion for the treatment of complex wide-necked intracranial aneurysms. Methods A retrospective chart review of all patients treated via intrasaccular flow diversion at a single institution over the last 12 months was performed. Results In total, seven patients underwent treatment of eight aneurysms via combined intrasaccular and endoluminal flow diversion. Of the seven patients, six were treated in a single setting. The most common aneurysm location was the posterior communicating artery. The majority of the aneurysms required steam shaping of the Via deployment catheter to place the WEB device orthogonally to the aneurysm dome. There were no complications. Conclusions We believe this is one of the first series reporting the combined use of the WEB device and endoluminal flow diversion for the treatment of intracranial aneurysms. This series demonstrates that the concurrent use of the WEB device with endoluminal flow diversion is safe for achieving immediate aneurysm treatment and may enhance the long-term durability in complex aneurysms.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Technical aspects of combined intrasaccular and endoluminal flow diversion

et al. 2020

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“…Approximately 26–36% of intracranial aneurysms (IAs) are wide-neck bifurcation aneurysms (WNBAs), defined as aneurysms with neck diameters ≥4 mm and a dome-to-neck ratio of ≤2 mm [ 1 , 2 ]. Endovascular treatment of WNBAs is challenging because it requires embolization of the aneurysm while preserving the bifurcation vessels to achieve complete occlusion [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal Woven EndoBridge (WEB) Device Size Selection Using Automated Volumetric Software

et al. 2021

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Introduction: Selecting the appropriate Woven EndoBridge (WEB) device sizing for the treatment of wide-neck bifurcation aneurysms (WNBAs) remains challenging. The aim of this study was to evaluate different volumetric-based imaging methodologies to predict an accurate WEB device size selection to result in a successful implantation. Methods: All consecutive patients treated with WEB devices for intracranial aneurysms from January 2019 to June 2020 were included. Aneurysm dimensions to calculate aneurysm volumes were measured using three different modalities: automated three-dimensional (3D) digital subtraction angiography (DSA), manual 3D DSA, and two-dimensional (2D) DSA. The device–aneurysm volume (DAV) ratio was defined as device volume divided by the aneurysm volume. WEB volumes and the DAV ratios were used for assessing the device implantation success and follow-up angiographic outcomes at six months. Pearson correlation, Wilcoxon Rank Sum test, and flow density approximations were used for estimating the WEB volumes and the imaging modality volumes for successful implantation. Results: A total of 41 patients with 43 aneurysms were included in the study. WEB device and aneurysm volume correlation coefficient was highest for 3D automatic (r = 0.943), followed by 3D manual (r = 0.919), and 2D DSA (r = 0.882) measurements. Measured median volumes were significantly different for 3D automatic and 2D DSA (p = 0.017). The highest rate of successful implantation (87.5%) was between 0.6 and 0.8 DAV ratio. Conclusion: Pre-procedural assessment of DAV ratios may increase WEB device implantation success. Our results suggest that volumetric measurements, especially using automated 3D volumes of the aneurysms, can assist in accurate WEB device size selection.

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“…6–10 Manufacturer recommendations and expert opinion recommend triaxial access for placement of the WEB device. 11 , 12…”

Section: Introductionmentioning

confidence: 99%

Transradial access for embolization of cerebral aneurysms with the woven EndoBridge device: Case series and review of the literature

Son¹,

Tavakoli-Sabour

2020

Interv Neuroradiol

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Background Transradial access is an increasingly utilized route for neurointerventions with benefits of lower rates of access site complications, earlier patient mobilization and increased patient satisfaction over transfemoral interventions. There is limited data on deployment of the Woven EndoBridge (WEB) via transradial access. We report a case series of consecutive patients undergoing cerebral aneurysm embolization with the WEB device via transradial biaxial access. Methods A database of neuroendovascular procedures was queried for consecutive aneurysm embolization procedures involving the WEB device and intended via the transradial approach between August 2019 and July 2020. Patient demographics, radiological aneurysm characteristics and procedure details were recorded and statistically evaluated. Google Scholar and Pubmed were searched for previous reports of transradial WEB embolization. Results Ten aneurysms were treated in ten patients. All aneurysms were treated with successful WEB deployment. Nine of the ten aneurysms were successfully treated via transradial biaxial access. One aneurysm required conversion to transfemoral access. There were no clinical complications and no morbidity or mortality. Conclusions Transradial embolization of cerebral aneurysms with the WEB device is safe and feasible with low rates of access failure or complications.

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

Cited by 105 publications

References 24 publications

Technical aspects of combined intrasaccular and endoluminal flow diversion

Technical aspects of combined intrasaccular and endoluminal flow diversion

Optimal Woven EndoBridge (WEB) Device Size Selection Using Automated Volumetric Software

Transradial access for embolization of cerebral aneurysms with the woven EndoBridge device: Case series and review of the literature

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