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Haffaf, Idriss, Frédéric Clarençon, Eimad Shotar, Claudia Rolla-Bigliani, Saskia Vande Perre, Bertrand Mathon, Mehdi Drir i Nader-Antoine Sourour. "Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results". Journal of NeuroInterventional Surgery 11, nr 5 (24.11.2018): 516–22. http://dx.doi.org/10.1136/neurintsurg-2018-014110.
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Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness of this device have recently been reported. However, long-term angiographic results are lacking. We report herein the 18 months’ angiographic outcome in patients treated for a wide-neck intracranial aneurysm with the MED.Materials and methodsNineteen patients (17 female, mean age 50 years) with 20 wide-neck intracranial aneurysms (six ruptured; 14 unruptured) were treated by the MED between January 2015 and June 2016. Procedure-related complications were systematically recorded; discharge and 6–9 months' follow-up modified Rankin Scale scores were assessed. Angiographic mid-term and long-term follow-up were performed with a mean delay of 6.4±1.5 months (n=16 aneurysms) and 17.7±4.2 months (n=15 aneurysms), respectively. Occlusion rates were evaluated after the procedure and at the mid-term and long-term follow-up using the Roy-Raymond scale.ResultsEmbolization with the MED was feasible in all except two cases (2/20, 10%). One per-procedural perforation was recorded (1/20, 5%) and one MED deployment failed because of the aneurysm’s shape (1/20, 5%). Three cases of thromboembolic complications were observed (3/20, 15%). Only one thromboembolic complication was responsible for clinical sequelae. Grade A occlusion rate was 61% (11/18) after the procedure, 75% at 6 months' follow-up (12/16), and 80% (12/15) at long-term follow-up. Two cases (2/18, 11%) of recanalization at mid-term were documented angiographically. No recanalization occurred between the mid-term and long-term follow-up.ConclusionMED is a hybrid embolization device, combining properties of a conventional coil with those of an intrasaccular flow disrupter. Our series focusing on long-term angiographic follow-up shows a satisfactory long-term occlusion rate. Larger series with longer angiographic follow-up times are warranted to confirm these preliminary results.
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Behme, D., A. Berlis i W. Weber. "Woven EndoBridge Intrasaccular Flow Disrupter for the Treatment of Ruptured and Unruptured Wide-Neck Cerebral Aneurysms: Report of 55 Cases". American Journal of Neuroradiology 36, nr 8 (7.05.2015): 1501–6. http://dx.doi.org/10.3174/ajnr.a4323.
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Pabón, Boris, Juan Andrés Mejía, Manuel Patiño, Víctor Torres, Nelson Serna, José Gutiérrez, Jairo Fernandez i in. "Abstract #7 WEB™ Aneurysm Embolization System Colombian Multicenter Experience (WEB.COM): Clinical and Angiographic Results in the Treatment of Intracranial Aneurysms Using an Intrasaccular Flow Disrupter". World Neurosurgery 158 (luty 2022): 349. http://dx.doi.org/10.1016/j.wneu.2021.10.039.
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van Rooij, SBT, WJ van Rooij, M. Sluzewski i JP Peluso. "The Woven EndoBridge (WEB) for recurrent aneurysms: Clinical and imaging results". Interventional Neuroradiology 25, nr 1 (12.09.2018): 21–26. http://dx.doi.org/10.1177/1591019918798806.
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Introduction The Woven EndoBridge (WEB) device is a novel intrasaccular flow disrupter designed for wide-necked aneurysms. We present our results of WEB treatment in previously treated and reopened aneurysms. Materials and methods Between February 2015 and December 2017, 17 patients with reopening of previously treated aneurysms were treated using the WEB device. Initial treatment was clipping in one, WEB in five and coiling in 11 aneurysms. Six aneurysms had two or three previous treatments. Mechanism of aneurysm reopening was clip remnant in one, compaction without regrowth in three, focal regrowth in five, reopening in partially thrombosed aneurysms in three and WEB compression in five aneurysms. Results Endovascular treatment of the recurrent aneurysm was possible in all 17 patients with good WEB position obtained. Additional devices were used in three of 17 patients (18%): coils in two and stent in one patient. No technical, hemorrhagic or thromboembolic complications occurred (0%, 97.5% confidence interval 0–22%). Overall imaging result at latest follow-up was complete occlusion in five (29%), neck remnant in six (35%), aneurysm reopening in six (35%) and persistent WEB filling in one aneurysm (6%). After retreatment with the WEB, two aneurysms were again additionally treated and three aneurysms are scheduled for additional treatment. Worst results were in partially thrombosed aneurysms. Conclusion The WEB device for recurrent aneurysms may be a feasible and safe option, especially in wide-necked, shallow aneurysm recurrences. Results were poor in partially thrombosed recurrent aneurysms.
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Shao, Miriam M., Timothy G. White, Jared B. Bassett, Ehsan Dowlati, Shyle H. Mehta, Cassidy Werner, Danielle Golub i in. "Intrasaccular Treatment of Intracranial Aneurysms: A Comprehensive Review". Journal of Clinical Medicine 13, nr 20 (16.10.2024): 6162. http://dx.doi.org/10.3390/jcm13206162.
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Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful tool for the neurointerventionalist. Methods: Here, we discuss landmark studies and provide a comprehensive, narrative review of the Woven EndoBridge (WEB; Microvention, Alisa Viejo, CA, USA), Artisse (Medtronic, Irvine, CA, USA), Contour (Stryker, Kalamazoo, MI, USA), Saccular Endovascular Aneurysm Lattice Embolization System (SEAL; Galaxy Therapeutics Inc, Milpitas, CA, USA), Medina (Medtronic, Irvine, CA, USA), and Trenza (Stryker, Kalamazoo, MI, USA) devices. Results: Intrasaccular devices have proven to be effective in treating complex aneurysms like WNAs. Conclusions: Intrasaccular flow disruptors have emerged as a new class of effective endovascular therapy, and results of ongoing clinical studies for the newer devices (e.g., SEAL and Trenza) are much anticipated.
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Papagiannaki, C., L. Spelle, A. C. Januel, A. Benaissa, J. Y. Gauvrit, V. Costalat, H. Desal i in. "WEB Intrasaccular Flow Disruptor—Prospective, Multicenter Experience in 83 Patients with 85 Aneurysms". American Journal of Neuroradiology 35, nr 11 (3.07.2014): 2106–11. http://dx.doi.org/10.3174/ajnr.a4028.
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Da Ros, Valerio, Alessio Bozzi, Chiara Comelli, Vittorio Semeraro, Simone Comelli, Nicola Lucarelli, Nicola Burdi i Roberto Gandini. "Ruptured Intracranial Aneurysms Treated with Woven Endobridge Intrasaccular Flow Disruptor: A Multicenter Experience". World Neurosurgery 122 (luty 2019): e498-e505. http://dx.doi.org/10.1016/j.wneu.2018.10.088.
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Caroff, J., C. Mihalea, J. Klisch, C. Strasilla, A. Berlis, T. Patankar, W. Weber i in. "Single-Layer WEBs: Intrasaccular Flow Disrupters for Aneurysm Treatment—Feasibility Results from a European Study". American Journal of Neuroradiology 36, nr 10 (9.07.2015): 1942–46. http://dx.doi.org/10.3174/ajnr.a4369.
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Diana, Francesco, Marta de Dios de Dios Lascuevas, Simone Peschillo, Eytan Raz, Shinichi Yoshimura, Manuel Requena Requena Ruiz, David Hernández Morales i Alejandro Tomasello. "Intrasaccular Flow Disruptor-Assisted Coiling of Intracranial Aneurysms Using the Novel Contour Neurovascular Systems and NEQSTENT: A Single-Center Safety and Feasibility Study". Brain Sciences 12, nr 8 (26.07.2022): 991. http://dx.doi.org/10.3390/brainsci12080991.
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Background: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were designed to reconstruct the aneurysmal neck and both can be used as assisting coiling devices. We aimed to report our preliminary experience with the flow disruptor-assisted coiling (IFD-AC) technique. Methods: We performed a retrospective analysis of prospectively collected data of all patients with IAs treated with the IFD-AC. Results: Between February 2021 and April 2022, we treated 15 IAs with the IFD-AC: 10 ruptured and 5 unruptured. The IFD-AC was successfully performed in 13 cases, with a post-operative RROC 1 in 12 cases (92.3%) and RROC 2 in 1 case (7.7%). There was one ischemic event (6.7%) and no hemorrhagic complications. Twelve patients underwent a mid-term radiologic follow-up: Ten IAs (83.4%) presented an adequate occlusion, while 2 (16.7%) had a recurrence. Conclusions: The IFD-AC, both with the CNS and the NQS, seems a safe technique with promising efficacy profile. The IFD-AC has proved to be safe without antiplatelet therapy in ruptured cases. Further studies are needed to confirm our preliminary results.
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Gajera, Jay, Julian Maingard, Michelle Foo, Yifan Ren, Anthony Lamanna, Daniel Nour, Jonathan Hall i in. "The Woven EndoBridge Device for the Treatment of Intracranial Aneurysms: Initial Clinical Experience within an Australian Population". Neurointervention 17, nr 1 (1.03.2022): 28–36. http://dx.doi.org/10.5469/neuroint.2021.00430.
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Purpose: Advances in endovascular technology have expanded the treatment options for intracranial aneurysms. Intrasaccular flow diversion is a relatively new technique that aims to disrupt blood inflow at the neck of the aneurysm, hence promoting intrasaccular thrombosis. The Woven EndoBridge device (WEB; MicroVention, Aliso Viejo, CA, USA) is an US Food and Drug Administration approved intrasaccular flow diverter for wide-necked aneurysms. We report the early interim clinical and radiological outcomes of patients with both ruptured and unruptured intracranial aneurysms (IAs) treated using the WEB device in an Australian population.Materials and Methods: A retrospective analysis was done of patients with ruptured or unruptured IAs who received treatment with WEB across 5 Australian neuroendovascular referral centers between May 2017 and November 2020. Angiographic occlusion was assessed with time-of-flight magnetic resonance angiography. Complications were recorded and clinical outcomes were assessed using the modified Rankin scale at follow-up.Results: In total, 66 aneurysms were treated in 63 patients, with successful deployment of the WEB device in 98.5% (n=65). Eighteen (26.9%) ruptured aneurysms were included. Failure of deployment occurred in a single case. Adjunct coiling and/or stenting was performed in 20.9% (n=14) cases. Sixty-two patients with 65 aneurysms using a WEB device were followed up (mean=9.1 months), and 89.4% of these had complete aneurysm occlusion while 1.5% remained patent. Functional independence was achieved in 93.5% of cases.Conclusion: Early results following the use of WEB devices in Australia demonstrate safety and adequate aneurysm occlusion comparable to international literature.
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Marotta, Thomas R., Howard A. Riina, Ian McDougall, Donald R. Ricci i Monika Killer-Oberpfalzer. "Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device". Journal of Neurosurgery 128, nr 2 (luty 2018): 475–81. http://dx.doi.org/10.3171/2016.10.jns162024.
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OBJECTIVEIntracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations.METHODSA preclinical model of wide-necked bifurcation aneurysms in rabbits was used to assess functional features and efficacy of aneurysm occlusion by the eCLIPs device.RESULTSThe eCLIPs device, in bridging the aneurysm neck, allows coil retention, disrupts flow away from the aneurysm, leaves the main vessel and side branches unencumbered by intraluminal metal, and serves as a platform for endothelial growth across the neck, excluding the aneurysm from the circulation.CONCLUSIONSThe eCLIPs device permits physiological remodeling of the bifurcation.
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Heiferman, Daniel M., Jeremy C. Peterson, Kendrick D. Johnson, Vincent N. Nguyen, David Dornbos, Kenneth A. Moore, Violiza Inoa, Daniel A. Hoit i Adam S. Arthur. "Woven EndoBridge Embolized Aneurysm Clippings: 2-Dimensional Operative Video". Operative Neurosurgery 21, nr 4 (25.06.2021): E365. http://dx.doi.org/10.1093/ons/opab218.
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Abstract The Woven EndoBridge (WEB) device (MicroVention, Aliso Viejo, California) is an intrasaccular flow disruptor used for the treatment of both unruptured and ruptured intracranial aneurysms. WEB has been shown to have 54% complete and 85% adequate aneurysm occlusion rates at 1-yr follow-up.1 Residual and recurrent ruptured aneurysms have been shown to have a higher risk of re-rupture than completely occluded aneurysms.2 With increased utilization of WEB in the United States, optimizing treatment strategies of residual aneurysms previously treated with the WEB device is essential, including surgical clipping.3,4 Here, we present an operative video demonstrating the surgical clip occlusion of previously ruptured middle cerebral artery and anterior communicating artery aneurysms that had been treated with the WEB device and had sizable recurrence on follow-up angiography. Informed consent was obtained from both patients. Lessons learned include the following: (1) the WEB device is highly compressible, unlike coils; (2) proximal WEB marker may interfere with clip closure; (3) no evidence of WEB extrusion into the subarachnoid space; (4) no more scarring than expected in ruptured cases; and (5) clipping is a feasible option for treating WEB recurrent or residual aneurysms.
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van Rooij, Sanne BT, Willem Jan van Rooij, Jo P. Peluso i Menno Sluzewski. "The Woven EndoBridge (WEB) as primary treatment for unruptured intracranial aneurysms". Interventional Neuroradiology 24, nr 5 (16.05.2018): 475–81. http://dx.doi.org/10.1177/1591019918772174.
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Purpose The intrasaccular flow disruptor Woven EndoBridge (WEB) device is developed for the treatment of wide-necked aneurysms without supportive devices. We used the WEB as primary treatment for unruptured aneurysms suitable for the device, regardless of neck size. Methods Between February 2015 and June 2017, 59 aneurysms in 51 patients were selectively treated with the WEB. There were 15 men and 36 women with a mean age of 59 years. Mean aneurysm size was 7.0 mm (range 3–22 mm). Of 59 aneurysms, 45 (76%) had a wide neck defined as ≥4 mm or dome-neck ratio ≤1.5. No stents or supporting balloons were used. Results Initial WEB position was judged good in all 59 unruptured aneurysms. One patient with a basilar tip aneurysm had a late thrombotic posterior cerebral artery occlusion by protrusion of the WEB over the artery. There were no procedural ruptures. Overall complication rate was 2.0% (1 of 51, 95% CI 0.01–11.3%). Imaging follow-up was available in 55 of 59 aneurysms (93%). At 3 months, 41 of 57 aneurysms (72%) were completely occluded, 12 (21%) had a neck remnant and 4 (7%) were incompletely occluded. Conclusion WEB treatment is safe and effective in selected unruptured aneurysms suitable for the device, regardless of neck size or location. There was no need for supportive devices. Three-quarters of all unruptured small aneurysms could be treated with the WEB. In our opinion, the WEB is a valuable alternative to coils, especially in wide-necked aneurysms.
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Gutierrez‐Aguirre, Salvador F., Otavio F. De Toledo, Eduarda M. Freitas, Victor H. C. Benalia, Amin Aghaebrahim, Ricardo A. Hanel i Eric Sauvageau. "Mediastinal Hematoma as a Potential Complication of Endovascular Intracranial Intervention". Stroke: Vascular and Interventional Neurology, 6.10.2024. http://dx.doi.org/10.1161/svin.124.001437.
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OBJECTIVE To highlight the rare incidence of mediastinal hematoma as a complication associated with transradial access, as reported in both cardiovascular and neurovascular fields. Interventionists must be aware of this potential risk and the strategies to manage it. CASE PRESENTATION A 66‐year‐old woman presented to an outside hospital's emergency department with 2 months of dizziness and vertigo. A right posterior communication artery aneurysm was discovered incidentally on workup images. On discussing potential options, including observation, the patient opted for endovascular intervention. The aneurysm was treated using a Woven Endobridge Single‐Layer Sphere (SLS) intrasaccular flow disrupter device. After the procedure, the patient was extubated but subsequently required reintubation because of the context of stridor. Radiologic evaluation revealed a mediastinal hematoma, which was suspected to be a direct complication from the transradial access. This required immediate treatment with coil embolization of the perforated vessel at the subclavian artery originating from the costocervical trunk. CONCLUSION Mediastinal hematoma is a rare complication after neurointerventional procedures by transradial access. Prompt diagnosis and appropriate treatment are critical to managing this potentially lethal condition.
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Calienes, Aaron Rodriguez, Juan Vivanco‐Suarez, Milagros Galecio‐Castillo, Bradley Gross, Mudassir Farooqui, Oktay Algin, Chaim Feigen, David Altschul i Santiago Ortega‐Gutierrez. "Abstract 039: Angiographic Outcomes of Woven EndoBridge and Balloon‐Assisted Coiling for the Treatment of Ruptured Wide‐Necked Aneurysms". Stroke: Vascular and Interventional Neurology 3, S2 (listopad 2023). http://dx.doi.org/10.1161/svin.03.suppl_2.039.
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Introduction The optimal endovascular approach for wide‐neck intracranial aneurysms (IAs) during the acute phase of bleeding remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks (1, 2). Various techniques have been developed to address these challenges, including balloon‐assisted coiling (BAC) and intrasaccular flow‐disruption. The Woven EndoBridge (WEB) is a flow disrupter that has gained popularity in treating ruptured IAs due to its effectiveness in occluding aneurysms with minimal rebleeding (3, 4). The aim of this study is to provide outcome comparisons between WEB and BAC in a specific cohort of patients with ruptured wide‐necked IAs. Methods In this international cohort study, we included consecutive patients treated for ruptured wide‐neck IAs with either WEB or BAC at three neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond‐Roy (RR) occlusion classification. Secondary outcomes included favorable functional outcome and periprocedural hemorrhagic/ischemia‐related complications. Comparisons were performed using multivariable logistic and ordinal regressions. Results One hundred four patients treated with WEB and 107 patients treated with BAC were included. The mean length of imaging follow‐up was 17.5 (± 17.6) months in the WEB group and 11.8 (± 10.3) months in the BAC group (p = 0.142). Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the two groups after adjusting for covariates (adjusted OR [aOR] = 1.02; 95% CI 0.46 – 2.25; p = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, aOR = 1.45; 95% CI 0.65 – 3.24; p = 0.368). Procedure‐related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%, p = 0.872). There was no statistically significant difference observed in the rates of ischemic events (WEB: 6.7% vs. BAC: 2.8%, p = 0.180) and hemorrhagic events (WEB: 3.8% vs. BAC: 7.5%, p = 0.255) between the two groups. Conclusion In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide‐neck IAs. Further research and direct comparative studies are needed to better guide treatment decisions for this patient population.
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Algin, Oktay. "Intrasaccular Flow Disruptor (Woven EndoBridge) Assisted Embolization of Vertebral Arteriovenous Fistulas". Neurointervention, 16.02.2024. http://dx.doi.org/10.5469/neuroint.2023.00514.
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Bañez, Ramon Martin Francisco, i Winston Chong. "Retrieval of Displaced Woven EndoBridge Intrasaccular Flow Disruptor Using Solitaire Platinum Revascularization Device". Neurointervention, 7.04.2022. http://dx.doi.org/10.5469/neuroint.2022.00059.
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The Woven EndoBridge (WEB; MicroVention, Aliso Viejo, CA, USA) intrasaccular flow disruptor is a therapeutic option for wide neck bifurcation intracranial aneurysms that does not require the use of adjunctive techniques such as stents or balloon remodeling. As with other endovascular devices, displacement of the WEB is a recognized complication. Few reports have been published regarding the management of this type of complication. We describe a case of retrieval of a displaced WEB using a Solitaire Platinum revascularization device (Medtronic, Minneapolis, MN, USA). Interventionists should be aware of this option in the management of such a complication.
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Diestro, Jose Danilo Bengzon, Mahmoud Dibas, Nimer Adeeb, Robert W. Regenhardt, Justin E. Vranic, Adrien Guenego, Sovann V. Lay i in. "Intrasaccular flow disruption for ruptured aneurysms: an international multicenter study". Journal of NeuroInterventional Surgery, 22.07.2022, neurintsurg—2022–019153. http://dx.doi.org/10.1136/jnis-2022-019153.
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BackgroundThe Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status.MethodsOur data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up.ResultsThe study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation.ConclusionThere was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.
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Zhou, Zibo, Wenjing Lan i Jinlu Yu. "Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects". Frontiers in Neurology 14 (15.11.2023). http://dx.doi.org/10.3389/fneur.2023.1239199.
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Middle cerebral artery (MCA) aneurysms are complex and widely distributed throughout the course of the MCA. Various types of aneurysms can occur in the MCA. Ruptured as well as unruptured MCA aneurysms may require treatment to avoid bleeding or rebleeding. Currently, clipping is regarded as the first-line choice for the treatment of MCA aneurysms. However, endovascular treatment (EVT) is emerging as an alternative treatment in selected cases. EVT techniques vary. Therefore, it is necessary to review EVT for MCA aneurysms. In this review, the following issues were discussed: MCA anatomy and anomalies, classifications of MCA aneurysms, the natural history of MCA aneurysms, EVT status and principle, deployments of traditional coiling techniques and flow diverters (FDs), and deployments and prospects of intrasaccular flow disruptors and stent-like devices. According to the review and our experience, traditional coiling EVT is still the preferred therapy for most MCA aneurysms. FD deployment can be used in selective MCA aneurysms. Parent artery occlusion (PAO) can be used to treat distal MCA aneurysms. In addition, new devices can be used to treat MCA aneurysms, such as intrasaccular flow disruptors and stent-like devices. In general, EVT is gaining popularity as an alternative treatment option; however, there is still a lack of evidence regarding EVT, and longer-term data are not currently available for most EVT devices.
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Radomi, Alexandra, Lukas Goertz, Robert Forbrig, Muriel Pflaeging, Christoph Kabbasch i Thomas Liebig. "Safety and efficacy of the Contour Neurovascular System for intracranial aneurysm treatment: a retrospective analysis of 76 patients". Journal of Neurosurgery, 1.08.2024, 1–9. http://dx.doi.org/10.3171/2024.5.jns232852.
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OBJECTIVE The Contour Neurovascular System (CNS) is a novel intrasaccular flow-disrupting device for the treatment of intracranial aneurysms. This study presents the authors’ institutional experience and midterm follow-up results with this device. METHODS Seventy-six consecutive patients (mean ± SD age 58.9 ± 12.4 years) were treated with the CNS for 76 aneurysms (63 unruptured, 10 recurrent, and 3 ruptured). Aneurysm characteristics, procedural details, and clinical/angiographic outcomes were retrospectively evaluated. RESULTS The most common aneurysm locations were the basilar tip in 25 (32.9%) cases and the anterior communicating artery in 22 (28.9%). There were 18 (23.7%) sidewall aneurysms. The mean ± SD aneurysm width was 5.6 ± 2.5 mm, and 68 (89.5%) aneurysms were wide-necked. The CNS was successfully implanted in 68 (89.5%) aneurysms, with 11 cases of additional coiling and 1 case each of additional stent and balloon. There were 3 (3.9%) thromboembolic events, of which 1 (1.3%) was symptomatic (a major ischemic stroke) and resulted in morbidity. There were no hemorrhagic events or deaths. At last available follow-up (mean 12 months), 32/56 (57.1%) aneurysms were completely occluded, 16/56 (28.6%) had neck remnants, and 8/56 (14.3%) had an aneurysm remnant. Three (5.4%) aneurysms were retreated. CONCLUSIONS The use of the CNS was safe and feasible but proper aneurysm selection appears to be required, which may be facilitated with increasing operator experience and further study of this device. Similar to other intrasaccular flow disrupters, midterm complete occlusion rates are moderate but may increase with longer follow-up.
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Saiegh, Fadi Al, David M. Hasan, Nikolaos Mouchtouris, Mario Zanaty, Nohra Chalouhi, Ritam Ghosh, Ahmad Sweid i in. "Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge (WEB) Flow Disruptor: A Multicenter Experience". Neurosurgery 66, Supplement_1 (20.08.2019). http://dx.doi.org/10.1093/neuros/nyz310_110.
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Abstract INTRODUCTION Coiling has become the first-line treatment option for acutely ruptured aneurysms 1 to 3. However, coiling of wide-necked bifurcation aneurysms is challenging and stent-assisted coiling requires dual anti-platelet therapy. The Woven EndoBridge (WEB) flow disruptor has been recently Food and Drug Administration (FDA)-approved for bifurcation aneurysms and is designed to achieve intrasaccular flow diversion without the need for antiplatelet therapy. However, its use has been mostly reserved for unruptured aneurysms. Here, we present our series of ruptured aneurysms that were treated with the WEB-device post FDA approval. METHODS We performed a review of the first cohort of patients with acute subarachnoid hemorrhage (SAH) from ruptured aneurysms who underwent endovascular treatment with the WEB-device at Thomas Jefferson and Iowa University Hospitals and identified 7 patients. RESULTS All 7 patients were female and the mean age was 71 yr (range 57-81). Hunt and Hess grades ranged from 2 to 5. The aneurysms treated included anterior communicating, posterior communicating, posterior-inferior cerebellar (PICA), basilar apex, and vertebrobasilar junction (VBJ). In 6 of the 7 aneurysms, 1 WEB device was sufficient to achieve adequate obliteration; the VBJ aneurysm was 14 mm in size and required 2. The majority of patients underwent treatment via transfemoral access followed by transradial. One patient underwent direct carotid puncture due to vessel tortuosity. Aneurysm rebleeding was not encountered in any of the WEB-treated aneurysms. One patient had an intraoperative rupture of their PICA aneurysm after dislodgment of the WEB device. There were no treatment-related deaths, but one patient died of cardiopulmonary failure. CONCLUSION Our series shows that the WEB device can be safely used in ruptured bifurcation aneurysms of various sizes in the anterior and posterior circulation. It does not require adjunctive stent use and is a valuable alternative to stent-assisted coiling as it obviates the need for anti-platelet therapy.
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Yu, Jinlu. "Current research status and future of endovascular treatment for basilar artery aneurysms". Neuroradiology Journal, 1.04.2024. http://dx.doi.org/10.1177/19714009241242584.
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Aneurysms occurring along the basilar artery (BA) account for <1% of all intracranial aneurysms. Endovascular treatment (EVT) in particular is recommended for large unruptured BA aneurysms and ruptured BA aneurysms. Given that EVT techniques vary, a detailed review of EVT for BA aneurysms is necessary. In this review, the following issues were discussed: the anatomy and anomalies of the BA, the classification of BA aneurysms, the natural history of BA aneurysms, the status of open surgery, the use of EVT for various types of BA aneurysms and the deployment of new devices. According to the findings of this review and based on our experience in treating BA aneurysms, traditional coiling EVT is still the optimal therapy for most BA aneurysms. However, in some BA aneurysms, flow diverter (FD) deployment can be used. In addition, there are also some new devices, such as intrasaccular flow disruptors and stent-like devices that can be used to treat BA aneurysms. In general, EVT can yield good clinical and angiographic outcomes for patients with BA aneurysms. In addition, recent new devices and techniques, such as new-generation FDs generated via surface modification and virtual reality simulation techniques, show promise for EVT for BA aneurysms. These devices and techniques may further improve EVT outcomes for BA aneurysms.
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Mihalea, Cristian, Felicia Otilia Humulescu, Hazem Abdelkhalek, Sorin Pescariu, Bogdan Valeriu Popa i Horia Ples. "Initial single centre experience with Barrel VRD stent in large neck aneurisms". Romanian Neurosurgery, 15.06.2019, 127–34. http://dx.doi.org/10.33962/roneuro-2019-025.
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Introduction. Despite the use of new techniques, such as Y-stenting, the waffle-cone technique and intrasaccular flow disrupters the treatment of wide-neck bifurcation aneurysms is still challenging, especially for those where adjacent branches are arising at the neck level. Moreover, the use of flow diverter stents in bifurcation aneurysms has been proposed by several teams, although the results remain controversial.This study is reflecting initial experience in our department with a relatively new device available on the market: Barrel VRD stent. The unique design feature of the device is the “belly-like” central part of the stent which protects the adjacent branches.Methods. We retrospectively reviewed all patients in whom stenting with braided or laser-cut stents had been performed in our center. Three patients were identified and analyzed. Technical success, complications, immediate angiographic outcomes, procedural data, are reported here.Results. One MCA bifurcation and two basilar tip large neck aneurysms with one branch arising from the neck level have been identified. Technical success was achieved in all procedures. Overall procedure-related morbidity and mortality was 0%. In the immediate post-treatment angiography, adequate occlusion (neck remnant or total occlusion) was observed in all patients. Short- and mild-term follow-up angiography showed adequate occlusion of the aneurysms.Conclusions. In this small case series, retrospective single-center analysis we showed that Barrel VRD - stent assisted coiling is a safe and feasible technique. Moreover, it offers an elegant and effective endovascular solution for large neck basilar tip aneurysms on which the neurosurgical clipping remains challenging.
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Carraro do Nascimento, Vinicius, Laetitia de Villiers, Permesh Singh Dhillon, Luis Domitrovic, Jean-Philippe Leblanc, Madison Booth i Hal Rice. "The Aristotle 18 and 24 microwires in neuroIntervention: Early experience at a single centre". Interventional Neuroradiology, 5.10.2023. http://dx.doi.org/10.1177/15910199231204923.
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Background Current neurointerventional procedures are expanding the use of large bore microcatheters, of up to 0.033” inner diameters, to accommodate intrasaccular flow disruptors or neck-bridging devices, including flow diverters. The use of large bore microwires may mitigate the ledge gap between wire and catheter, facilitate navigation and offer support in distal tortuous anatomy. We aim to report our early experience using the novel Aristotle (Scientia Vascular, West Valley City, UT) 18 and 24 microwires in neurovascular interventions. Methods We analysed neurointerventional procedures in which the Aristotle 18 and 24 microwires were used at a single centre. Prospectively collected data, from March 2022 to February 2023, including patient's clinical outcome (successful target vessel, aneurysm catheterisation, peri-procedural complications (thromboembolic, haemorrhagic, vessel dissection or perforation) were analysed. Results Overall, the use of Aristotle 18 and 24 microwires was recorded in 84 neurointerventional procedures during the study period, including endovascular aneurysm treatment (n = 30), endovascular thrombectomy (n = 46), dural venous sinus manometry/stent placement (n = 7), and extracranial carotid artery stent placement (n = 1). The Aristotle 18 microwire was used in conjunction with 0.021” microcatheters and the Aristotle 24 microwire with the 0.027 or 0.033” microcatheters. In all cases (100%), the target vessel or aneurysm was reached with the microwire, allowing seamless advancement of the selected microcatheters. No procedure related complications were recorded. Conclusions The use of the Aristotle 18 and 24 microwires in neurointerventional procedures is feasible and safe. The microwires provide reduced ledge gap, improved torquability, support and safety over standard 0.014” microwires.
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Khatri, Deepak, Kainaat Javed, Mohamad Jalloh, Rose Fluss, Neil Haranhalli i David Altschul. "Transcarotid access for the treatment of recurrent, previously ruptured wide necked bifurcation aneurysm with the WEB device: A technical video". Interventional Neuroradiology, 16.09.2022, 159101992211270. http://dx.doi.org/10.1177/15910199221127060.
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The Woven Endobridge (WEB) device is an FDA-approved intrasaccular flow disruptor to treat most intracranial wide-necked bifurcation aneurysms. 1 Based on the rising experience with safe and effective results, it has been increasingly utilized for the treatment of residual and recurrent aneurysms. 2 , 3 Additionally, the device has been reported as an off-label treatment option for Posterior communicating (Pcom) artery aneurysms with optimal morphology. 4 A transfemoral or transradial artery access is conventionally utilized for WEB embolization. 1 – 3 In this technical video, we share our experience with the use of direct carotid puncture to perform WEB embolization for a large recurrent Pcom aneurysm in an elderly female with a history of subarachnoid hemorrhage that was initially treated with surgical clipping. A direct puncture of the left common carotid artery (CCA) under ultrasound guidance was performed after failed attempts to select the left ICA via both transfemoral and transradial access due to type 3 aortic arch and extreme tortuosity of the proximal left CCA. The aneurysm was successfully treated with a 5 mm × 2 mm WEB SL device. There are limited studies of transcarotid access for neurointerventional procedures including mechanical thrombectomy, intracranial stent placement etc. 5 , 6 To the best of our knowledge, this technical video represents the first documented report of WEB embolization via transcarotid access. We aim to highlight the feasibility of transcarotid arterial access for WEB embolization as an effective bailout strategy. In addition, the nuances of direct carotid puncture along with possible complications, and potential management strategies have been discussed.
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Diestro, Jose Danilo Bengzon, Mahmoud Dibas, Nimer Adeeb, Robert W. Regenhardt, Justin E. Vranic, Adrien Guenego, Sovann V. Lay i in. "Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study". Journal of Neurosurgery, 1.10.2023, 1–9. http://dx.doi.org/10.3171/2023.8.jns235.
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OBJECTIVE The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device. METHODS The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use. RESULTS The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use. CONCLUSIONS This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.
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Gaudino, Chiara, Stefania Elena Navone, Valerio Da Ros, Laura Guarnaccia, Giovanni Marfia, Patrizia Pantano, Simone Peschillo, Fabio Maria Triulzi i Francesco Biraschi. "Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms". Frontiers in Neurology 13 (11.01.2023). http://dx.doi.org/10.3389/fneur.2022.1096651.
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BackgroundAlthough endovascular treatment of ruptured intracranial aneurysms is well-established, some critical issues have not yet been clarified, such as the effects of timing on safety and effectiveness of the procedure. The aim of our study was to analyze the incidence of intra-procedural complications according to the timing of treatment, as they can affect morbidity and mortality.Materials and methodsWe retrospectively analyzed all patients who underwent endovascular treatment for ruptured intracranial aneurysms at three high flow center. For all patients, imaging and clinical data, aneurysm's type, mean dimension and different treatment techniques were analyzed. Intra-procedural complications were defined as thrombus formation at the aneurysm's neck, thromboembolic events, and rupture of the aneurysm. Patients were divided into three groups according to time between subarachnoid hemorrhage and treatment (<12 h hyper-early, 12–36 h early, and >36 h delayed).ResultsThe final study population included 215 patients. In total, 84 patients (39%) underwent hyper-early, 104 (48%) early, and 27 (13%) delayed endovascular treatment. Overall, 69% of the patients were treated with simple coiling, 23% with balloon-assisted coiling, 1% with stent-assisted coiling, 3% with a flow-diverter stent, 3% with an intrasaccular flow disruptor device, and 0.5% with parent vessel occlusion. Delayed endovascular treatment was associated with an increased risk of total intra-procedural complications compared to both hyper-early (p = 0.009) and early (p = 0.004) treatments with a rate of complications of 56% (vs. 29% in hyper-early and 26% in early treated group—p = 0.011 and p = 0.008). The delayed treatment group showed a higher rate of thrombus formation and thromboembolic events. The increased risk of total intra-procedural complications in delayed treatment was confirmed, also considering only the patients treated with simple coiling and balloon-assisted coiling (p = 0.005 and p = 0.003, respectively, compared to hyper-early and early group) with a rate of complications of 62% (vs. 28% in hyper-early and 26% in early treatments—p = 0.007 and p = 0.003). Also in this subpopulation, delayed treated patients showed a higher incidence of thrombus formation and thromboembolic events.ConclusionsEndovascular treatment of ruptured intracranial aneurysms more than 36 h after SAH seems to be associated with a higher risk of intra-procedural complications, especially thrombotic and thromboembolic events.
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Adeeb, Nimer, Basel Musmar, Hamza Adel Salim, Assala Aslan, Anika Alla, Nicole M. Cancelliere, Rachel M. McLellan i in. "Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization". Journal of Neurosurgery, 1.10.2024, 1–11. http://dx.doi.org/10.3171/2024.5.jns232204.
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OBJECTIVE The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors’ objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment. METHODS The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size. RESULTS The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters. CONCLUSIONS This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.
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Kashkoush, Ahmed, Mohamed E. El-Abtah, Shaarada Srivatsa, Ansh Desai, Mark Davison, Rebecca Achey, Ashutosh Mahapatra, Thomas Patterson, Nina Moore i Mark Bain. "Comparative effectiveness of stent-assisted coiling and Woven EndoBridge embolization for the treatment of unruptured wide-neck bifurcation intracranial aneurysms". Journal of Neurosurgery, 1.11.2022, 1–7. http://dx.doi.org/10.3171/2022.10.jns221138.
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OBJECTIVE Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs. METHODS Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices. RESULTS Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202–834] days vs 228 [177–494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8–3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630. CONCLUSIONS Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.
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Padmanaban, Varun, Junjia Zhu, Shouhao Zhou, Sameer A. Ansari, Jay U. Howington, Daniel H. Sahlein, Juan G. Tejada i in. "Safety and efficacy of endovascular versus microsurgical treatment of unruptured wide-necked middle cerebral artery aneurysms: a propensity score–matched analysis of the NeuroVascular Quality Initiative Quality Outcomes Database Cerebral Aneurysm Registry". Journal of Neurosurgery, 1.12.2023, 1–9. http://dx.doi.org/10.3171/2023.10.jns231659.
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OBJECTIVE Unruptured, wide-necked middle cerebral artery (WN-MCA) aneurysms have traditionally been considered ideal candidates for microsurgery (MS), although endovascular treatment (EVT) has dramatically increased in popularity with the advent of novel devices such as intrasaccular flow disruptors. The purpose of this study was to evaluate the safety and efficacy of MS versus EVT for unruptured WN-MCA aneurysms. METHODS The NeuroVascular Quality Initiative Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multiinstitutional, prospectively collected procedural database, was queried for cases of unruptured WN-MCA aneurysms treated with MS or EVT between 2015 and 2022. A wide neck was defined as an aneurysm neck ≥ 4 mm or a dome/neck ratio ≤ 2. Demographics and aneurysm characteristics were queried. Propensity score matching (PSM) was utilized to match aneurysm size, number of aneurysms treated, patient age, and aneurysm status. Safety outcomes were evaluated including intraoperative and postoperative complication rates. Aneurysm occlusion status and clinical outcomes using the modified Rankin Scale (mRS) score at discharge and the last follow-up were also assessed. RESULTS Of 671 unruptured MCA aneurysms, 319 were wide necked. Thirty cases were excluded, as the aneurysm had been previously treated. Two hundred eighty-nine operations (203 EVT, 86 MS) in 282 patients satisfied inclusion criteria. After PSM, there were 86 operations in each group for analysis. The mean aneurysm width was 5.0 (EVT) versus 4.9 mm (MS; p = 0.285). Safety data showed similar intraoperative (7.0% EVT vs 3.5% MS, p = 0.496) and postoperative (4.7% vs 7%, p = 0.746) complication rates. The MS patients were more likely to have complete aneurysm occlusion at discharge (90.4% vs 58.8%, p < 0.001). In a limited subset of patients (52.9%) for whom outcome data were available, the EVT patients were more likely to have an mRS score 0 at discharge (50/59 [84.7%] vs 29/54 [53.7%], p < 0.0003] and at the last follow-up (36/55 [65.5%] vs 13/36 [36.1%], p = 0.006). CONCLUSIONS This study describes a large, modern cohort of propensity score–matched patients who underwent treatment of unruptured WN-MCA aneurysms. Safety data on intraoperative and postoperative complication rates were similar in both treatment groups. MS was more likely to result in complete aneurysm occlusion at discharge. In a subset of patients with available outcome data, EVT was associated with better functional outcomes at discharge and the last follow-up. Given the lack of complete follow-up data and rates of retreatment, these results should be interpreted cautiously.