Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge Device: Experience Post-FDA Approval
- 1 May 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 87 (1), E16-E22
- https://doi.org/10.1093/neuros/nyaa092
Abstract
BACKGROUND: Coil embolization of ruptured bifurcation aneurysms is challenging and often necessitates adjunctive stenting, which requires antiplatelet therapy in the setting of subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB; Terumo) device is an alternative self-expanding 3D mesh that does not require antiplatelet agents. However, its use has been mostly reserved for unruptured aneurysms. OBJECTIVE: To assess the safety and feasibility of ruptured aneurysm treatment with the WEB. METHODS: Retrospective analysis of 9 SAH patients with 11 aneurysms that were treated with the WEB device at 2 institutions after FDA approval. RESULTS: Hunt and Hess grades were III and IV in 4 (44%) each and V in 1 (11%). All patients were treated within 24 h of hospitalization, and a single WEB was used in all but one aneurysm. Aneurysms treated were 3 basilar tip, 2 anterior communicating artery, 2 posterior inferior cerebellarartery, 1 middle cerebral artery, 1 carotid-ophthalmic artery, 1 posterior communicating artery, and 1 vertebrobasilar junction. Mean aneurysm height and width were 6.2 2.2 mm (range: 3-10) and 5.6 +/- 3.0 mm (range: 3.3-14), respectively. Mean dome-to-neck ratio was 1.7 +/- 0.8 (range: 1.0-3.8). There was one intraoperative rupture that occurred because of device dislodgement and was managed with embolization. There were no treatment-related mortalities and no re-rupture after securement of the aneurysms with the WEB. CONCLUSION: Our preliminary experience indicates that the WEB device can be used safely for ruptured aneurysms of various sizes in the anterior and posterior circulation. Larger series with long-term follow-up are necessary to confirm our findings.Keywords
This publication has 16 references indexed in Scilit:
- Placement of the Woven EndoBridge (WEB) device via distal transradial access in the anatomical snuffbox: A technical noteJournal of Clinical Neuroscience, 2019
- Factors that determine aneurysm occlusion after embolization with the Woven EndoBridge (WEB)Journal of NeuroInterventional Surgery, 2018
- Woven Endobridge (WEB) device for endovascular treatment of complex unruptured aneurysms—a single center experienceNeuroradiology, 2016
- Woven Endobridge (WEB) Device for endovascular treatment of ruptured intracranial wide-neck aneurysms: a single-center experienceNeuroradiology, 2014
- Clipping Versus Coiling for Ruptured Intracranial AneurysmsStroke, 2013
- The Barrow Ruptured Aneurysm TrialJournal of Neurosurgery, 2012
- Results of Embolization Used as the First Treatment Choice in a Consecutive Nonselected Population of Ruptured Aneurysms: Clinical Results of the Clarity GDC StudyNeurosurgery, 2011
- The Woven EndoBridge: A New Aneurysm Occlusion DeviceAmerican Journal of Neuroradiology, 2011
- A Novel Grading Scale for the Angiographic Assessment of Intracranial Aneurysms Treated Using Flow Diverting StentsInterventional Neuroradiology, 2010
- International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trialThe Lancet, 2002