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Zur G, Fageeh A, Diouf A, Charette S, Charbonneau B, Sellami L, Dos Santos M, Lesiuk H, Drake B, Fahed R. Embolization of a pseudoaneurysm of the innominate artery with a Woven EndoBridge (WEB) device. Interv Neuroradiol 2024:15910199241240504. [PMID: 38529582 DOI: 10.1177/15910199241240504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The Woven EndoBridge (WEB) is an intra-aneurysmal flow disruptor designed for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile.1, 2 It does not require concomitant antiplatelet therapy compared to other devices such as flow diverters or intracranial stents. Innominate artery pseudoaneurysms are a rare consequence of blunt traumatic injury, infection, or atherosclerotic disease.3, 4 We describe the case of an innominate artery pseudoaneurysm successfully treated with a WEB SL device instead of stenting, therefore alleviating the need for dual antiplatelet therapy. The treatment was successful and uneventful and postprocedural computed tomography angiography confirmed the complete occlusion of the pseudoaneurysm.
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Affiliation(s)
- Gil Zur
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | - Areej Fageeh
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | - Ange Diouf
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | - Stacey Charette
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
| | | | | | - Marlise Dos Santos
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurosurgery, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Howard Lesiuk
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurosurgery, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Brian Drake
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurosurgery, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Robert Fahed
- Interventional Neuroradiology Section, The Ottawa Hospital, Ottawa, Canada
- Divison of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
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2
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Kutbay U, Algin O. Quantitative radial force measurements of Woven EndoBridge devices. Interv Neuroradiol 2023:15910199231209072. [PMID: 37908102 DOI: 10.1177/15910199231209072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Lateral/radial forces and the mechanical properties of Woven EndoBridge (WEB) devices have significant importance for therapeutic success. In other words, adequate apposition of the lateral wall of a cerebral aneurysm is critical for preventing recurrence or re-rupture risk. OBJECTIVE This study aimed to investigate the pressure values applied by different WEB devices to the lateral walls of aneurysms and the relationships between these pressure measurements and the diameters of WEB devices. METHODS By placing four WEB devices of different sizes and types between two rigid metal plates, the lateral forces applied by these WEB devices to plates of different apertures were measured quantitatively. We tested a single device of each size over multiple periods. The total number of examined WEB devices is four. RESULTS There was a significant negative relationship between plate distances and pressure values (correlation coefficient:-0.956, p = 0.000). The lateral wall apposition pressure of a 4- or 5-mm aperture size was higher than a 6-mm aperture size for SL-type WEB devices with a 7-mm diameter. Similarly, the lateral wall apposition pressure detected for a 3- or 3.5-mm aperture size was higher than a 4-mm aperture size for W5-4.5-3 and W5-5-3.6. It was observed that maximum lateral wall pressure was detected in plate measurements of SLS-type devices compared to SL-type devices. The diameter and height values of 3 of the 4 unconstrained WEB devices analyzed differed from the catalog values. CONCLUSION It seems that SLS-type devices apply more pressure on the aneurysm's lateral borders than SL-type devices.
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Affiliation(s)
- Ugurhan Kutbay
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Gazi University, Ankara, Turkey
| | - Oktay Algin
- Interventional MR Clinical R&D Institute, Ankara University, Ankara, Turkey
- National MR Research Center (UMRAM), Bilkent University, Ankara, Turkey
- Radiology Department, Ankara University, Medical Faculty, Ankara, Turkey
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Kobeissi H, Ghozy S, Pakkam M, Bilgin C, Tolba H, Kadirvel R, Brinjikji W, Kallmes DF. Aneurysmal recurrence and retreatment modalities after Woven EndoBridge (WEB) device implantation: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231206082. [PMID: 37801545 DOI: 10.1177/15910199231206082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is used to treat wide-neck bifurcation aneurysms (WNBAs). We conducted a systematic review and meta-analysis to determine the retreatment rate strategies following aneurysmal recurrence of WEB device treated WNBAs. METHODS This study is reported following the PRISMA 2020 guidelines. We conducted a systematic review of the literature using PubMed, Scopus, Embase, and Web of Science. Data were pooled using a random-effects model. We calculated pooled prevalence and corresponding 95% confidence intervals (CI). RESULTS We included 11 studies. The overall retreatment rate was 171/1875 aneurysms (10.3%; 95% CI = 8.3-12.9). Stent-assisted coiling was used to treat 59 aneurysms (36.7%; 95% CI = 26.4-48.5), and flow diverters were used to treat 44 aneurysms (18.7%; 95% CI = 9.9-32.5). Following retreatment, the complete occlusion rate was 57/91 aneurysms (62.8%; 95% CI = 48.2-75.3) and the adequate occlusion rate was 24/91 aneurysms (26.4%; 18.4%-36.4%). The most common aneurysmal recurrence site was the anterior communicating artery (44/136 aneurysms, 32.4%; 95% CI = 25.0-40.7). CONCLUSIONS Roughly 10% of WNBAs initially treated with the WEB device will undergo retreatment. Retreatment is an effective strategy for WEB-treated aneurysms, with high rates of adequate and complete occlusion. Future studies should work to identify risk factors for aneurysmal recurrence.
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Affiliation(s)
- Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Madona Pakkam
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Hatem Tolba
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Kranawetter B, Hernández S, Mielke D, Ernst MS, Malinova V, Rohde V. Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05596-5. [PMID: 37178247 DOI: 10.1007/s00701-023-05596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping. METHODS A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified. RESULTS Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms. CONCLUSIONS Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.
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Affiliation(s)
- B Kranawetter
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
| | - S Hernández
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - D Mielke
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - M S Ernst
- Department of Neuroradiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - V Malinova
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - V Rohde
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
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