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

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Abstract

Wide-necked bifurcation aneurysms (WNBAs) make up 26–36% of all brain aneurysms. Treatments for WNBAs pose unique challenges due to the need to preserve major bifurcation vessels while achieving a durable occlusion of the aneurysm. Intrasaccular flow disruption is an innovative technique for the treatment of WNBAs. The Woven EndoBridge (WEB) device is the only United States Food and Drug Administration approved intrasaccular flow disruption device. In this review article we discuss various aspects of treating WNBAs with the WEB device, including indications for use, aneurysm/device selection strategies, antiplatelet therapy requirement, procedural technique, potential complications and bailouts, and management strategies for residual/recurrent aneurysms after initial WEB treatment.

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Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series

Laurent Pierot, Jacques Moret, Xavier Barreau … (2017)

Background Flow disruption with the WEB is an innovative endovascular approach for treatment of wide-neck bifurcation aneurysms. Initial studies have shown a low complication rate with good efficacy. Purpose To report clinical and anatomical results of the WEB treatment in the cumulative population of three Good Clinical Practice (GCP) studies: WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm), French Observatory, and WEBCAST-2. Methods WEBCAST, French Observatory, and WEBCAST-2 are single-arm, prospective, multicenter, GCP studies dedicated to the evaluation of WEB treatment. Clinical data were independently evaluated. Postoperative and 1-year aneurysm occlusion was independently evaluated using the 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. Results The cumulative population comprised 168 patients with 169 aneurysms, including 112 female subjects (66.7%). The patients' ages ranged between 27 and 77 years (mean 55.5±10.2 years). Aneurysm locations were middle cerebral artery in 86/169 aneurysms (50.9%), anterior communicating artery in 36/169 (21.3%), basilar artery in 30/169 (17.8%), and internal carotid artery terminus in 17/169 (10.1%). The aneurysm was ruptured in 14/169 (8.3%). There was no mortality at 1 month and procedure/device-related morbidity was 1.2% (2/168). At 1 year, complete aneurysm occlusion was observed in 81/153 aneurysms (52.9%), neck remnant in 40/153 aneurysms (26.1%), and aneurysm remnant in 32/153 aneurysms (20.9%). Re-treatment was carried out in 6.9%. Conclusions This series is at the moment the largest prospective, multicenter, GCP series of patients with aneurysms treated with WEB. It shows the high safety and good mid-term efficacy of this treatment. Clinical trial registration French Observatory: Unique identifier (NCT18069); WEBCAST and WEBCAST-2: Unique identifier (NCT01778322).

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Demographic, procedural and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT).

David Fiorella, Andrew J. Molyneux, Alexander Coon … (2017)

The Woven EndoBridge (WEB) represents a novel intrasaccular therapeutic option for the treatment of intracranial wide-necked bifurcation aneurysms (WNBAs). The WEB-IT Study is a pivotal Investigational Device Exemption (IDE) study to determine the safety and effectiveness of the WEB device for the treatment of WNBAs located in the anterior and posterior intracranial circulations. We present the patient demographics, procedural characteristics, and 30-day adverse event data for the US WEB-IT study.

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Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device

Laurent Pierot, Laurent Spelle, Andrew J. Molyneux … (2015)

Abstract BACKGROUND: Flow disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Initial series have shown a low complication rate with good efficacy. OBJECTIVE: To report clinical and anatomical results of the WEB treatment in the cumulated population of WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm) and French Observatory series. METHODS: WEBCAST and French Observatory are single-arm, prospective, multicenter, Good Clinical Practice studies dedicated to the evaluation of WEB treatment. Ruptured and unruptured bifurcation aneurysms located in the basilar artery, middle cerebral artery, anterior communicating artery, and internal carotid artery terminus were included in both studies. Clinical data were independently evaluated. Postoperative, 6-month (in WEBCAST), and 1-year aneurysm occlusion was independently evaluated with a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. RESULTS: The cumulated population was 113 patients (74 female, 65.5%) 33 to 74 years of age with 114 aneurysms with a mean neck size of 5.6 mm. There was no mortality at 1 month, and morbidity was 2.7%. A statistically significant difference in the rate of occurrence of thromboembolic events was observed between the use of any antiplatelet agent and the use of no antiplatelet agent (P < .001). At 1 year, complete aneurysm occlusion was observed in 56.0%, neck remnant in 26.0%, and aneurysm remnant in 18.0%. Worsening of aneurysm occlusion between the procedure and 12 months was observed in 2.0% and between 6 months and 1 year in 7.1%. CONCLUSION: The analysis in this large cumulated population of studies confirms favorable safety and efficacy of WEB treatment.

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Journal

Journal ID (nlm-ta): J Neurointerv Surg

Journal ID (iso-abbrev): J Neurointerv Surg

Journal ID (hwp): neurintsurg

Journal ID (publisher-id): jnis

Title: Journal of Neurointerventional Surgery

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1759-8478

ISSN (Electronic): 1759-8486

Publication date (Print): May 2020

Publication date (Electronic): 31 January 2020

Volume: 12

Issue: 5

Pages: 512-520

Affiliations

[1 ] departmentNeurology , University of Tennessee Health Science Center , Memphis, Tennessee, USA

[2 ] departmentNeurosurgery , University of Tennessee Health Science Center , Memphis, Tennessee, USA

[3 ] departmentDepartment of Neurosurgery , Semmes-Murphey Clinic , Memphis, Tennessee, USA

[4 ] departmentDepartment of Research Collaborations , Siemens Medical Solutions USA Inc , Hoffman Estates, Illinois, USA

[5 ] departmentDepartment of Neuroradiology , Stony Brook University Hospital , Stony Brook, New York, USA

[6 ] departmentNeuroradiology , Reims Champagne-Ardenne University , Reims, France

[7 ] departmentDepartment of Neuroradiology , University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK

[8 ] departmentNeuroradiology, NEURI Center, Bicetre Hospital, APHP , Paris-Saclay University , Saint-Aubin, France

[9 ] departmentRadiology, Koru Hospital , Yuksek Ihtisas Universitesi , Ankara, Turkey

[10 ] departmentRadiology , Bayindir Hastanesi Kavaklidere , Ankara, Turkey

Author notes

[Correspondence to ] Dr Adam S Arthur, Semmes-Murphey Clinic, Memphis, TN 38120, USA; aarthur@ 123456semmes-murphey.com

Author information

Laurent Pierot http://orcid.org/0000-0002-6893-661X

Adam S Arthur http://orcid.org/0000-0002-1536-1613

Article

Publisher ID: neurintsurg-2019-015506

DOI: 10.1136/neurintsurg-2019-015506

PMC ID: 7231463

PubMed ID: 32005760

SO-VID: c8e59786-4c99-4bd7-a78f-82fbc390fbba

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 09 October 2019

Date revision received : 10 December 2019

Date accepted : 24 December 2019

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ScienceOpen disciplines: Surgery

Keywords: aneurysm,device,flow diverter,technique

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ScienceOpen disciplines: Surgery

Keywords: aneurysm, device, flow diverter, technique

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

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Most cited references 22

Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series

Demographic, procedural and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT).

Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device

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