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WEB (Woven EndoBridge) device for intracranial aneurysm treatment: technical, radiological, and clinical findings in a consecutive North American cohort

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Abstract

Background

Utilization of Woven EndoBridge (WEB) for treatment of intracranial aneurysms has increased due to increasing operator experience. We aimed to report our contemporary series of a North American center with the WEB, examining factors associated with occlusion rates.

Method

Consecutive patients (2019–2022) with intracranial aneurysms treated with WEB device were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (RR1/RR2) were examined. Procedural and clinical results were reported.

Results

A total of 104 consecutive aneurysms/patients (25 men/79 women; median age, 63 years, IQR: 55–71) were treated with single-layer WEB-SL in our institution. Seventeen patients (16%) had a ruptured aneurysm. The median aneurysm dome size was 5.5 mm (IQR = 4.5–6.5), and the most common locations were AcomA (36/104 = 34.6%), MCA bifurcation (29/104 = 27.9%), and BT (22/104 = 21.2%). The rate of technical failure was 0.9%. The median intervention time was 32 min (IQR = 25–43). Overall, 8 (7.6%) cases needed additional interventions: 4 (3.8%) additional stenting, 3 cases (3.8%) of intravenous tirofiban infusion (because of the excessive WEB protrusion), and one case (0.9%) of additional coiling (need to complete the neck occlusion). At 12-month follow-up, 67 patients were available showing 59/67 (88%) and 6/67 (9%) of complete occlusion and neck remnant, respectively on dual-energy CTA. There were no cases necessitating retreatment. Ruptured presentation (OR = 0.09, 95% CI = 0.008–0.9, p = .024), undersized WEB (OR = 15, 95% CI = 1.2–50, p = .006), WEB shape change (OR = 0.07, 95% CI = 0.001–0.6, p = .05), aneurysm neck diameter (OR = 0.4, 95% CI = 0.2–0.9, p = .05), and angle between the parent artery and the aneurysm dome (OR = 0.2, 95% CI = 0.01–0.8, p = .008) were significantly associated with occlusion status (RR1-2) at follow-up. However, in the multivariate logistic regression, these factors did not reach the statistical significance. The overall rate of morbidity was 0.9%.

Conclusions

Our contemporary North American experience on consecutive intracranial aneurysms treated with WEB confirms the medium-term efficacy of this strategy, with low procedural time and morbidity. Further research is needed to demonstrate long-term occlusion rates.

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Data availability

Data are available upon reasonable request.

Abbreviations

WEB:

Woven EndoBridge

RR:

Raymond-Roy

BT:

Basilar tip

AcomA:

Anterior communicating artery

MCA:

Middle cerebral artery

ICA:

Internal carotid artery

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Authors and Affiliations

  1. Departments of Neurologic Surgery and Radiology, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Federico Cagnazzo, Harry J. Cloft, Giuseppe Lanzino & Waleed Brinjikji

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  1. Federico Cagnazzo
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  2. Harry J. Cloft
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Correspondence to Federico Cagnazzo.

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Dr. Cagnazzo and Dr. Cloft certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Dr. Brinjikji reports being a consultant for Medical Director for MIVI, Medtronic, Stryker, Microvention, Asahi, Balt, and Imperative Care. Dr. Lanzino reports being a consultant for Covidien/Medtronic.

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Cagnazzo, F., Cloft, H.J., Lanzino, G. et al. WEB (Woven EndoBridge) device for intracranial aneurysm treatment: technical, radiological, and clinical findings in a consecutive North American cohort. Acta Neurochir 165, 2077–2086 (2023). https://doi.org/10.1007/s00701-023-05668-6

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