Abstract
PurposeTreatment of wide-necked intracranial aneurysms using the Woven Endobridge (WEB) device has become broadly accepted. Feared complications with the potential of increased poor clinical outcome include dislocations and migration of the device. This study was carried out to determine the effectiveness of a variety of different strategies to rescue migrated WEB devices.MethodsIn a porcine model, WEB devices of different sizes (SL [single layer] 3.5 × 2mm and SL 4.0 × 3 mm, SL 8 × 5 mm and SLS 8 mm [single layer spherical]) were placed into both the subclavian and axillary arteries. A total of 32 rescue maneuvers (8 per rescue device) were performed. Small WEBs were rescued using reperfusion catheters (RC) (SOFIA Plus and JET 7), larger WEBs were rescued using dedicated rescue devices (Microsnare and Alligator). Rescue rates, times, attempts and complications were assessed.ResultsRescue attempts of migrated WEBs were successful in all cases (100%). Rescue time (p = 0.421) and attempts (p = 0.619) of small WEBs using RCs were comparable without significant differences. Aspiration alone was not successful for larger WEBs. Rescue of larger WEBs was slightly faster (122.75 ± 41.15 s vs. 137.50 ± 54.46 s) with fewer attempts (1 vs. 1.37) when using the Microsnare compared to the Alligator device. Complications such as entrapment of the WEB in the RCs, vasospasm, perforation, or dissection were not observed.ConclusionRescue of migrated WEB devices is a feasible and effective method and 100% successful rescue rates and appropriate rescue times can be achieved for small WEBs using RCs and for larger WEBs using dedicated rescue devices (Microsnare and Alligator).
Highlights
The Woven Endobridge (WEB) device (MicroVention, Tustin, CA, USA) entered the market in 2011 and was designed to treat wide-necked intracranial aneurysms without the need for neck supporting devices or dual antiplatelet therapy [1]
Rescuing smaller WEBs with the applied reperfusion catheters (RC) was achieved with an overall rescue time of
In 3 cases during aspiration with the SOFIA and 2 cases with the JET 7, the first aspiration attempt failed since the WEBs were lost during retraction of the RC
Summary
The Woven Endobridge (WEB) device (MicroVention, Tustin, CA, USA) entered the market in 2011 and was designed to treat wide-necked intracranial aneurysms without the need for neck supporting devices (e.g. balloons or stents) or dual antiplatelet therapy [1]. Many studies have shown promising results in the treatment of widenecked intracranial aneurysms with high rates of adequate occlusion and low morbidity and mortality rates [2, 3]. With the introduction of the new generation (low-profile) WEB-17 device even small (
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