WEB Device Research Articles

Predictors of Aneurysm Obliteration in Patients Treated with the WEB Device: Results of a Multicenter Retrospective Study.

Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment. This is a review of a prospectively maintained database across 30 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB who had available intraprocedural data and long-term follow-up. We studied 763 patients with a mean age of 59.9 (SD, 11.7) years. Complete aneurysm occlusion was observed in 212/726 (29.2%) cases, and contrast stasis was observed in 485/537 (90.3%) of nonoccluded aneurysms. At the final follow-up, complete occlusion was achieved in 497/763 (65.1%) patients, and retreatment was required for 56/763 (7.3%) patients. On multivariable analysis, history of smoking, maximal aneurysm diameter, and the presence of an aneurysm wall branch were negative predictors of complete occlusion (OR, 0.5, 0.8, and 0.4, respectively). Maximal aneurysm diameter, the presence of an aneurysm wall branch, posterior circulation location, and male sex increase the chances of retreatment (OR, 1.2, 3.8, 3.0, and 2.3 respectively). Intraprocedural occlusion resulted in a 3-fold increase in the long-term occlusion rate and a 5-fold decrease in the retreatment rate (P < .001), offering a specificity of 87% and a positive predictive value of 85% for long-term occlusion. Intraprocedural occlusion can be used to predict the chance of long-term aneurysm occlusion and the need for retreatment after embolization with a WEB device. Smoking, aneurysm size, and the presence of an aneurysm wall branch are associated with decreased chances of successful treatment.

Effects of a Preoperative Patient-Controlled Analgesia Education Program Using Smart Learning in Laparoscopic Cholecystectomy Patients

BackgroundPatients undergoing laparoscopic cholecystectomy develop severe postoperative pain, and this acute pain often becomes chronic. ObjectivesThis study determines the effects of preoperative education on patient-controlled analgesia (PCA) through smart learning in patients using PCA after undergoing laparoscopic cholecystectomies. DesignWe conducted a quasi-experimental study with a nonequivalent control group pretest–posttest design. ParticipantsA total of 60 adult patients aged 20-65 years, admitted for laparoscopic cholecystectomy at a hospital in Korea, participated in a smart learning training program. MethodsThe concept of smart learning, which integrates learning content and solutions with the fourth industrial revolution using mobile devices such as smartphones and media tablets was applied in this study. This smart learning training program comprised three phases: (1) prebriefing, where patients accessed PCA knowledge via a program created by researchers and accessible using a mobile web device (e.g., smartphone or an iPad), with training covering pain characteristics, PCA effects, precautions, and usage methods; (2) simulation, where patients learned using PCA with a machine; (3) debriefing, where patients reviewed their knowledge and skills. ResultsComparing the pain between the experimental and control groups, the pain decreased significantly in both the experimental (Z = –4.40, p < .001) and control groups (Z = –4.41, p < .001), with no significant difference between groups (Z = –1.00, p = .319). Preoperative knowledge significantly increased in both the experimental (Z = –4.74, p < .001) and control groups (Z = –3.55, p < .001), with a significant difference between groups (Z = –6.05, p < .001). Total satisfaction with pain control was higher in the experimental group than in the control group. ConclusionsA structured educational program on PCA use is an effective nursing intervention. PCA educational programs using smart learning could help patients undergoing laparoscopic cholecystectomy understand postoperative pain, promote efficient PCA use, and enhance their satisfaction with pain control.

Rare Case of a Delayed WEB Device Collapse in a Large Basilar Apex Aneurysm (P9-5.013)

Rare Case of a Delayed WEB Device Collapse in a Large Basilar Apex Aneurysm (P9-5.013)

Stent-assisted Woven EndoBridge embolization for the treatment of pulsatile tinnitus caused by an ipsilateral high-riding jugular bulb.

Pulsatile tinnitus can be caused by a high-riding jugular bulb (HRJB), characterized by the superior position of the jugular bulb in the petrous temporal bone. The anatomical position and morphology of this entity make it challenging for endovascular treatment. We report our experience with two patients successfully treated with a stent-assisted Woven EndoBridge (WEB; Microvention, Tustin, CA, USA) device. We describe two cases of HRJB in patients presenting with disabling pulsatile tinnitus. Temporary balloon occlusion of the jugular bulb prior to the intervention reduced tinnitus intensity. Both patients were subsequently treated under general anesthesia with the WEB device deployed in the HRJB which was held by a stent deployed in the sigmoid sinus. Both procedures were successful with good positioning of the WEB device and no procedural complications. Both patients had complete resolution of pulsatile tinnitus immediately after the procedure. Follow-up imaging showed successful occlusion of the venous cavity with a widely patent stent. Among patients with pulsatile tinnitus caused by an ipsilateral HRJB, a stent-assisted WEB device seems to be a viable endovascular option with angiographic and clinical success.

Niimath and fslmaths: replication as a method to enhance popular neuroimaging tools.

Neuroimaging involves the acquisition of extensive 3D images and 4D time series data to gain insights into brain structure and function. The analysis of such data necessitates both spatial and temporal processing. In this context, "fslmaths" has established itself as a foundational software tool within our field, facilitating domain-specific image processing. Here, we introduce "niimath," a clone of fslmaths. While the term "clone" often carries negative connotations, we illustrate the merits of replicating widely-used tools, touching on aspects of licensing, performance optimization, and portability. For instance, our work enables the popular functions of fslmaths to be disseminated in various forms, such as a high-performance compiled R package known as "imbibe", a Windows executable, and a WebAssembly plugin compatible with JavaScript. This versatility is demonstrated through our NiiVue live demo web page. This application allows 'edge computing' where image processing can be done with a zero-footprint tool that runs on any web device without requiring private data to be shared to the cloud. Furthermore, our efforts have contributed back to FSL, which has integrated the optimizations that we've developed. This synergy has enhanced the overall transparency, utility and efficiency of tools widely relied upon in the neuroimaging community.

Modification of Woven Endo-Bridge After Intracranial Aneurysm Treatment: A Methodology for Three-Dimensional Analysis of Shape and Relative Position Changes.

During follow-up of patients treated with WEB devices, shape changes have been observed. The quantitative three-dimensional measurement of the WEB shape modification (WSM) would offer useful information to be studied in association with the anatomical results and try to better understand mechanisms implicated in this modification phenomenon. We present a methodology to quantify the morphology and position of the WEB device in relation to the vascular anatomy. Three-dimensional rotational angiography (3DRA) images of seven aneurysms patients treated with WEBs were used, which also accompanied by a post-treatment 3DRA image and a follow-up 3DRA image. The device was manually segmented, obtaining the 3D models after treatment and at the follow-up. Volume, surface area, height, maximum diameter and WSM ratio of both surfaces were calculated. Position changes were evaluated measuring WEB axis and relative position between post-treatment and follow-up. Changes in WEB volume and surface area were observed with a mean modification of and , respectively. The positional variables also showed differences, mean change of device axis direction was and mean change of distance was . Inter-observer and intra-observer variability analyses did not show differences (ANOVA ). This methodology allows quantifying the morphological and position changes suffered by the WEB device after treatment, offering new information to be studied in relation to the occurrence of WEB shape modification.

Implementation of Structured Dyadic Methods to Improve Learning Results in Web and Mobile Device Programming Class XI Students in Software Engineering Expertise Program

This research is a Classroom Action Research (CAR) to 36 students of class XI RPL SMK Negeri 4 Bandung. This study aims to improve learning outcomes in the subjects of Web Programming and Mobile Devices for class XI RPL students of SMK Negeri 4 Bandung for the 2020/2021 academic year through the application of the Structured Dyadic Method. The data collection technique is done by using learning result test, observation and documentation. The data analysis technique used is descriptive quantitative data analysis with a percentage in the form of calculating the learning outcomes test and the observation results. The results of this classroom action research are 1) cognitive learning outcomes increase, in cycle I the average cognitive score of students is 51.25 or 22 students have reached KKM. In the second cycle the average cognitive score of students increased to 83.75 or 36 students had reached the KKM. 2) The learning outcomes of students' affective domains increased, in the first cycle as many as 22 students had reached the very good or good category and increased to 33 students in the second cycle. 3) The students' psychomotor learning outcomes increased, in the first cycle as many as 28 students had reached the very good or good category and increased in the second cycle to 33 students. Therefore, it can be concluded that the application of the Structured Dyadic Method learning method can improve learning outcomes in the cognitive, affective and psychomotor domains of class XI RPL SMK Negeri 4 Bandung Academic Year 2020/2021.

Abstract 037: Aneurysm Occlusion Rates with WEB Treatment: Single‐Institution Study and Review

Introduction To provide our single‐institution experience and outcome data with the WEB device in 51 patients treated for ruptured and unruptured intracranial aneurysms. Methods Occlusion rates in a cohort of 51 patients treated with WEB were collected at time of procedure and at last follow‐up between the years 2019 and 2021. Angiographic outcomes were assessed on the WEB occlusion scale (WOS) and occlusion status scale (OSC). Compaction was assessed on imaging. Functional outcomes were assessed using the modified Rankin Scale. Thromboembolic complications and retreatments were recorded. Statistical analysis was performed to identify predictors of inadequate occlusion. Results A total of 51 patients underwent endovascular embolization using the WEB device with a mean follow‐up of 14.9 months. Ruptured aneurysmal subarachnoid hemorrhage accounted for 15.7% (8/51) of all patients. Most of the patients (92.1%) were functionally independent at presentation. The most common aneurysm location in the present study was MCA bifurcation (52.9%). The median maximal aneurysm diameter was 6.9mm, while the median neck size was 4.4mm. Last follow‐up consisted of 49 patients and imaging was obtained in 45 patients. Adequate occlusion was documented at 97.8% (WOS) and 93.3% (OSC). Retreatment was required in 1 aneurysm. Minor compaction was noted in 11.1% with no cases of major compaction. The majority of patients had the same presenting and post‐procedure mRS. Thromboembolic complications were encountered in 7.8% (4/51) of procedures; 3 of which were symptomatic and none were permanent. There were no hemorrhagic complications. An analysis of the data shows that larger aneurysm dimensions, necessity for adjunctive stent, and minor compaction were significantly associated with inadequate occlusion. Aneurysm height and dome width remained independent predictors of inadequate occlusion Conclusion This study confirms the safety and efficacy profile of the WEB device for the embolization of intracranial aneurysms at our institution. A high rate of adequate occlusion at a midterm follow‐up demonstrates high efficacy of the WEB device in our experience. Predictors of inadequate occlusion, which we explored, proved consistent with the literature on known variables associated with residual aneurysms.

Abstract 173: A Case Series of Basilar Tip Aneurysm Endovascular Treatment – The Barrow Neurological Institute Experience

Introduction Basilar‐tip aneurysm (BTA) is the most common aneurysm found in the posterior circulation, representing 5–8% of total intracranial aneurysms. Endovascular techniques are first‐line for treatment of the vast majority of posterior circulation artery aneurysms because of their deep location and the high mortality and morbidity associated with microsurgical clipping. Coil embolization (CE) is safer and more efficacious in the treatment of BTAs compared to open surgery but has increased rate of recanalization. Two adjunctive modifications of CE ‐ balloon remodeling techniques (BRT) and stent‐assisted coiling (SAC) ‐ have been utilized to facilitate occlusion of BTAs of variable anatomies/morphologies, sizes, and rupture status. We aimed to compare the clinical utility, safety and efficacy of these adjuvant therapies for treating BTAs. Methods A retrospective secondary analysis of a prospectively collected database at our institution was performed, including all patients with endovascularly treated basilar tip aneurysms database from January 1996 through January 2019 (n=121; CE=26; BRT=51; SAC=44). This project was approved by the local institutional review board. Patient data on demographics, aneurysmal characteristics and management, post‐operative outcomes, ICU management, and withdrawal of care were abstracted from the medical record of eligible patients. Univariate statistics used Welch’s two‐sample t‐test for continuous data and chi‐squared test for frequency‐based variables. Multivariate analysis used multivariate Poisson and Firth’s logistic regression. Results Aneurysms treated with CE were found to be smaller compared to BAC and SAC, with a median difference of 4 mm. For ruptured aneurysms, Adjuvant therapy (BAC or SAC) was used to treat larger dimension aneurysms compared to CE (p = 0.046). Adjusted for other factors, aneurysm dimension was an independent factor influencing recanalization or recurrence (OR = 1.16, p = 0.006), retreatment (OR = 1.165, p = 0.005), and obliteration (Raymond Roy Grade, continuous, β = 0.033, p = 0.043). Ruptured aneurysms were most frequently treated with CE (80.8%), followed by BAC (47.1%), and least frequently with SAC (6.8%) (p &lt; 0.001). We also found an association with time of approval to retreatment. Stents approved by FDA after 2014 (used in 13 cases) had a greater rate of retreatment (46.2% vs. 10.7%). Adjusted for other factors, BAC had 3 times greater odds of recanalization or recurrence compared to SAC. CE demonstrated a 1.19‐month greater time to retreatment than BAC and a 1.89‐month longer time to retreatment than SAC. Overall, CE had a 1.28‐month greater time to retreatment than adjuvant therapy (SAC or BAC). Conclusion CE and its adjuvant therapies have similar safety profile but pose variable efficacy in terms of obliteration, recurrence, retreatment, and durability over time. This study represents one of the largest data sets on endovascular adjuvant therapy of BTAs and has the potential to inform clinical decision making when considering CE with BRT vs. SAC for BTA of specific size and morphology. In the future, inclusion of BTAs treated with WEB device and more novel flow divertor devices in this data set can further inform clinical decision making.

The Woven EndoBridge device, an effective and safe alternative endovascular treatment of intracranial aneurysm-systematic review.

This study is a systematic review about the WEB device and addresses the efficacy and safety of this device for the endovascular treatment of ruptured and unruptured intracranial aneurysms. This systematic literature review followed PRISMA-P guidelines and included studies published until 2010. PubMed and ScienceDirect databases were searched, resulting in 22 articles meeting the inclusion criteria. The studies involved 1705 patients and 1224 aneurysms, predominantly wide-neck aneurysms in the middle cerebral artery, internal carotid artery, and basilar artery. The treatment success rate was 28.1%, with the WEB-SL and WEB-SLS devices being commonly used. The immediate post-treatment adequate occlusion rate was 33.3%, increasing to 49.7% at follow-up. Thromboembolic complications occurred in 6.5% of cases, while other complications were observed in 3.1% of cases. The mortality rate associated with the WEB device was low, approximately 1%. The WEB device demonstrates favorable outcomes in treating patients with intracranial aneurysms, with adequate occlusion rates improving over time. Thromboembolic complications are the primary concern, but overall complication and mortality rates remain low. Further research is needed to optimize device selection, standardize classification systems, and enhance long-term evaluation and training protocols.

Intra-cranial aneurysm treatment with contour or WEB - a single center comparison of intervention times and learning curves.

Treating aneurysms with intra-saccular flow disruption is a feasible alternative to coil-embolization. Besides the established WEB device, the novel Contour Neurovascular System has emerged as a potentially easier alternative regarding sizing and deployment. We report the learning curve experienced at our center from the first 48 patients treated with Contour and compared it with 48 consecutive WEB cases. Both groups were compared concerning intervention time, sizing failures leading to device changes and radiation dose. Additionally, we analyzed potential learning effects by comparing the first 24 Contour cases with our last 24 Contour cases and WEB cases respectively. Patient demographics, acute vs. incidental cases and aneurysm localization were comparable in both groups. The deployment time was faster in our 48 Contour cases (median: 22.0 ± 17.0 min), than in the WEB group (median: 27.5 ± 24.0 min). Total intervention time was similar for Contour (median: 68.0 ± 46.9 min) and WEB cases (median: 69.0 ± 38.0 min). Device implantation times in our WEB cases were slightly shorter in the later cases (median: 25.5 ± 24.1 min) than in the earlier (median: 28.0 ± 24.4 min) cases. In the Contour cohort, deployment times were similar for the first 24 cases (median: 22.0 ± 14.5 min) and the final 24 (median: 22.0 ± 19.4 min). Radiation dose was lower in the Contour group (1469.0 ± 1718 mGy*cm2 vs. 1788.0 ± 1506 mGy*cm2 using the WEB device). Less intra-procedural device changes were performed in the Contour cohort (6 of 48 cases, 12.5%), than in the WEB group (8 of 48 cases, 16.7%). Aneurysm occlusion times and consequently radiation doses, as well as the amount of device changes were lower in the Contour group. Occlusion times did not differ in the first and last 24 Contour cases, leading to the assumption that the handling of Contour does not require extended training. A short training effect in occlusion times was noted, however, between the first and last WEB cases as shorter procedure times were seen in the latter cases.

Abstract Number ‐ 134: How far can we go? WEB technology for the treatment of sidewall IA. Single Institution.

Introduction Few years after introduction, Flow disruption technology using WEB device has been used safely for the treatment of wide‐neck bifurcation aneurysms, but the use of this endosaccular approach to treat side‐wall lesions in terms of feasibility, safety, stability and aneurysm occlusion rate after this treatment is unknown. Methods Patients were carefully selected. IRB approved. Clinical, anatomical, angiographical and technical considerations were analyzed. Procedure related complications, procedural time, antiplatelet therapy requirements. Web Occlusion Scale (WOS) was used for the Follow‐up. Results From August 2017 and March 2021 a total of 14 wide‐necked, sidewall, IA were selected for WEB treatment. Aneurysm mean size 5.3mm in width and 5.8 in height. Aneurysm Location: ICA 8 cases (five PComA, two Carotid‐ophtalmic segment, one AChoA segment), Superior Cerebellar Artery SCA in 5 patients (35%), and one impressive case in posterior circulation associated with a basilar fenestration next to VBJ. Eight cases were unruptured (57%), and six cases with history of SAH‐ acute setting. DAPT used pre operatively in all elective cases but none patient remain under antiplatelets after procedure. Technical success of 100%. Mean procedure time: 24 min. None related procedure complications recorded. Immediately angiographic occlusion was evidenced in 9 cases. Radiological Follow up (ranging 1‐ 26 months) available in 9/14 showed a WOS adequate occlusion in all cases. Conclusions In our early experience using WEB device to treat different conditions than bifurcation IA´s, the results showed that endossacular approach was feasible in highly selected patients, safety profile in agreement with previous bifurcation experiences and very effective to treat challenge cases with a high probability of recurrence or therapeutic failure. Larger series and controlled studies are required to expand its indications in a near future.

USABILITY TESTING METHODS FOR ASSESSING A MOBILE APPLICATION

When conducting research to study the usability of a web page, user interface or device for its further mass use, usability testing is used. The usability test helps to find the best solution of the interface from all efforts, as well as to check the suitability of the resource for users from different countries, when, for example, language switching is provided. The work analyzes various methods of usability testing for the ease of use of websites, applications and other interfaces. The main stages of UX testing and the scenario for interviewing respondents are defined. This article presents methods and evaluations of software product quality indicators testing. The object of the study is usability testing, as interaction with the software product, its perception by the target audience and quality assessment and determination of criteria for evaluating the usability of the mobile application for iOS for purchasing an electronic ticket for tourist trips. As a result of UX-testing, the weak points of the interface are revealed, which cause difficulties for users and the inconsistency of the interface with their expectations. Based on the results of testing, the developers refine the product and bring it to the optimal user requirements. Usability testing was conducted using a survey of respondents without the participation of a moderator. A scheme for step-by-step implementation of testing has been developed. Using a Likert scale, the application was evaluated using a questionnaire that includes five factors: learnability, efficiency, recall, errors, and satisfaction. The result for each criterion and the overall usability indicator of the model application were presented.

Heterogeneous model to evaluate CFD in intracranial bifurcation aneurysms treated with the WEB device to predict angiographic outcome.

The Woven EndoBridge device (WEB) was developed as an alternative to treat Wide-Necked bifurcation aneurysms. It has proven to be effective and safe, however, cases of recanalization have been reported. The purpose of this study was to evaluate and quantify hemodynamic parameters and indexes with CFD of the intracranial aneurysms before and after WEB simulation and to establish their relationship to complete occlusion. Using the heterogeneous model based on the marching cubes algorithm, we created 3D representations of 27 bifurcated intracranial aneurysms treated with the single-layer WEB device to evaluate hemodynamics parameters with CFD, calculated with and without the WEB. We observed a lower treatment entry concentration indices (ICI) (2.12 ± 1.31 versus 3.14 ± 0.93, p-value: 0.029) previous to placement of WEB and higher pre-treatment FN (7.56 ± 5.92 versus 3.35 ± 1.51, p-value: 0.018) and post-treatment FN (5.34 ± 5.89 versus 1.99 ± 0.83, p-value: 0.021) for cases with successful occlusions. Lower post-treatment SRa (197.81 ± 221.29 versus 80.02 ± 45.25, p-value: 0.044) and higher pre (0.11 ± 0.07 versus 0.25 ± 0.19, p-value: 0.011) and post-treatment MATT (0.69 ± 1.23 versus 1.02 ± 0.46, p-value: 0.006) were observed in non-occluded cases. In our CFD analysis of the hemodynamic parameters of IA, we found lower ICI before the placement of the WEB device and higher FN pre- and post-treatment for cases with successful occlusions. Non-occluded cases had lower post-treatment SRa and higher pre-treatment and post-treatment MATT.

Geometry of intracranial aneurysms and of intrasaccular devices may influence aneurysmal occlusion rates after endovascular treatment.

The Woven EndoBridge device (WEB) is used to treat wide-neck bifurcation aneurysms. These devices are deployed inside the sac. Therefore, the mesh structure provides apposition with the aneurysm wall and induces aneurysmal thrombosis. The objective of our study was to evaluate the anatomic and device-related parameters and indexes with Computational Fluid Dynamics (CFD) of the intracranial aneurysms before and after WEB simulation and find their relationship to complete occlusion. Using the heterogeneous model based on the marching cubes algorithm, we created 3D representations of 27 bifurcated intracranial aneurysms treated with the single-layer WEB device to evaluate anatomic and device-related parameters with CFD. In our CFD analysis, we observed higher large volumes (Va) (0.25 ± 0.18 versus 0.39 ± 0.09, p-value= 0.025) and higher volume to neck surface ratio (Ra) (1.32 ± 0.17 versus 1.54 ± 0.14, p-value= 0.021) in cases with occlusion failure. Large aneurysm volumes (Va) and higher volume to neck surface ratio (Ra) could be associated with occlusion failure in aneurysms treated with the WEB device.

Resilient Service Authentication for Smart City Application Using IoT

Internet of Things (IoT) support for smart city systems improves service scales by ignoring various user congestion. People are looking for different security features for reliable and robust applications. Here, the Permanent Denial of Service (PDoS) problem arises from improper user identification. This article introduces the Service-Reliant Application Authentication (SRAA) to prevent PDoS attacks in a smart area of the city. In this authentication method, the security of the application is ensured through the distribution of guarded access. The supervised access distribution uses user interface features and sync with the user device. Abnormality in linking user device, application, and authentication is seen in Back Propagation (BP) readings. BP learning reduces given weights based on abnormalities trained during the access distribution process. The oddity is reflected in the sequence from previous training sessions to ensure consistent synchronization of distributed services. From PDoS, the web device displays a few unattended loads on the service, which reduces service failure. The effectiveness of the proposed verification method is verified using delays to verify metric accuracy, false standard, sync failure, and bit rate.

Comparative effectiveness of stent-assisted coiling and Woven EndoBridge embolization for the treatment of unruptured wide-neck bifurcation intracranial aneurysms.

Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs. Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices. Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202-834] days vs 228 [177-494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8-3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630. Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.

Management of WEB device migration and mal-position in endovascular treatment of cerebral aneurysms.

With increasing advances in technology, the breadth of aneurysms that are treatable via an endovascular approach has increased. Wide necked aneurysms remain difficult to treat but the emergence of dedicated intrasaccular flow disruption devices such as the Woven EndoBridge (WEB, Micorvention) has increasingly seen previously ruptured and unruptured wide necked aneurysms successfully embolised and secured from the circulation using a single device.We are reporting two cases of WEB device treatment from the earliest experience with this device at our institution. These were complicated by partial extrusion in one case and remote migration of the WEB device in another case. Our initial cases highlight the importance of case selection and the need for accurate WEB sizing which are paramount to ensure complete occlusion of the aneurysm without complications of dislocation or extrusion into the parent vessel. Since then, we have performed over 170 cases with the WEB device. We also present a comprehensive review of the limited literature available on the management of mal-positioned and dislocated WEB devices. This allows us to reflect on how to avoid these complications and the different management options at the disposal of the neuro-interventionalist once such a complication has already occured. Rescue devices and manoeuvres that we reflect on include microcatheter manipulation, alligator retrieval device, stent retrievers, microsnares, aspiration, and stenting. Ultimately, each case needs to be individually evaluated and the best strategy selected depends on the context and specific circumstances.

Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up

BackgroundWoven EndoBridge (WEB) devices are becoming a reliable option for the treatment of wide-neck bifurcation aneurysms, but clear predictive factors are still missing to understand the one in five aneurysm...

WEB vs coiling in ruptured aneurysms: A propensity score matched comparison of safety and efficacy.

We aim to compare the safety and efficacy of WEB with coiling for acutely ruptured aneurysms.METHODS: All consecutive ruptured aneurysms with width suitable for WEB (2-10 mm) treated over 5 years (1/1/2015 to 31/12/2019) were included. We recorded WFNS, Fisher grade, patient demographics and aneurysm characteristics (size, location, D/W and aspect ratio, lobulation). Primary endpoints were mRS status at 3 months, aneurysm occlusion on latest available imaging follow-up, retreatment rate and procedural complications. We applied propensity score matching using aneurysm morphology (size, D/N ratio, ASPECT ratio and lobulation) to optimise matching for WEB versus coil comparison and minimise the effects of confounding. A total of 493 patients were identified, 97 treated with the WEB device. 1:1 propensity score matching was used to establish a matched group of 97 patients treated with coiling. The WEB arm showed 3% procedural complication rate, with no haemorrhagic complications and use of adjunctive device in 4%. Satisfactory occlusion on follow-up (mean 14 months) was 79%, with 19% retreatment rate. The coil arm had 8% complication rate, with use of an adjunctive device in 52% of cases (balloon 44%, stent 8%). Satisfactory occlusion on follow-up (mean 22 months) was 90%, with 8% retreatment rate. Treatment of ruptured wide-necked bifurcation aneurysms with WEB has a lower complication rate than coiling with high rate of satisfactory occlusion. However, there was a higher retreatment rate when compared with patients treated with coiling. An adjunct device (balloon or stent), was used in over 50% of aneurysms in the coiling group.