WEB Device Research Articles

Bailout Strategies for Abrupt Change in Woven Endobridge 17 Device Orientation After Detachments: Technical Note of 2 Anterior Communicating Artery Aneurysm Cases

Little information is available regarding technical challenges with the new lower profile Woven EndoBridge (WEB 17) system intended for smaller aneurysms. We report illustrative cases of technical complications encountered with 2 anterior communicating artery aneurysms treated by the WEB 17 system requiring rescue stenting in both cases, discussing technical nuances regarding potential reasons for the encountered failures along with management plan. Over a span of 1 year (January 2021 to January 2022), 45 WEB embolization procedures were performed at 2 institutions. Two procedures were complicated by abrupt change in orientation of the WEB device immediately after detachment from the delivery wire. In the first case, abrupt angulation with subsequent migration and prolapse out of the aneurysm sac into the distal right anterior cerebral artery was encountered with unsuccessful retrieval despite multiple attempts using a variety of devices, eventually requiring rescue stenting. A similar sudden orientation change was noted in the second case with partial prolapse from the aneurysm sac similarly bailed out by intracranial stenting. Both patients recovered to preprocedural baseline with no permanent deficits and eventually were discharged home. Intrasaccular WEB 17 embolization may be technically challenging in smaller wide-necked aneurysms with acute aneurysm-parent artery angulation with abrupt changing of WEB device orientation after detachments with device migration and prolapse into the parent vessel requiring rescue stenting. Proper WEB 17 device sizing and vigilance in the transition phase between the end of deployment and detachment windows of the procedure are paramount to treatment success. Routine use of antiplatelets in cases of anatomical aneurysms that are anticipated to be challenging might be a useful strategy if bailout stenting is needed.

The Woven EndoBridge Device for the Treatment of Intracranial Aneurysms: Initial Clinical Experience within an Australian Population.

PurposeAdvances in endovascular technology have expanded the treatment options for intracranial aneurysms. Intrasaccular flow diversion is a relatively new technique that aims to disrupt blood inflow at the neck of the aneurysm, hence promoting intrasaccular thrombosis. The Woven EndoBridge device (WEB; MicroVention, Aliso Viejo, CA, USA) is an US Food and Drug Administration approved intrasaccular flow diverter for wide-necked aneurysms. We report the early interim clinical and radiological outcomes of patients with both ruptured and unruptured intracranial aneurysms (IAs) treated using the WEB device in an Australian population.Materials and MethodsA retrospective analysis was done of patients with ruptured or unruptured IAs who received treatment with WEB across 5 Australian neuroendovascular referral centers between May 2017 and November 2020. Angiographic occlusion was assessed with time-of-flight magnetic resonance angiography. Complications were recorded and clinical outcomes were assessed using the modified Rankin scale at follow-up.ResultsIn total, 66 aneurysms were treated in 63 patients, with successful deployment of the WEB device in 98.5% (n=65). Eighteen (26.9%) ruptured aneurysms were included. Failure of deployment occurred in a single case. Adjunct coiling and/or stenting was performed in 20.9% (n=14) cases. Sixty-two patients with 65 aneurysms using a WEB device were followed up (mean=9.1 months), and 89.4% of these had complete aneurysm occlusion while 1.5% remained patent. Functional independence was achieved in 93.5% of cases.ConclusionEarly results following the use of WEB devices in Australia demonstrate safety and adequate aneurysm occlusion comparable to international literature.

The effect of social media influencers’ characteristics on consumer intention and attitude toward Keto products purchase intention

Social media influencers have become a more effective modern marketing approach used by businesses to influence consumers' intention and attitude. This study explores this influence by involving several factors of influencer’s characteristics on both consumers’ attitude and intention. Also, a moderation role of vloggers as a new emerging marketing tool is also examined in this research. To conduct this research and achieve its key objective, the study uses a quantitative research method to collect data from TikTok users which has also become a more worldwide favorable web device for short videos. PLS-SEM method is conducted in the phase of analysis and the results show a significant influence of the hypothesized research model except the influence of source relatability on consumer attitude and the moderating role of vloggers on consumer intention. The research findings provided unsurprisingly implications and supported the existing related literature in this field but contribute to cover the research knowledge gap through the integrated new model including numerous variables that have not been examined previously together in a unique framework.

Plotting through the pandemic

The COVID-19 pandemic necessitated the development of teaching resources that can be used in Emergency Remote Teaching (ERT). The closure of educational institutions necessitated that teaching and learning approaches would ensure continuity of the teaching enterprise. A teacher and two final year medical students developed an online, asynchronous resource to teach undergradute medical students in obstetrics on the use of the partogram (a labour monitoring tool) and a gravidogram (a pregnancy monitoring tool). The resource was designed to be used on any web browser and device using low bandwith to ensure accessbility where there is limited connectivity. Students were able to asynchronously engage with the learning material, complete the labour and pregnancy graphs based on cases designed for the exercise and submit it to the teacher for feedback. This short report sheds light on the process and lessons learned from the developement of this electronic learning resource.

WEB device for treatment of posterior communicating artery aneurysms

BackgroundWoven EndoBridge (WEB) device treatment of wide-neck bifurcation aneurysms has proved to be safe and effective, but the use of these devices in sidewall aneurysms has been reported only in...

A comparison between the CS-TOF and the CTA/DSA for WEB device management.

There is no study on the role of three-dimensional compressed sensing time of flight MR angiography (3D-CS-TOF) in the management of the WEB device. We evaluated the efficacy of 3-tesla 3D-CS-TOF for the management and follow-up of the WEB device implantations. Seventy-three aneurysms of 69 patients treated with the WEB device were retrospectively examined. Morphological parameters and embolization results of the aneurysms were assessed and compared on 3D-CS-TOF, CTA, and DSA images. Occluded, neck remnant, and recurrent aneurysms were observed in 61 (83.6%), 7 (9.6%), and 5 (6.8%) aneurysms, respectively. Inter- and intra-reader agreement values related to aneurysm size measurements were perfect. Aneurysms size, age, and proximal vessel tortuosity were negatively correlated with the visibility of the aneurysms and parent vessels on 3D-CS-TOF images (p = 0.043; p = 0.032; p < 0.001, respectively). Subarachnoid hemorrhage and age are associated with 3D-CS-TOF artifacts (p = 0.031; p = 0.005, respectively). 3D-CS-TOF findings are in perfect agreement with DSA or CT angiography (CTA) results (p < 0.001). According to our results, 3D-CS-TOF can be an easy, fast, and reliable alternative for the management or follow-up of WEB assisted embolization.

鋼 I 桁下フランジ連結板取替えのためのウェブバイパス工法の適用範囲およびバイパス部材の形状に関する解析的検討

鋼 I 桁下フランジ連結板取替えのためのウェブバイパス工法の適用範囲およびバイパス部材の形状に関する解析的検討

Semi-automated cerebral aneurysm segmentation and geometric analysis for WEB sizing utilizing a cloud-based computational platform.

Accurate aneurysm measurements are important for selecting the WEB device. The objective was to validate a cloud-based platform, SurgicalPreview (SP) against manual measurements for aneurysm analysis. Two sets of measurements each for SP and manual methods were obtained for 40 aneurysms. Reliability and agreement were assessed with intra-class correlation coefficient (ICC) and Bland-Altman plots respectively. Kappa coefficient was used to assess agreement for predicting WEB size. There was good reliability for repeat SP measurements: aneurysm diameter (ICC-1, 95%CI 0.98-1), height (ICC-1, 95%CI 0.99-1) and neck diameter (ICC-0.96, 95%CI 0.93-0.98). There was good reliability for the two manual diameter (ICC-0.97, 95%CI 0.9-0.97) and height (ICC-0.93, 95%CI 0.87-0.96) measurements and moderate for neck diameter (ICC-0.76, 95%CI 0.54-0.87). There was greater agreement for SP versus manual repeat measurements on Bland-Altman plots. Reliability between the SP and manual methods was good for aneurysm diameter (ICC-0.98, 95%CI 0.95-1) and height (ICC-0.96, 95%CI-0.93-0.98) and moderate for neck. (ICC-0.6, 95%CI -0.22-0.87). The Bland-Altman plots confirmed better agreement between the two methods for the aneurysm diameter and height than the neck. There was strong agreement between the methods for predicting the WEB diameter (Kappa-0.84, 95%CI 0.71-0.97) and moderate for predicting WEB height (Kappa-0.66, 95%CI 0.43-0.89). There was moderate agreement for predicted versus deployed WEB diameter: SP (Kappa-0.56, 95%CI 0.38-0.74), Manual (Kappa-0.53, 95%CI 0.34-0.71). The SurgicalPreview® had greater agreement for repeat measurements. There was good reliability between the two methods for predicting WEB diameter and height and moderate agreement between predicted versus deployed WEB diameter.

Intracranial aneurysm treatment with WEB and adjunctive stent: preliminary evaluation in a single-center series

BackgroundIntrasaccular flow disruption with WEB is a safe and efficacious technique that has significantly changed endovascular management of wide-neck bifurcation aneurysms (WNBAs). Use of stent in combination with WEB is...

Teleproctoring for Neurovascular Procedures: Demonstration of Concept Using Optical See-Through Head-Mounted Display, Interactive Mixed Reality, and Virtual Space Sharing-A Critical Need Highlighted by the COVID-19 Pandemic.

Physician training and onsite proctoring are critical for safely introducing new biomedical devices, a process that has been disrupted by the pandemic. A teleproctoring concept using optical see-through head-mounted displays with a proctor's ability to see and, more important, virtually interact in the operator's visual field is presented. Test conditions were created for simulated proctoring using a bifurcation aneurysm flow model for WEB device deployment. The operator in the angiography suite wore a Magic Leap-1 optical see-through head-mounted display to livestream his or her FOV to a proctor's computer in an adjacent building. A Web-based application (Spatial) was used for the proctor to virtually interact in the operator's visual space. Tested elements included the quality of the livestream, communication, and the proctor's ability to interact in the operator's environment using mixed reality. A hotspot and a Wi-Fi-based network were tested. The operator successfully livestreamed the angiography room environment and his FOV of the monitor to the remotely located proctor. The proctor communicated and guided the operator through the procedure over the optical see-through head-mounted displays, a process that was repeated several times. The proctor used mixed reality and virtual space sharing to successfully project images, annotations, and data in the operator's FOV for highlighting any device or procedural aspects. The livestream latency was 0.71 (SD, 0.03) seconds for Wi-Fi and 0.86 (SD, 0.3) seconds for the hotspot (P = .02). The livestream quality was subjectively better over the Wi-Fi. New technologies using head-mounted displays and virtual space sharing could offer solutions applicable to remote proctoring in the neurointerventional space.

Development of a Smart Technique for Mobile Web Services Discovery

Web service (WS) presents a good solution to the interoperability of different types of systems that aims to reduce the overhead of high processing in a resource-limited environment. With the increasing demand for mobile WS (MWS), the WS discovery process has become a significant challenging point in the WS lifecycle that aims to identify the relevant MWSs that best match the service requests. This discovery process is a resource-consuming task that cannot be performed efficiently in a mobile computing environment due to the limitations of mobile devices. Meanwhile, a cloud computing can provide rich computing resources for mobile environments given its unlimited and easily scalable resources. This paper proposes a semantic WS discovery and invocation framework in mobile environments based on cloud and a relationship-aware matchmaking algorithm. The discovery algorithm enriches MWS and user requests semantically with the functional and non-functional properties of Ontology Web Language for Services, such as Quality of Web Service, device context, and user preferences. The WS repository is filtered based on logical reasoning and a parameter-based matching algorithm to minimize the matching space and improve runtime performance. The cosine similarity between the user request and services repository is then assessed to generate the most relevant WS. The relationships among concepts in the ontology are considered to improve the recall and precision ratio. After the WS discovery process, users can invoke and test these services in a mobile environment through a dynamic user interface. The interface of the invocation process is changed according to the WS description document. An application prototype is also developed to evaluate the framework based on a Cordova cross-mobile development framework.

Applications of a Novel Microangioscope for Neuroendovascular Intervention.

Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique. Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization. The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device). This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.

WEB Device Shape Changes in Elastase-Induced Aneurysms in Rabbits.

While WEB devices have been shown to be safe and effective for aneurysm treatment, WEB-shape modification compression has been associated with incomplete aneurysm occlusion. We explored the relationship between occlusion rates and WEB-shape modification in different WEB device types in an experimental aneurysm model. Elastase-induced aneurysms were created in rabbits and treated with dual-layer (n = 12), single-layer (n = 12), or single-layer sphere (n = 12) WEB devices. Aneurysms were followed up either at 3 or 12 months. Angiographic occlusion was graded using the WEB Occlusion Scale: grade I, complete; grade II, complete but recess filling; grade III, residual neck; or grade IV, residual aneurysm. WEB-shape modification and histologic features were also analyzed. Grade I or II occlusion was seen in 16 (44%) aneurysms, and grade I, II, or III ("adequate") occlusion was observed in 22 (61.1%) aneurysms at follow-up. WEB-shape modification was observed in 22 (61.1%) aneurysms. WEB-shape modification was higher in single-layer (9/12) and dual-layer (10/12) devices compared with single-layer sphere devices (3/12). Aneurysms with WEB-shape modification had a higher level of thrombus organization in the dome compared with those without WEB-shape modification (68% [15/22] versus 50% [7/14]). WEB-shape modification was not correlated with angiographic or histologic outcomes but was significantly correlated with levels of fibrosis and smooth muscle cells in the aneurysm. WEB-shape modification is not associated with incomplete aneurysm occlusion of WEB devices in the rabbit model but may be related to connective tissue formation and the healing response to WEB device implantation.

WEB Device for Ruptured Aneurysms

Cortez, Gustavo; Monteiro, Andre; Akture, Erinc; Arthur, Adam S MD, MPH; Peterson, Jeremy; Dornbos, David; Jabbour, Pascal MD; Sweid, Ahmad; Tjoumakaris, Stavropoula I MD; Gooch, Michael; Delgado, Josser; Kayan, Yasha; Rai, Ansaar; Boo, Sohyun; Siddiqui, Adnan; Waqas, Muhammad MBBS; Aghaebrahim, Nima MD; Sauvageau, Eric MD; Hanel, Ricardo A MD, PhD Author Information

Comparison of operating room variables, radiation exposure and implant costs for WEB versus stent assisted coiling for treatment of wide neck bifurcation aneurysms.

BackgroundThe WEB device offers another option for treating wide neck bifurcation aneurysms (WNBA). The objective was to compare procedure variables, radiation and implant cost between WEB and stent assisted coiling (SAC) for WNBA.MethodsA retrospective comparison of similarly sized WNBA treated with SAC or WEB over 5-years was performed. The operating room (arrival-departure), anesthesia (intubation-extubation), procedure duration (puncture-closure), fluoroscopy time and radiation dose(m-Gy) were recorded from the patients’ charts. Implant cost per case of all implants (stents, coils, WEB) that were opened whether deployed or not was captured including any coils used in the WEB cases. The implant cost represented the true cost incurred by the institution.ResultsThere were 46 WEB and 41 SAC cases with no significant difference in aneurysm size. There were more MCA and ACOMM (p = 0.005) and more ruptured aneurysms (p = 0.02) in the WEB group. Regarding procedure variables (hours:minutes): Operating room time WEB 2:31 (±0:37) versus SAC 3:41 (±0:50) (p < 0.0001); anesthesia duration WEB 2:05 (±0:31) versus SAC 3:13 (±0:51) (p < 0.0001) and procedure duration WEB 1:16 (±0:29) versus SAC 2:09 (±0:46) (p < 0.0001). Regarding radiation: Fluoroscopy time WEB 0:34 (±0:18) versus SAC 1:06 (±0:35) (p < 0.0001) and radiation dose WEB 2392(±1086)m-Gy versus SAC 3442 (±1528)m-Gy (p = 0.0007). The implant cost was $17,028(±$5,527) for the WEB versus $23,813 (±$7,456) for the SAC group (p < 0.0001).ConclusionThe WEB group had significantly shorter operating room, procedure and anesthesia duration compared to the SAC group. The radiation dose and fluoroscopy time was lower for the WEB group. The total implant cost per case was significantly lower for the WEB versus the SAC group.

Multiple intra-aneurysmal WEB devices: Case discussions and operative technique

The Woven Endobridge (WEB, Sequent Medical, Aliso Viejo, California) device has emerged as an FDA approved endosaccular flow diverting alternative for patients with complex aneurysm morphology. We describe for the first time, in patients with dual anti platelet therapy (DAPT) non compliance, two cases during which multiple WEB devices were deployed within the aneurysm sac to achieve flow disruption. Two ophthalmic segment internal carotid artery aneurysms are treated by the deployment of an additional WEB device within the sac. We subsequently discuss the techniques utilized to ensure parent vessel patency. We demonstrate that patients with contraindications to endovascular modalities requiring DAPT may be candidates for a multi WEB intra-aneurysmal construct.

Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge Device: Experience Post-FDA Approval.

Coil embolization of ruptured bifurcation aneurysms is challenging and often necessitates adjunctive stenting, which requires antiplatelet therapy in the setting of subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB; Terumo) device is an alternative self-expanding 3D mesh that does not require antiplatelet agents. However, its use has been mostly reserved for unruptured aneurysms. To assess the safety and feasibility of ruptured aneurysm treatment with the WEB. Retrospective analysis of 9 SAH patients with 11 aneurysms that were treated with the WEB device at 2 institutions after FDA approval. Hunt and Hess grades were III and IV in 4 (44%) each and V in 1 (11%). All patients were treated within 24 h of hospitalization, and a single WEB was used in all but one aneurysm. Aneurysms treated were 3 basilar tip, 2 anterior communicating artery, 2 posterior inferior cerebellarartery, 1 middle cerebral artery, 1 carotid-ophthalmic artery, 1 posterior communicating artery, and 1 vertebrobasilar junction. Mean aneurysm height and width were 6.2±2.2mm (range: 3-10) and 5.6±3.0mm (range: 3.3-14), respectively. Mean dome-to-neck ratio was 1.7±0.8 (range: 1.0-3.8). There was one intraoperative rupture that occurred because of device dislodgement and was managed with embolization. There were no treatment-related mortalities and no re-rupture after securement of the aneurysms with the WEB. Our preliminary experience indicates that the WEB device can be used safely for ruptured aneurysms of various sizes in the anterior and posterior circulation. Larger series with long-term follow-up are necessary to confirm our findings.

EWVHunter: Grey-Box Fuzzing with Knowledge Guide on Embedded Web Front-Ends

At present, embedded devices have become a part of people’s lives, so detecting security vulnerabilities contained in devices becomes imperative. There are three challenges in detecting embedded device vulnerabilities: (1) Most network protocols are stateful; (2) the communication between the web front-end and the device is encrypted or encoded; and (3) the conditional constraints of programs in the device reduce the depth and breadth of fuzz testing. To address these challenges, we propose a new type of gray-box fuzz testing framework in this paper, called EWVHunter, which is mainly used to find authentication bypass and command injection vulnerabilities in embedded devices. The key idea in this paper is based on the observation that most embedded devices are controlled through the web front-end. Such embedded devices often contain rich information in the communication protocol between the web front-end and device. Therefore, by filling data at the input source on the web front-end and reusing web front-end program logic, we can effectively solve the impact of the stateful network protocol and communication data encryption on fuzzing without relying on any knowledge about the communication protocol. Additionally, we use firmware information extraction to enhance EWVHunter so that it can detect vulnerabilities in deep layer codes and hidden interfaces. In our research, we implemented EWVHunter and evaluated 8 real-world embedded devices, and our approach identified 12 vulnerabilities (including 7 zero-days), which affect a total of 31,996 online devices.

Technical aspects of web device in aneurysm treatment

Wide-neck bifurcation aneurysms (WNBAs) make up 26–36% of all brain aneurysms. Intrasaccular flow disruption is an innovative technique for the treatment of WNBAs. The Woven EndoBridge (WEB) device (Sequent Medical,...

WEB as a combined support and embolization device in a giant partially thrombosed donut-shaped aneurysm

BackgroundGiant partially thrombosed aneurysms are challenging lesions for which treatment can be difficult due to their unfavourable anatomical configuration and abnormal flow conditions. Case descriptionThe patient presented in this report suffered from a symptomatic giant partially thrombosed donut-shaped aneurysm of the left-sided supraophthalmic internal carotid artery. Due to the location and the size of the aneurysm, endovascular treatment was performed. Navigation of the microcatheter-microwire-system distal to the aneurysm for stent deployment was technically not possible due to limited support, caused by the large aneurysm. Therefore, a WEB device was placed in the distal leg of the donut-shaped aneurysm. Additionally to the occlusion of this part of the aneurysm, the WEB device enabled enough support to navigate the microcatheter-microwire-system distal to the aneurysm. After deployment of a flow-diverting stent, coiling of the aneurysm was performed. Follow-up angiography showed complete occlusion of the aneurysm. The patient suffered from severe headaches which were no longer present 6 months after treatment. ConclusionsThe WEB intraaneurysmal flow diverter can be effectively used as combined support and embolization device for the treatment of complex aneurysms in selective cases where other catheterization and embolization strategies have failed.