Woven EndoBridge Device Research Articles

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.

Lateral Compression is the Strongest Independent Predictor of Aneurysm Occlusion After Endovascular Treatment of Intracranial Aneurysms With the Woven EndoBridge Device

BACKGROUND AND OBJECTIVES: The effect of lateral compression (LC) of the Woven EndoBridge (WEB) device on intracranial aneurysm (IA) occlusion and retreatment has not been studied in depth. This study aims to determine the effect of LC on aneurysm occlusion and retreatment after endovascular treatment with WEB. METHODS: We retrospectively reviewed IAs treated with WEB at our institution between February 5th, 2019, and March 31st, 2022. LC was determined in the immediate postdetachment angiogram by measuring the mean implanted WEB width at the equator in two orthogonal projections and subtracting it from the nominal WEB width. LC was then converted to the percentage of nominal WEB width (percent LC [%LC]). Independent predictors of complete and adequate aneurysm occlusion at follow-up and retreatment were determined using multivariate logistic regression analysis. Optimal %LC thresholds were determined using receiver operating characteristic analysis. RESULTS: One hundred and fifty-five IAs were included, with a mean size of 6.4 mm, a mean neck of 3.6 mm, and a mean time to last follow-up of 15.5 months. At last follow-up, complete and adequate aneurysm occlusion was present in 98 (63.2%) and 139 (89.7%) IAs, respectively. Twelve IAs were retreated (7.7%). %LC was the strongest independent predictor of complete and adequate aneurysm occlusion at first and last follow-up and an independent predictor of aneurysm retreatment. Optimal %LC thresholds for complete and adequate aneurysm occlusion at first follow-up were >17.1% and >15.7%, respectively. Compared with IAs in which these thresholds were not attained, IAs in which these thresholds were attained had significantly higher rates of complete (31% vs 68%, P-value <.0001) and adequate occlusion (81% vs 96%, P-value .004) at first follow-up. The optimal %LC threshold for aneurysm retreatment was ≤15.6%. IAs with ≤15.6% LC had a significantly higher rate of retreatment (15%) than IAs with >15.6% LC (4%, P-value .025). CONCLUSION: LC is the strongest independent predictor of aneurysm occlusion in IAs treated with WEB.

Comparison of the Contour Neurovascular System and Woven EndoBridge device for treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall.

The authors compared the Contour Neurovascular System (Contour) with the Woven EndoBridge (WEB) device for the treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall. Prospective clinical and radiological data were collected for all patients treated with either the Contour or WEB at a tertiary university hospital from May 2018 to June 2022. In patients who had at least 3 months of follow-up data available (median patient age 60.0 [IQR 51.8-67.0] years, male/female ratio 1:1.4), the authors compared 40 aneurysms in 34 patients treated with the Contour and 30 aneurysms in 30 patients treated with the WEB. Overall, 26 middle cerebral artery, 24 anterior communicating artery, 9 basilar artery tip, 4 posterior communicating artery, 4 internal carotid artery, 1 anterior cerebral artery, 1 posterior inferior cerebellar artery, and 1 superior cerebellar artery aneurysm were treated. In the Contour cohort, complete occlusion at last follow-up was achieved for 30 aneurysms (75%) and a small neck remnant was seen in 6 aneurysms (15%), summing up to an adequate occlusion rate of 90%. One aneurysm (2.5%) had to be retreated, and 1 symptomatic thromboembolic event (2.5%) was observed with complete remission at discharge. Three adjunctive stents (10%) had to be used due to branch occlusion. In the WEB cohort, adequate occlusion was also seen in 90% of aneurysms (complete occlusion in 19 [63.3%] and remnant neck in 8 [26.7%], with a retreatment rate of 20%). Four WEBs (13.3%) needed additional stent placement due to device protrusion into a branch, 2 asymptomatic thromboembolic events (6.7%) were noted, and 1 major ischemic event (3.3%) due to M2 occlusion was noted. One patient treated with the WEB died between follow-ups of causes unrelated to the aneurysm, treatment, or device. Time from first measurement to deployment and thus total treatment time was significantly shorter in the Contour group (p = 0.004), regardless of whether a prior angiogram was available for aneurysm measurement and device sizing. Results for the Contour were promising, although longer follow-up is necessary to draw more solid conclusions on the utility and risk profile of this new device compared with the already widely used WEB device. Adequate occlusion at last follow-up was the same for both devices, whereas the probability of complete occlusion at last follow-up was significantly higher for the Contour, and the WEB showed a significantly higher retreatment rate. Median deployment times were significantly shorter with the Contour than the WEB.

Balloon assisted Woven endobridge deployment (BAWD): A safety and efficacy study.

Balloon-assisted deployment/remodelling is a proven adjunctive technique for coil embolization of intracranial aneurysms, and it may be a helpful adjunct in delivering the Woven EndoBridge (WEB) device. To evaluate the safety, efficacy and feasibility of balloon-assisted WEB deployment in both ruptured and unruptured intracranial aneurysms in both typical and atypical locations. Patients who underwent treatment of ruptured and unruptured intracranial aneurysms with the BAWD technique were retrospectively identified from a prospectively maintained database at two neurointerventional centres. Patient demographics, aneurysm characteristics, technical procedure details, clinical and imaging outcomes were reviewed. Thirty-three aneurysms (23 women) were identified with a median age of 58 years. There were 15 (45.5%) ruptured aneurysms, 25 (64.3%) in the anterior circulation and 12 (36.4%) aneurysms having an atypical location for WEB treatment. The average aneurysm size was 6.8 mm (greatest dimension), 4.6 mm (height) and 4.5 mm (width), and 25 (75.8%) aneurysms had a wide neck morphology. One patient died (3.0%) secondary to a procedure-related complication, and there was no procedure-related permanent morbidity. Complete and adequate aneurysm occlusion on mid-term follow-up DSA was 85.2% and 92%, respectively. Balloon-assisted WEB deployment appears to be a safe and effective technique that may increase the utility of the WEB device. Further prospective studies on BAWD should be considered.

Persistent flow inside the Woven EndoBridge at angiographic follow-up: A multicenter study.

The occurrence of persistent intra-device filling (BOSS 1, using the Bicêtre Occlusion Scale Score (BOSS)) in aneurysms treated with a Woven Endobridge (WEB) device is infrequent based on angiographic follow-up. To date, three monocentric case series were published studying BOSS 1 cases. Through a multicenter retrospective study, we aimed to report the incidence, and risk factors of intra-WEB persistent filling. We reached out to European academic centers that treat patients using WEB devices and requested de-identified data of patients treated with a WEB device and underwent angiographic follow-up, at least 3 months after embolization, to assess the BOSS 1 occlusion score. We compared baseline characteristics, treatment modalities, and aneurysm data of the included BOSS 1 patients with those of a control group consisting of non-BOSS 1 patients (n = 116) who had an available angiographic follow-up. Univariable and multivariable models were employed for analysis. Among the pooled sample of 591 aneurysms treated with WEB, the rate of persistent flow (BOSS 1) at angiographic follow-up was 5.2% (n = 31 out of 591), performed after an average of 8.7 ± 6.3 months. In the multivariable-adjusted analysis, dual antiplatelet therapy in the postoperative period (adjusted odds ratio [aOR] 4.3 [95% CI 1.3-14.2]), and WEB undersizing (aOR 10.8 [95% CI 2.9-40]) were independently associated with a BOSS 1 persistent flow result. Persistent blood flow within the WEB device during angiographic follow-up (BOSS 1) is an uncommon occurrence. Our findings indicate that post-procedural dual antiplatelet therapy and undersizing of the WEB device are independently associated with the presence of BOSS 1 at follow-up.

Long-term outcomes of the Woven EndoBridge device for treatment of intracranial aneurysms: A systematic review and meta-analysis.

The Woven EndoBridge (WEB) has been specifically developed to manage wide neck bifurcation intracranial aneurysms. A wide range of aneurysm occlusion rates and device-related complications are reported in different papers, and a lack of collective evidence in this regard. To clarify the long-term efficacy and safety outcomes of intracranial aneurysm treatment with WEB devices. A systematic literature search was performed on PubMed, Scopus, Web of Science, and Embase databases on April 25, 2023. Considering the eligibility criteria, all the studies reporting the outcomes of the intracranial aneurysm treatment with WEB device at 1 and/or more than 1 year were included. Data elements of interest were extracted and analyzed using R software version 4.2.1. Twenty-seven articles were included. Complete occlusion rate was 56.85%, 67.10%, and 56.34% at one year, beyond one year, and at/beyond two years of follow-up, respectively. Adequate occlusion rate was 87.11% at one year, 91.16% beyond one year, and 88.87% at/beyond two years of follow-up. WEB compression and aneurysm recurrence rates increased from 17.62% and 0.58% at one year to 42.59% and 18.99% beyond one year of follow-up, respectively. An increase in retreatment rate from 3.45% at one year to 7.15% beyond one year of follow-up was found. The current study supports the long-term efficacy of WEB devices for the treatment of intracranial aneurysms. However, an increase in WEB compression, aneurysm recurrence, and retreatment rates beyond one year reveals the importance of follow-ups after the first year of WEB placement.

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

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. 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. A total of 104 consecutive aneurysms/patients (25 men/79 women; median age, 63years, 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 5.5mm (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 32min (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%. 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.

Safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide necked bifurcation aneurysms: final 5 year results of the pivotal WEB Intra-saccular Therapy study (WEB-IT)

IntroductionThe US Woven EndoBridge Intra-saccular Therapy (WEB-IT) study is a pivotal, prospective, single arm, investigational device exemption study to evaluate the safety and effectiveness of the WEB device for the...

Woven Endobridge embolization: Indications and innovation.

The treatment of intracranial aneurysms has seen incredible advancements over the last few decades. Long-term occlusion of wide-neck bifurcation aneurysms remains technically challenging. The Woven Endobridge (WEB) embolization device is innovative in its construction and uses. The design of the device has evolved over the last decade. Pre-clinical and clinical trials are ongoing and continue to inform the development of intrasaccular flow-diverting devices. The WEB device is currently approved by the U.S. Food and Drug Administration (FDA) for treating wide-neck aneurysms. The safety and efficacy of the WEB device have yielded promising clinical results that may have additional indications. This review aims to discuss the development of the WEB device and the current state of the WEB device in the treatment of wide-neck aneurysms. We also summarize ongoing clinical studies and potential innovative uses.

Decision-making tree for optimal Woven EndoBridge device sizing with ideal Woven EndoBridge-aneurysm volume (iWAVe) ratio

PurposeOptimal size selection is important for successful Woven EndoBridge (WEB) treatment. Conventional recommendations for WEB sizing based on aneurysm width and height sometimes require device exchange. We aimed to design a novel volume-based parameter, the ideal WEB-aneurysm volume (iWAVe) ratio, for optimal WEB sizing. MethodsConsecutive patients who underwent WEB treatment for wide-neck bifurcation aneurysms between January 2021 and May 2022 were retrospectively reviewed. Aneurysm volume was automatically calculated using software. We measured the aneurysm volume based on the expected position of the device within the aneurysm. The WAVe ratio was defined as the ratio of the aneurysm volume to WEB volume. We dichotomized aneurysms treated with a successful sizing or unsuccessful sizing for WEB (successful group and unsuccessful group, respectively). ResultsThirty-five patients were eligible for study enrollment. Ten patients (28.6%) needed to exchange the WEB on the first attempt and required another WEB on the second attempt resulting in deployment success. Hence, 35 aneurysms were in the successful group and 10 were in the unsuccessful group. The median WAVe ratio was 1.0 (range 0.76–1.31) in the successful group and 1.27 (0.58–1.89) in the unsuccessful group. Using logistic regression, iWAVe ratio was from 0.90–1.16 to secure a >80% probability of success by the 95% lower confidence limit. The sensitivity and specificity of the iWAVe ratio for optimal size selection on the first attempt were 0.60 and 1.00, respectively. ConclusionDecision-making based on aneurysm width and the iWAVe ratio could promote optimal WEB sizing.

WEB shape modifications: angiography–histopathology correlations in rabbits

BackgroundWEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in...

Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series

BackgroundSince its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping.MethodsA retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified.ResultsOverall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms.ConclusionsMicrosurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.

Long-Term Follow-Up of Cerebral Aneurysms Completely Occluded at 6Months After Intervention with the Woven EndoBridge (WEB) Device: a Retrospective Multicenter Observational Study.

The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have same or improved long-term aneurysm occlusion after the initial 6-month follow up. The aim of this study is to assess the long-term follow-up in aneurysms that have achieved complete occlusion at 6months. We also compared the predictive value of different imaging modalities used. This is an analysis of a prospectively maintained database across 13 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB device who achieved complete occlusion at first follow-up and had available long-term follow-up. A total of 95 patients with a mean age of 61.6 ± 11.9years were studied. The mean neck diameter and height were 3.9 ± 1.3mm and 6.0 ± 1.8mm, respectively. The mean time to first and last follow-up was 5.4 ± 1.8 and 14.1 ± 12.9months, respectively. Out of all the aneurysms that were completely occluded at 6months, 84 (90.3%) showed complete occlusion at the final follow-up, and 11(11.5%) patients did not achieve complete occlusion. The positive predictive value (PPV) of complete occlusion at first follow was 88.4%. Importantly, this did not differ between digital subtraction angiography (DSA), magnetic resonance angiography (MRA), or computed tomography angiography (CTA). This study underlines the importance of repeat imaging in patients treated with the WEB device even if complete occlusion is achieved short term. Follow-up can be performed using DSA, MRA or CTA with no difference in positive predictive value.

Woven EndoBridge Device Migration and Microsnare Retrieval Strategy: Single Institutional Case Reports with Technical Video Demonstration.

The Woven EndoBridge (WEB) (MicroVention/Terumo) device is a treatment option for wideneck bifurcation aneurysms. An uncommon adverse effect is WEB device migration. While certain bailout strategies for WEB recovery have been described, there is still a paucity of information on optimal strategies to maximize both short and long-term post-operative outcomes. We add 2 cases at our institution to the existing literature of WEBectomy in the setting of complicated intracranial aneurysm treatment. We discuss the long-term imaging outcomes with additional fluoroscopy video demonstrating our technique. Our findings reflect a clear benefit for the use of the Amplatz GooseneckTM microsnare (Medtronic) device as a means of WEB recovery, coupled with potential stent-assisted WEB embolization to remove the aneurysm from the parent circulation, while minimizing recurrence and thromboembolic complications.

Aneurysm Treatment with Woven EndoBridge-17: Angiographic and Clinical Results at 12 Months from a Retrospective, 2-Center Series.

This retrospective, 2-center study investigated the feasibility, safety, and efficacy at 12-month follow-up of the treatment of ruptured, unruptured, and recurrent intracranial aneurysms using the latest generation of the Woven EndoBridge (WEB) device, the WEB-17 system. Aneurysms treated with WEB-17 were extracted from the databases of 2 neurovascular centers. Patients, aneurysm characteristics, complications, and clinical and anatomic results were analyzed. From February 2017 to May 2021, two hundred twelve patients with 233 aneurysms (181/233, 77.7%, unruptured-recurrent, and 52/233, 22.3%, ruptured) were included. High treatment feasibility (95.3%) was reported and was similar in ruptured aneurysms (94.2%) and unruptured-recurrent aneurysms (95.6%) (P = .71) and in typical (95.4%) and atypical (94.7%) locations (P = .70), but it was lower in aneurysms with an angle between the parent artery and main aneurysm axis of ≥45° (90.2%) compared with those with an angle of <45° (97.1%) (P = .03). Global mortality and morbidity were 1.9% and 3.8% at 1 month, respectively, and 4.4% and 1.9% at 12 months, respectively. One-month morbidity (P = .02) and mortality (P = .003) were higher in the ruptured group (10.0% and 8.0%, respectively) compared with unruptured-recurrent group (1.9% and 0.0%, respectively). Overall adequate occlusion (complete occlusion and neck remnant) was 86.3%. The percentage of adequate occlusion was higher (P = .05) in the unruptured-recurrent group (88.5%) compared with the ruptured group (77.5%). The WEB-17 system showed high feasibility for ruptured and unruptured aneurysms, typical and atypical locations, and some aneurysms with an angle of ≥45°. As the most recent generation device, the WEB-17 also demonstrates high safety and good efficacy.

How a decade of aneurysms embolization with the Woven EndoBridge has changed our understanding and practices?

BackgroundSafety and efficacy of the WEB (Woven EndoBridge) device have been extensively evaluated in several good clinical practice studies. Nonetheless, the WEB had several structural evolutions overtime up to the fifth generation WEB device (WEB17). Here, we tried to understand how this may have modified our practices and enlarged our indications for its use. MethodsWe retrospectively analyzed data from all patients with aneurysms treated (or intended to be treated) with a WEB at our institution between July 2012 and February 2022. The time frame was split in two periods: before and after the arrival of the WEB17 in our center (February 2017). Results252 patients with 276 wide-necked aneurysms were included; 78 aneurysms (28.2%) were ruptured. Successful embolization with a WEB device was achieved in 263/276 aneurysms (95.3%). With the availability of WEB17, treated aneurysms were significantly smaller (8.2 mm versus 5.9 mm, p<0.001) and off-label location significantly increased (4.4% versus 17.3%, p = 0.02) with an increase of sidewall aneurysm (4.4% versus 11.6%, p = 0.06). Also, WEB were more significantly oversized (1.05 versus 1.11, p<0.01). Adequate and complete occlusion rates increased constantly during the two periods (54.8% versus 67.5%, p = 0.08 and 74.2% versus 83.7%, p = 0.10, respectively). The proportion of ruptured aneurysms slightly increased between the two periods (24.6% versus 29.5%, p = 0.44). ConclusionsOver the first decade of its availability, the WEB device usage shifted towards smaller aneurysms and broader indications, including ruptured aneurysms. The oversizing strategy also became the standard of practice for WEB deployment in our institution.

Abstract Number ‐ 214: Woven EndoBridge in Conjunction with Coiling: Novel Technique for Treatment of a Large Basilar‐tip Aneurysm

Introduction Basilar tip aneurysmscan bechallenging to treatgiven their location andoftencomplex geometryand size.Endovascular coilinghas historically been the standardoftreatmentfor less complex aneurysms, proving to bebothsuccessfulandsafe.However, recanalization ratesfor large and giant aneurysmshave beenunacceptably high.More recently, devicessuch asthe Woven EndoBridge (WEB) have been developed toreduce the rate of recanalization.Here we describea uniquecase of alarge basilar tip aneurysm that was treated withcombination oftheWEBdeviceandcoilembolizationsimultaneously. Methods Case report. Results A woman in her fifties presented with several days of headache, nausea and vomiting, vision changes, and unsteady gait. MRA of the brain visualized a large unruptured basilar tip saccular aneurysm which was confirmed via a diagnostic cerebral angiogram (size: 12.9×11.2×14.0 mm, neck: 4.5 mm) [Figure 2A]. Given the sizeand locationof the aneurysm,we attempted embolization with the largest available WEBSLdevice. This device was undersized for the aneurysm.We therefore utilized a novel combinationcoiling,to partially fill the dome and posterior aneurysm sac,and the largest WEB SL available (11×9 mm). Using a radial system, the WEB device was partly unsheathed at the base of the aneurysm. Then, using a femoral system three coils (18 Hydroframe 28cm 7mm, 18 Hydroframe 15cm 7mm 10, 10 Hydroframe 23cm 7mm) were introduced into the remaining space of the aneurysm, filling the void between the aneurysm dome and the partly deployed WEB SL device. Once all coils were appropriately placed and stable, the WEB device was fully deployed, which lead to successful embolization and occlusion of the aneurysm [Figure 2B]. Conclusions The challenge of treatinglargebasilar tip aneurysmshasencouragedthedevelopment of innovative devices and novel interventional techniques.Here we demonstratethepossibility ofcombiningaWEBdevicewith standard coilingto treatlarge, wide‐necked basilar tip saccularaneurysms that are not ideal candidates for standard therapy.

Abstract Number ‐ 126: Use of Woven EndoBridge device for Aneurysms in Off‐Labeled Locations: Systematic Review and Meta‐Analysis

Introduction The Woven EndoBridge (WEB) device was originally approved to treat intracranial wide‐necked saccular bifurcation aneurysms. Recent studies have suggested its use for the treatment of intracranial aneurysms (IA) in alternative locations with variable success. We aimed to evaluate the safety and efficacy of the WEB for IAs in off‐labeled locations using a meta‐analysis (MA) of the literature. Methods We performed a systematic review of all studies including patients treated with WEB for IAs in locations different than what is currently on‐label FDA until May 2022. Our primary efficacy and safety outcomes were adequate occlusion at last follow up and a composite of intraprocedural and postprocedural complications, respectively. The Raymond‐Roy (RR) scale and the Bicêtre Occlusion Scale Score (BOSS) were used to define complete (RR: 1; BOSS: 0‐0’) and adequate (RR:1‐2; BOSS: 0–2) occlusion. Additional safety outcomes included intraprocedural (thromboembolic, hemorrhagic, device deployment, or air embolism) and postprocedural (ischemic or hemorrhagic) complications, and mortality. We performed a random‐effects MA of proportions and assessed the certainty of the evidence using the GRADE approach. Statistical heterogeneity across studies was assessed with I2 statistics. Logistic regression of the patient level data was used to study the predictors of complete occlusion. Results Ten studies were selected, and 285 patients (79% female; mean age 58 years) with 288 aneurysms (35% ruptured) were included. Adequate and complete occlusion rates were 89% (95% CI 81–94%; I2 = 0%; moderate‐certainty evidence) and 64% (95% CI 57–70%; I2 = 13%; moderate‐certainty evidence), respectively. The composite safety outcome rate was 8% (95% CI 3–17%; I2 = 34%; very low‐certainty evidence). The intraprocedural and postprocedural complication rates were 6% (95% CI 4–10%; I2 = 0%; very low‐certainty evidence) and 1% (95% CI 0–1%; I2 = 33%; very low‐certainty evidence), respectively. The mortality rate was 2% (95% CI 1–7%; I2 = 0%; very low‐certainty evidence). Aneurysm width (OR = 0.5; p = 0.03) was the only significant predictor of complete occlusion. Conclusions The preliminary studies evaluating the use of WEB for the treatment of IAs in off‐labeled locations has demonstrated rates of adequate occlusion and procedural complications comparable to the landmark studies that evaluated the use of the WEB for on‐label bifurcation aneurysms. Given the level of evidence, we consider the interpretation of our results should be done cautiously until confirmation from larger prospective studies are obtained.

Ruptured Cerebral Aneurysm:Endovascular Techniques and Devices

Coil embolization remains the first-line treatment for ruptured aneurysms. Coil embolization alone has limitations for wide-neck aneurysms. On the other hand, devices implanted in the parent vessel, such as coil-assisted stents and flow diverters, require antiplatelet therapy; therefore, intrasaccular devices are likely to be the mainstay in ruptured cases. Currently, developed intrasaccular embolization devices are limited in size and require large-diameter catheters for guidance. Recently, the Woven EndoBridge device has been reported to work well and may be used in an increasing number of patients in the future. For large/giant aneurysms, staged embolization may improve the curative effect. Various hydrophilic metal coating techniques have been developed that may reduce the use of antiplatelet agents; however, sufficient data for ruptured cases have not been obtained.

Abstract Number ‐ 141: Microemboli Monitoring After Intrasaccular Flow Disruption: Single‐center Experience

Introduction The management of wide‐necked bifurcation aneurysms can be challenging due to multiple factors. Intrasaccular flow disruption with the Woven EndoBridge (WEB) has demonstrated a safe and effective profile. Current microemboli data after the WEB device placement is non‐existent. We evaluated the rate of embolic signals (MES) after WEB device implantation. Methods We performed a retrospective analysis of a prospectively maintained database including patients who underwent WEB device implantation for the treatment of unruptured intracranial aneurysms between 2021 and 2022. Variables studied included patient demographics, modified Rankin Scale (mRS) before and 3 months post‐treatment, comorbidities, aneurysm characteristics, platelet inhibition tests, and activated clotting time. All patients were on aspirin and a P2Y12 inhibitor and had therapeutic levels on platelet aggregation assays. Intraoperative heparin was given in all cases to keep a therapeutic ACT. P2Y12 drugs were stopped after the procedure. In all patients, MES monitoring was performed in the immediate postoperative period and &gt;12 hours after the procedure. Results 34 patients with 34 aneurysms were analyzed. Mean age was 67.4 years and 85% were females. Mean aneurysm size was 13.1 ± 2.0 mm and mean neck size 4.4 ± 1.5 mm. Locations were middle cerebral artery bifurcation and M1‐M2 segment (n = 13), basilar artery tip (n = 10), anterior communicating artery (n = 8), internal carotid artery terminus (n = 2) and pericallosal artery (n = 1). A single WEB was implanted in 100% of the cases. MES were negative in all cases. 3‐month mRS remained stable or improved in all cases. No procedure‐related complications were seen. Conclusions Our findings reinforce the safety profile of intrasaccular flow disruption. These findings differ from a previous analysis of unruptured aneurysms in our institution where a 7.7% incidence of MES was reported after endovascular treatment of unruptured aneurysms with primary or assisted coiling.