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. 2020 Jul 1;87(1):E16-E22.
doi: 10.1093/neuros/nyaa092.

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

Fadi Al Saiegh  1 , David Hasan  2 , Nikolaos Mouchtouris  1 , Mario Zanaty  2 , Ahmad Sweid  1 , Omaditya Khanna  1 , Nohra Chalouhi  1 , Ritam Ghosh  1 , Stavropoula Tjoumakaris  1 , M Reid Gooch  1 , Robert Rosenwasser  1 , Pascal Jabbour  1
Affiliations

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

Fadi Al Saiegh et al. Neurosurgery. .

Abstract

Background: 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.

Objective: To assess the safety and feasibility of ruptured aneurysm treatment with the WEB.

Methods: Retrospective analysis of 9 SAH patients with 11 aneurysms that were treated with the WEB device at 2 institutions after FDA approval.

Results: 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 ± 2.2 mm (range: 3-10) and 5.6 ± 3.0 mm (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.

Conclusion: 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.

Keywords: Cerebral aneurysm; Embolization; Endovascular; Subarachnoid hemorrhage; WEB device.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
A 76-yr-old female who presented with Hunt and Hess grade III SAH. A, AP view of a left ICA injection showing an anterior communicating aneurysm. B, Road-map view and microcatheterization of the aneurysm for deployment of a 5 × 3 WEB device. C, Nonsubtracted view showing the WEB device in place. D, AP view of left ICA injection showing complete occlusion of the aneurysm.
Figure 2.
Figure 2.
A, Patient with Hunt and Hess grade V SAH whose left vertebral artery (VA) injection showed a left vertebrobasilar junction (VBJ) aneurysm, which required placement of 2 WEB devices. B, Magnified view of the aneurysm immediately after WEB device deployment (white arrows pointing at WEB device markers). C, Subtracted view showing the outline of the 2 WEB devices in the aneurysm (black arrows).
Figure 3.
Figure 3.
Patient who had a Hunt and Hess grade III SAH and had intraoperative aneurysm rupture. A and B show a 3D model of a right vertebral artery (VA) injection and 2 dysplastic aneurysms at the origin of the PICA. B, Measurements of both aneurysms are shown in the bottom half of the picture and Table (patient #7). C, Nonsubtracted view showing 2 WEB devices with one in each aneurysm (white arrows). D, Subtracted view in the venous phase after right VA injection showing stasis in both aneurysms. Right VA injection in AP E and lateral F views after deconstruction with Onyx and coils. Note patency of the right PICA on both views.
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