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. 2021 Jul;42(7):1276-1281.
doi: 10.3174/ajnr.A7115. Epub 2021 Apr 29.

Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device

J-B Girot  1   2 , J Caroff  3 , J Cortese  1 , C Mihalea  1 , A Rouchaud  4 , V Da Ros  5 , J V Martinez  1 , L Contreras  1   6 , L Ikka  1 , V Chalumeau  1 , A Ozanne  1 , G B D Aguiar  1   7 , S Gallas  1 , J Moret  1   8 , L Spelle  1   8
Affiliations

Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device

J-B Girot et al. AJNR Am J Neuroradiol. 2021 Jul.

Abstract

Background and purpose: The Woven EndoBridge has proved to be a safe and effective treatment, especially for wide-neck intracranial aneurysms. The recent fifth-generation Woven EndoBridge came with smaller devices. The purpose of this study was to assess the safety and efficiency of Woven EndoBridge treatment of small and very small aneurysms.

Materials and methods: Between September 2017 and March 2020, all consecutive patients treated with a 3- or 3.5 mm-width Woven EndoBridge device were included in this retrospective intention-to-treat study. Clinical and radiologic findings were evaluated at immediate and last-available follow-up. Angiographic outcome was assessed by an external expert reader.

Results: One hundred twenty-eight aneurysms were treated with a fifth-generation Woven EndoBridge device including 29 with a width of ≤3.5 mm. Ten aneurysms were ruptured (34%). In 3 cases (10%), Woven EndoBridge treatment could not be performed because the aneurysm was still too small for the smallest available Woven EndoBridge device and another endovascular strategy was chosen. The median follow-up time was 11.2 months. Complete and adequate occlusion was obtained in 71% and 90% of the treated aneurysms, respectively. Retreatment was needed in 2 cases (10%). Symptomatic ischemic complications leading to transient neurologic deficits occurred in 2 cases (7%) (1 procedure-related and 1 device-related) but with full spontaneous recovery at discharge.

Conclusions: The fifth-generation Woven EndoBridge device seems to be a safe and technically feasible treatment for both ruptured and unruptured small and very small intracranial aneurysms, with satisfactory occlusion rates on midterm follow-up. However, further study is needed to evaluate longer-term efficiency.

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Figures

FIG 1.
FIG 1.
Ruptured anterior communicating artery aneurysm treatment using an SL 3.5 × 2 mm WEB. A, Left internal carotid angiogram shows the aneurysm. B, 3D rotational angiography with aneurysm measurement. C, A postdeployment angiogram shows a good filling of the aneurysmal sac with persistent opacification inside the WEB. D and E, Three-month follow-up angiogram shows complete exclusion of the aneurysm. F, Three-month follow-up VasoCT confirms the aneurysm exclusion, with slight WEB compaction.
FIG 2.
FIG 2.
Technical failure in a left superior cerebellar artery with an SL 3 × 2 WEB. A, A left vertebral angiogram shows the left cerebellar aneurysm. B, 3D rotational angiography with aneurysm measurement. C, WEB deployment attempt, with the proximal marker (white arrow) protruding into the basilar trunk. D, Final angiogram after coiling. E, Retrospective Sim&Cure simulation showing SL 3 WEB protrusion into the superior cerebellar artery and basilar trunk.
See this image and copyright information in PMC

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