Intrasaccular flow-diversion for treatment of intracranial aneurysms: the Woven EndoBridge

Abstract

Endovascular approach is now the first option for the treatment of most intracranial aneurysms (IA). However, remaining limitations are the suboptimal stability of aneurysm occlusion and the treatment of complex IA. The use of conventional and flow diverter stents has partially addressed these limitations. Nevertheless, as intraluminal devices, stents require aggressive antiplatelet therapy and are associated with higher thromboembolic (TE) complication rates. Intrasaccular flow disrupters (IFD) are newly developed braided-wire devices designed to achieve flow disruption at the neck without placing material in the parent vessel and without the need of antiplatelet therapy. First clinical series have shown promising anatomical and clinical results. Our purpose is to describe the available IFD and to review the literature about their efficacy, safety, limitations, and developments.

WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory

“…[10][11][12][13][14][15][16][17] The rate of thromboembolic events with the WEB (14.5%) was quite similar to that reported in the Analysis of Treatment by Endovascular Approach of Nonruptured Aneurysms (ATENA) and Clinical and Anatomical Results In the Treatment of Ruptured Intracranial Aneurysms (CLARITY) series (respectively, 7.3% and 13.3%).…”

“…Treatment with the WEB has been evaluated in several retrospective series showing good safety results. [10][11][12][13] In addition, midterm and long-term anatomic results have been evaluated in retrospective series showing good stability of the treatment. 14,15 To have a more rigorous evaluation of the safety and efficacy, 2 prospective, Good Clinical Practice series were initiated simultaneously in Europe (WEB Clinical Assessment of IntraSaccular Aneurysm Therapy [WEBCAST]) and in France (French Observatory).…”

WEB Treatment of Intracranial Aneurysms: Feasibility, Complications, and 1-Month Safety Results with the WEB DL and WEB SL/SLS in the French Observatory

“…The increasing wire count in a single, braided layer-combined with multiple wire diameters-allows the WEB SL and SLS to achieve rapid contrast stasis and to balance radial force with conformability. 15 This uniform response may be important clinically in that small and large WEB devices must have an appropriate radial force to remain where they are deployed (ie, WEB radial force is greater than the parent artery blood flow force) but must remain soft enough to conform safely to the aneurysm (ie, WEB radial force is less than the compressive force on the aneurysm from the subarachnoid space).…”

WEB in Partially Thrombosed Intracranial Aneurysms: A Word of Caution

“…Conceptually, the WEB combines the advantage of flow diversion (diseased arterial wall treatment and stable occlusion) and selective intrasaccular embolization without the need for long-term antiplatelet therapy. 13 With the WEB, the surface exposed at the neck is smoother, compared with coils, providing potentially better support for neoendothelialization. These attributes prompted us to use the WEB in partially thrombosed intracranial aneurysms.…”

“…This could be secondary to lysis of the thrombus after treatment. 13 It may be argued that the device displacement would not have happened if we had allowed further oversizing of the WEB. However, the concerns of potential distortion of the device geometry and device protrusion into the parent vessel prevented us from deviating too much from the manufacturer's sizing recommendation.…”