Woven EndoBridge device shape modification can be mitigated with an appropriate oversizing strategy: a VasoCT based study

Abstract

BackgroundThe Woven EndoBridge (WEB) shape modification (WShM) during follow-up may be a potential cause of poor angiographic outcomes. WShM predisposing factors have not yet been determined. Our systematic use of rotational cone beam computed tomography (VasoCT) imaging during follow-up allowed us to perform the first quantitative analysis of the shape of WEBs over time. Our goal was to identify possible strategies to reduce the occurrence of this phenomenon.MethodsAll patients treated in our hospital with a WEB device between October 2015 and January 2019 were included. Using VasoCT acquisitions, systematically performed after implantation and during follow-up, we analyzed WEB morphology. WShM was defined as the percentage reduction in the distance between the two WEB markers.ResultsSixty-three aneurysms treated with a WEB device were finally included in this analysis. At the last follow-up (mean 15.5 months), mean WShM was 48%±24. The mean WShM was significantly higher in the aneurysm recurrence group than in the adequate occlusion group (51±6.5% vs 36±3.4%, difference 15% points (95% CI 0.7 to 30); p<0.05). Conversely, the extent of WShM did not directly correlate with occlusion rates. Indeed, 32% of completely occluded aneurysms presented severe WShM (≥50%). Importantly, the absence of WShM guaranteed complete occlusion in our study (n=12). We demonstrated that oversizing the width of the WEB significantly correlated with WShM reduction during follow-up (r=−0.38, p=0.002).ConclusionWShM can be partly overcome by use of an appropriate width oversizing strategy that could lead to improved angiographic results.

Ten Years of Clinical Evaluation of the Woven EndoBridge: A Safe and Effective Treatment for Wide-Neck Bifurcation Aneurysms

“…1 months): 47.8% and 39.6%, respectively. 44 This study also showed that the extent of WEB shape modification did not directly correlate with anatomical results and that an appropriate WEB oversizing strategy mitigated WEB shape modification and could lead to improved angiographic results. Another recent series (32 aneurysms) that defined WEB shape modification as any reduction in WEB device height greater than 5% reported the phenomenon in 90.6% of aneurysms.…”

Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment

“…The Woven EndoBridge (WEB) device (Microvention, CA) currently represents the most extensively studied intrasaccular device,1 2 and has proven to be a very safe option to treat wide-necked bifurcation aneurysms 3. Since its introduction, angiographic results have improved year on year, likely due to the sharing of operator experiences in device sizing,4 5 and yet 5–12% of patients still require retreatment 3 6–10…”

Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up

“…Whether WEB shape modification reflects ‘retraction’ or ‘compaction’ of the WEB device is still disputed in the literature (presumably both)15 21; but our results suggest it should be avoided anyway. In their recent publication, Caroff et al proposed to use a WEB oversizing strategy to prevent the shape modification of the WEB, as both were significantly correlated 22…”