Retreatment of Residual and Recurrent Aneurysms After Embolization With the Woven EndoBridge Device: Multicenter Case Series

Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Adam A. Dmytriw, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Robert W. Regenhardt, NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
Juan Vicenty-Padilla, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Naif M. Alotaibi, NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
Elad Levy, Department of Neurological Surgery, Jacobs School of Medicine at Biomedical Sciences, Buffalo, New York, USA.
Muhammad Waqas, Department of Neurological Surgery, Jacobs School of Medicine at Biomedical Sciences, Buffalo, New York, USA.
Jacob Cherian, Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Jeremiah N. Johnson, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Pascal Jabbour, Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
Ahmad Sweid, Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
Bradley Gross, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Robert M. Starke, Department of Neurosurgery, University of Miami, Miami, Florida, USA.
Ajit Puri, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Francesco Massari, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Christoph J. Griessenauer, Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Caleb Rutledge, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Omar Tanweer, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Parham Yashar, Yashar Neurosurgery, Los Angeles, California, USA.
Gustavo M. Cortez, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
Mohammad A. Aziz-Sultan, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Aman B. Patel, NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Ricardo A. Hanel, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Peter Kan, Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.

Document Type

Article

Abstract

BACKGROUND: The Woven EndoBridge (WEB) device (Terumno Corp. [parent company of Microvention]) was approved by the U.S. Food and Drug Administration as the first intrasaccular device for intracranial aneurysm treatment in December 2018. Its use has become more common since then, but both trial results and postmarket experiences have raised questions about the efficacy in achieving complete aneurysm obliteration. Retreatment after WEB embolization has not been extensively discussed. OBJECTIVE: To discuss the incidence and retreatment of aneurysms after initial WEB embolization. METHODS: Retrospective review across 13 institutions identified all occurrences of WEB retreatment within neurovascular databases. Details regarding demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed. RESULTS: Thirty aneurysms were retreated in 30 patients in a cohort of 342 WEB-treated aneurysms. The retreatment rate was 8.8%. Endovascular methods were used for 23 cases, and 7 were treated surgically. Two aneurysms presented with rehemorrhage after initial WEB embolization. Endovascular treatments included stent-assisted coiling (12), flow diversion (7), coiling (2), PulseRider (Johnson & Johnson)-assisted coiling (1), and additional WEB placement (1). Surgical treatments included primary clipping (6) and Hunterian ligation (1). There were no major complications within the study group. CONCLUSION: WEB retreatments were successfully performed by a variety of techniques, including stent-assisted coiling, clipping, and flow diversion as the most common. These procedures were performed safely with subsequent obliteration of most aneurysms. The potential need for retreatment of aneurysms should be considered during primary WEB treatments.

Medical Subject Headings

Disease Progression; Embolization, Therapeutic (methods); Endovascular Procedures (methods); Humans; Intracranial Aneurysm (surgery); Retreatment; Retrospective Studies; Treatment Outcome

Publication Date

5-1-2022

Publication Title

Neurosurgery

E-ISSN

1524-4040

Volume

90

Issue

5

First Page

569

Last Page

580

PubMed ID

35244028

Digital Object Identifier (DOI)

10.1227/neu.0000000000001883

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