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Woven Endobridge (WEB) Device as a Re-treatment Strategy after Unsuccessful Surgical Clipping

Research output: Contribution to journalArticle

Thomas Calvert Booth, Carmen Parras-Farinas, Ruth-Mary deSouza, Naga Kandasamy, Jo Bhattacharya, Prem Rangi, Jonathan Downer

Original languageEnglish
JournalWorld Neurosurgery
Early online date13 Mar 2020
DOIs
Publication statusE-pub ahead of print - 13 Mar 2020

King's Authors

Abstract

Background
Surgical clipping of intracranial aneurysms is typically robust and durable. However, residual aneurysmal components may be seen after clipping. Furthermore, there may be occasional aneurysmal recurrence. These are both clinically relevant because subarachnoid hemorrhage after clipping is a rare but important event. The rationale for any treatment is to substantially lower the future risk of hemorrhage. Small series have demonstrated coiling as a re-treatment strategy after unsuccessful clipping, but none have explored the feasibility of Woven Endobridge (WEB) implantation.
Case description
We examined the feasibility of WEB implantation as second-line treatment for wide-necked residual aneurysms after unsuccessful clipping. We also recorded the safety and efficacy in this small series of 6 patients. To determine safety, we measured the modified Rankin Scale (mRS) before and after the procedure, and at two later time-points (mean follow-up 5 months and 15 months). To determine efficacy, we obtained radiographic aneurysm occlusion outcomes (including WEB Occlusion Scale) at these two time-points. Four middle cerebral artery and two anterior communicating artery complex aneurysms were treated with WEB implantation showing feasibility in 6/6 (100%) cases. Follow-up at 15 months demonstrated no change from pre-procedural mRS and there were no other complications. There was adequate occlusion in 5/6 (83%) cases.
Conclusions
WEB implantation provided a feasible option in this challenging re-treatment scenario. We emphasize that this is a small series and prospective data is required to make outcome inferences for this population. Nonetheless, we observed no complications and high adequate occlusion rates.

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