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Treatment strategies for recurrent and residual aneurysms after Woven Endobridge implantation
  1. Christoph Kabbasch1,
  2. Lukas Goertz2,
  3. Eberhard Siebert3,
  4. Moriz Herzberg4,
  5. Christina Hamisch2,
  6. Anastasios Mpotsaris1,5,
  7. Franziska Dorn4,
  8. Thomas Liebig4
  1. 1 Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
  2. 2 Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
  3. 3 Department of Neuroradiology, University Hospital of Berlin (Charité), Cologne, Germany
  4. 4 Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
  5. 5 Department of Neuroradiology, University Hospital of Aachen, Cologne, Germany
  1. Correspondence to Dr Lukas Goertz, Center for Neurosurgery, University Hospital of Cologne, Cologne 50937, Germany; lukas.goertz{at}uk-koeln.de

Abstract

Background Woven Endobridge (WEB) embolization is a safe and efficient technique for endovascular treatment of intracranial aneurysms. However, the management of aneurysm recurrence after WEB placement has not been well described to date. We present our multicenter experience of endovascular retreatment of aneurysm recurrence after WEB implantation.

Methods This is a multicenter study of patients who underwent endovascular retreatment after WEB implantation in three German tertiary care centers. Treatment strategies, complications, and angiographic outcome were retrospectively assessed.

Results Among 122 aneurysms treated with the WEB device, 15 were retreated. Of these, six were initially treated with the WEB only, two were pretreated by coiling, and seven large aneurysms were treated in a multimodality approach. Ten were true aneurysm remnants and five were neck remnants. The reasons for retreatment were WEB migration (n=6), initial incomplete occlusion (n=5), and WEB compression (n=4). Retreatment strategies included coiling (n=4), stent-assisted coiling (n=7), flow diversion (n=3), and placement of an additional WEB (n=1). All procedures were technically successful and there were no procedure-related complications. Among 11 patients available for follow-up after retreatment, three were retreated again. At last angiographic follow-up, available in 11/15 cases at a median of 23 months, complete occlusion was obtained in eight cases and neck remnants in three.

Conclusions This pilot study shows that endovascular retreatment of recurrent or residual aneurysms after WEB implantation can be done safely and can achieve adequate occlusion rates.

  • aneurysm
  • coil
  • device

https://doi.org/10.1136/neurintsurg-2018-014230

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    Footnotes

    • CK and LG contributed equally.

    • Contributors LG, CK, ES, MH, CH, AM and FD acquired the data. CK, LG and TL developed the project, analyzed the data and drafted the manuscript. All authors revised the paper critically for important intellectual content and provided final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CK and LG contributed equally as first authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CK and FD serve as consultants for Acandis GmbH (Pforzheim, Germany). TL serves as proctor for MicroVention Inc/Sequent Medical (Aliso Viejo, California, USA). The other authors declare that they have no competing interests.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data will be made available upon request in an anonymized manner.