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Abstract
Introduction The Woven EndoBridge (WEB) device has gained widespread acceptance for the treatment of intracranial aneurysms, offering a safe and effective endosaccular alternative to traditional endovascular techniques. However, its application beyond aneurysm treatment remains largely underexplored. Leveraging its design, the WEB device offers reversible temporary or permanent occlusion with a precise landing spot. Its precision and minimally invasive nature enhance most single hole AV-fistulae treatment, such as Vertebral Venous fistula, usually without the need for additional embolic agents. Its deployment for parent vessel sacrifice offers a balloon-like occlusion method, with full control of landing adjacent to important branches. Additionally, in Vein of Galen malformations (VOGM) management, the WEB can be deployed across the AV-Fistula site in a retrograde manner via venous approach and avoid large arterial access, which can be extremely challenging in the pediatric age group. An example of this application in VOGM is included in the figure. The nature of jugular bulb diverticulum anatomy mimics that of a wide neck aneurysm and treatment can be performed without the need for adjunct stents or DAPT. The Spherical WEB (SLS) may be used to treat Direct CC Fistulae, like erstwhile Latex balloons in a similar trans-arterial approach, to cork the fistula. Another promising area for the WEB device application is in the transvenous embolization of AVMs. Here, the WEB could complement the ‘pressure cooker technique,’ serving to a create a controlled, high-pressure environment within the AVM nidus.
Methods This pictorial case series (figure 1) aims to illuminate the novel use of the WEB device in managing non-aneurysmal neurovascular pathologies to demonstrate potential benefits in this uncharted territory. We retrospectively analyzed six patients successfully treated at our institution, encompassing three vein of Galen malformations, one vertebral-venous fistula, and two cases of jugular bulb diverticulae.
Results Of the 6 patients treated with novel applications of the WEB device in managing non-aneurysmal neurovascular pathologies, there was no aborted or failed procedures and no procedural complications.
Conclusions The findings from this case series suggest alternative uses to for the WEB device outside of aneurysms alone. By showcasing its application in a variety of non-aneurysmal settings, we aim to stimulate further investigation and adoption of this technique in managing complex neurovascular disorders.
Disclosures B. Ghodke: None. J. Clarke: None. R. Meyer: None. M. Anderson: None. M. Levitt: 1; C; Medtronic, Stryker. 6; C; Proprio, Stroke Diagnostics, Synchron, Hyperion Surgical, Fluid Biomed, Apertur, Metis Innovative, Aeaean Advisers, Stereotaxis, Arsenal Medical. L. Kim: 2; C; Phillips North America. 4; C; Spi Surgical. S. Chen: None. M. Walker: None.