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Original research
Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment
  1. Jildaz Caroff1,
  2. Kevin Janot2,
  3. Sebastien Soize1,3,4,
  4. Gaultier Marnat5,
  5. Jonathan Cortese1,6,
  6. Cristian Mihalea1,
  7. Septimiu Daniel Popescu1,
  8. Léon Ikka1,
  9. Vanessa Chalumeau1,
  10. Sophie Gallas1,
  11. Augustin Ozanne1,
  12. Eman Eltantawy1,7,
  13. Lamiae Grimaldi8,
  14. Xavier Barreau5,
  15. Denis Herbreteau2,
  16. Laurent Pierot3,4,
  17. Laurent Spelle6
  1. 1Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
  2. 2Neuroradiology, CHU Tours, Tours, Centre, France
  3. 3Neuroradiology, CHU Reims, Reims, France
  4. 4Champagne-Ardenne University, Reims, France
  5. 5Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
  6. 6Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicetre, France
  7. 7Neurology, Mansoura University Faculty of Medicine, Mansoura, Egypt
  8. 8Clinical Research Unit; University, Faculty of Medicine Simone Veil, Versailles Saint Quentin University ; INSERM, CESP, Hospital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
  1. Correspondence to Dr Jildaz Caroff, Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France; jildaz.caroff{at}aphp.fr

Abstract

Background Around 10% of Woven EndoBridge device (WEB)-treated intracranial aneurysms will need retreatment, and it is generally believed to be more challenging than retreatment after an initial coiling. We aim to report retreatment strategies and outcomes after initial WEB embolizations.

Methods Databases from four treatment centers, containing consecutive aneurysms treated with a WEB between 2013 and 2022, were reviewed. Demographics, aneurysm characteristics, retreatment strategies and outcomes were collected and analyzed.

Results From a 756 WEB database, 57 aneurysms were included. The global retreatment rate was 7.5% (95% CI 5.6% to 9.4%). The retreatment rate was significantly higher in the ruptured compared with the unruptured population (13% vs 3.9%, respectively, P<0.0001). Aneurysms were retreated on average 21.2 months after the initial WEB treatment (range 4.8–70 months). Surgery was performed in 11% and endovascular treatment in 89% of cases, consisting of flow diversion (48%), stent-assisted coiling (30%), coiling (12%), and second WEB placement (10%). Imaging follow-up was available in 88% of all WEB retreatments (50/57) (average 17 months, 49% digital subtraction angiography), demonstrating complete occlusion in 56% and ‘adequate’ occlusion in 88%. Morbidity was 5.3% (95% CI 0% to 12.0%) and mortality 0%. No patient experienced rebleeding during the follow-up period.

Conclusion The retreatment rate after an initial WEB treatment seems to compare favorably with that of coiling. Endovascular treatment of recurrence following WEB implantation is feasible in most situations; it generally requires the use of a stent and leads to a high rate of satisfactory occlusion.

  • Aneurysm
  • Technique
  • Device

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @jildazz, @CRISTIANMIHALEA, @SeptimiuPopescu, @doc soph

  • Contributors JC contributed to the conception and design of the study and the drafting of the manuscript and is responsible for the overall content as the guarantor. JC, KJ, SS, GM contributed to data collection and analysis. All authors contributed to revising the manuscript for important intellectual content. All authors approved the final version to be published.

  • 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 JC reports payment for lectures from Medtronic. GM reports consulting fees from Microvention. DH reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, educational events or proctoring from Microvention; financial support for attending meetings and/or travel costs from Microvention. XB reports receiving consulting fees from Sequent, as well as payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sequent. LP reports consulting fees from Balt, Microvention, Perflow, Phenox, and Vesalio; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Balt, Microvention, Perflow, Phenox, and Vesalio; financial support for attending meetings and/or travel costs from Balt, Microvention, and Phenox. LSp reports receiving grants or contracts from Philips (institutional) and consulting fees from Balt, Medtronic, Phenox, Microvention, and Stryker; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Balt, Medtronic, Microvention, and Stryker; and financial support for attending meetings and/or travel costs from Balt, Medtronic, Microvention, and Stryker.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.