PT  - JOURNAL ARTICLE
AU  - Jildaz Caroff
AU  - Kevin Janot
AU  - Sebastien Soize
AU  - Gaultier Marnat
AU  - Jonathan Cortese
AU  - Cristian Mihalea
AU  - Septimiu Daniel Popescu
AU  - Léon Ikka
AU  - Vanessa Chalumeau
AU  - Sophie Gallas
AU  - Augustin Ozanne
AU  - Eman Eltantawy
AU  - Lamiae Grimaldi
AU  - Xavier Barreau
AU  - Denis Herbreteau
AU  - Laurent Pierot
AU  - Laurent Spelle
TI  - Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment
AID  - 10.1136/jnis-2022-019645
DP  - 2022 Oct 25
TA  - Journal of NeuroInterventional Surgery
PG  - jnis-2022-019645
4099  - http://jnis.bmj.com/content/early/2022/10/26/jnis-2022-019645.short
4100  - http://jnis.bmj.com/content/early/2022/10/26/jnis-2022-019645.full
AB  - 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.Data are available upon reasonable request.