Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series

Background Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retr...

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Bibliographic Details
Published in:Acta neurochirurgica 2023-07, Vol.165 (7), p.1881-1889
Main Authors: Kranawetter, B., Hernández, S., Mielke, D., Ernst, M.S., Malinova, V., Rohde, V.
Format: Article
Language:English
Subjects:
Aneurysm
Aneurysm, Ruptured - diagnostic imaging
Aneurysm, Ruptured - surgery
Aneurysms
Cardiovascular system
Cerebral blood flow
Embolization, Therapeutic - methods
Endovascular Procedures - methods
Humans
Interventional Radiology
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - surgery
Ischemia
Medicine
Medicine & Public Health
Minimally Invasive Surgery
Neurology
Neuroradiology
Neurosurgery
Original
Original Article
Retreatment
Retrospective Studies
Surgical Orthopedics
Treatment Outcome
Vascular Neurosurgery – Aneurysm
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Summary:Background Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping. Methods A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified. Results Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms. Conclusions Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.
ISSN:0942-0940
0001-6268
0942-0940
DOI:10.1007/s00701-023-05596-5