Bailout Strategies for Abrupt Change in Woven Endobridge 17 Device Orientation After Detachments: Technical Note of 2 Anterior Communicating Artery Aneurysm Cases.

Salem, MM ; Ali, A ; et al.

In: World neurosurgery, Jg. 162 (2022-06-01), S. 68-72

academicJournal

Background: Little information is available regarding technical challenges with the new lower profile Woven EndoBridge (WEB 17) system intended for smaller aneurysms.

Methods: We report illustrative cases of technical complications encountered with 2 anterior communicating artery aneurysms treated by the WEB 17 system requiring rescue stenting in both cases, discussing technical nuances regarding potential reasons for the encountered failures along with management plan.

Results: Over a span of 1 year (January 2021 to January 2022), 45 WEB embolization procedures were performed at 2 institutions. Two procedures were complicated by abrupt change in orientation of the WEB device immediately after detachment from the delivery wire. In the first case, abrupt angulation with subsequent migration and prolapse out of the aneurysm sac into the distal right anterior cerebral artery was encountered with unsuccessful retrieval despite multiple attempts using a variety of devices, eventually requiring rescue stenting. A similar sudden orientation change was noted in the second case with partial prolapse from the aneurysm sac similarly bailed out by intracranial stenting. Both patients recovered to preprocedural baseline with no permanent deficits and eventually were discharged home.

Conclusions: Intrasaccular WEB 17 embolization may be technically challenging in smaller wide-necked aneurysms with acute aneurysm-parent artery angulation with abrupt changing of WEB device orientation after detachments with device migration and prolapse into the parent vessel requiring rescue stenting. Proper WEB 17 device sizing and vigilance in the transition phase between the end of deployment and detachment windows of the procedure are paramount to treatment success. Routine use of antiplatelets in cases of anatomical aneurysms that are anticipated to be challenging might be a useful strategy if bailout stenting is needed.

Titel:	Bailout Strategies for Abrupt Change in Woven Endobridge 17 Device Orientation After Detachments: Technical Note of 2 Anterior Communicating Artery Aneurysm Cases.
Autor/in / Beteiligte Person:	Salem, MM ; Ali, A ; Riina, HA ; Burkhardt, JK
Zeitschrift:	World neurosurgery, Jg. 162 (2022-06-01), S. 68-72
Veröffentlichung:	New York : Elsevier, 2022
Medientyp:	academicJournal
ISSN:	1878-8769 (electronic)
DOI:	10.1016/j.wneu.2022.03.081
Schlagwort:	Humans Prolapse Retrospective Studies Treatment Outcome Embolization, Therapeutic methods Endovascular Procedures methods Intracranial Aneurysm complications Intracranial Aneurysm diagnostic imaging Intracranial Aneurysm surgery
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [World Neurosurg] 2022 Jun; Vol. 162, pp. 68-72. <i>Date of Electronic Publication: </i>2022 Mar 22. MeSH Terms: Embolization, Therapeutic* / methods ; Endovascular Procedures* / methods ; Intracranial Aneurysm* / complications ; Intracranial Aneurysm* / diagnostic imaging ; Intracranial Aneurysm* / surgery ; Humans ; Prolapse ; Retrospective Studies ; Treatment Outcome Contributed Indexing: Keywords: Aneurysm; Flow diversion; WEB Entry Date(s): Date Created: 20220326 Date Completed: 20220608 Latest Revision: 20220819 Update Code: 20231215

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