Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße 1, 66424, Homburg/Saar, Germany.
Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
Clin Neuroradiol. 2021 Jun;31(2):431-438. doi: 10.1007/s00062-020-00893-3. Epub 2020 Mar 12.
Treatment of wide-necked intracranial aneurysms using the Woven Endobridge (WEB) device has become broadly accepted. Feared complications with the potential of increased poor clinical outcome include dislocations and migration of the device. This study was carried out to determine the effectiveness of a variety of different strategies to rescue migrated WEB devices.
In a porcine model, WEB devices of different sizes (SL [single layer] 3.5 × 2mm and SL 4.0 × 3 mm, SL 8 × 5 mm and SLS 8 mm [single layer spherical]) were placed into both the subclavian and axillary arteries. A total of 32 rescue maneuvers (8 per rescue device) were performed. Small WEBs were rescued using reperfusion catheters (RC) (SOFIA Plus and JET 7), larger WEBs were rescued using dedicated rescue devices (Microsnare and Alligator). Rescue rates, times, attempts and complications were assessed.
Rescue attempts of migrated WEBs were successful in all cases (100%). Rescue time (p = 0.421) and attempts (p = 0.619) of small WEBs using RCs were comparable without significant differences. Aspiration alone was not successful for larger WEBs. Rescue of larger WEBs was slightly faster (122.75 ± 41.15 s vs. 137.50 ± 54.46 s) with fewer attempts (1 vs. 1.37) when using the Microsnare compared to the Alligator device. Complications such as entrapment of the WEB in the RCs, vasospasm, perforation, or dissection were not observed.
Rescue of migrated WEB devices is a feasible and effective method and 100% successful rescue rates and appropriate rescue times can be achieved for small WEBs using RCs and for larger WEBs using dedicated rescue devices (Microsnare and Alligator).
使用编织式颅内支架（WEB）装置治疗宽颈颅内动脉瘤已被广泛接受。该装置可能出现脱位和迁移等并发症，从而导致不良临床结局的风险增加。本研究旨在确定多种不同策略对挽救迁移的 WEB 装置的有效性。
在猪模型中，将不同尺寸的 WEB 装置（单层 SL 3.5×2mm 和 SL 4.0×3mm、单层 SL 8×5mm 和 SLS 8mm、单层球形）分别置于锁骨下动脉和腋动脉内。共进行了 32 次挽救操作（每种挽救装置 8 次）。小 WEB 采用再灌注导管（RC）（SOFIA Plus 和 JET 7）挽救，大 WEB 采用专用挽救装置（Microsnare 和 Alligator）挽救。评估挽救成功率、时间、次数和并发症。
所有情况下（100%）迁移 WEB 的挽救尝试均成功。使用 RC 挽救小 WEB 时，挽救时间（p=0.421）和次数（p=0.619）无显著差异。单纯抽吸对大 WEB 无效。与 Alligator 装置相比，使用 Microsnare 挽救大 WEB 时速度稍快（122.75±41.15s 比 137.50±54.46s），挽救次数更少（1 次比 1.37 次）。未观察到 WEB 被 RC 困住、血管痉挛、穿孔或夹层等并发症。
挽救迁移的 WEB 装置是一种可行且有效的方法，使用 RC 挽救小 WEB 和专用挽救装置（Microsnare 和 Alligator）挽救大 WEB 可实现 100%的挽救成功率和适当的挽救时间。
