Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA.
World Neurosurg. 2022 Jun;162:68-72. doi: 10.1016/j.wneu.2022.03.081. Epub 2022 Mar 22.
Little information is available regarding technical challenges with the new lower profile Woven EndoBridge (WEB 17) system intended for smaller aneurysms.
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.
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.
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.
针对较小的动脉瘤，新型低剖面编织式 EndoBridge（WEB 17）系统的技术挑战相关信息有限。
我们报告了 2 例前交通动脉动脉瘤采用 WEB 17 系统治疗时遇到的技术并发症病例，这 2 例均需要在治疗中进行挽救性支架置入，讨论了潜在失败原因的技术细节以及处理计划。
在 2021 年 1 月至 2022 年 1 月期间，2 家机构共进行了 45 例 WEB 栓塞术。其中 2 例在 WEB 装置与输送导丝分离后，装置方向突然改变，导致治疗复杂化。在第一个病例中，WEB 装置突然成角，随后迁移并从动脉瘤囊中脱出，进入右侧大脑前动脉远端，尽管使用了多种器械进行了多次尝试，均未成功取出，最终需要进行挽救性支架置入。第二个病例中也出现了类似的 WEB 装置突然成角，部分从动脉瘤囊中脱出，同样通过颅内支架置入治疗。这 2 例患者最终均恢复至术前基线水平，没有永久性残疾，出院回家。
在急性瘤颈-载瘤动脉成角的较小宽颈动脉瘤中，WEB 17 瘤内栓塞可能具有技术挑战性，WEB 装置在分离后会发生方向改变，导致装置迁移和脱出至载瘤动脉，需要进行挽救性支架置入。WEB 17 装置的适当尺寸选择以及在部署结束和操作分离窗口之间的过渡阶段保持警惕，对于治疗成功至关重要。如果需要进行挽救性支架置入，对于预计具有挑战性的解剖学动脉瘤，常规使用抗血小板药物可能是一种有用的策略。
