Gravino Gilbert, Masri Souhyb, Chandran Arun, Puthuran Mani
Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom.
Interv Neuroradiol. 2025 Feb;31(1):132-141. doi: 10.1177/15910199221122857. Epub 2022 Aug 25.
With increasing advances in technology, the breadth of aneurysms that are treatable via an endovascular approach has increased. Wide necked aneurysms remain difficult to treat but the emergence of dedicated intrasaccular flow disruption devices such as the Woven EndoBridge (WEB, Micorvention) has increasingly seen previously ruptured and unruptured wide necked aneurysms successfully embolised and secured from the circulation using a single device.We are reporting two cases of WEB device treatment from the earliest experience with this device at our institution. These were complicated by partial extrusion in one case and remote migration of the WEB device in another case. Our initial cases highlight the importance of case selection and the need for accurate WEB sizing which are paramount to ensure complete occlusion of the aneurysm without complications of dislocation or extrusion into the parent vessel. Since then, we have performed over 170 cases with the WEB device. We also present a comprehensive review of the limited literature available on the management of mal-positioned and dislocated WEB devices. This allows us to reflect on how to avoid these complications and the different management options at the disposal of the neuro-interventionalist once such a complication has already occured. Rescue devices and manoeuvres that we reflect on include microcatheter manipulation, alligator retrieval device, stent retrievers, microsnares, aspiration, and stenting. Ultimately, each case needs to be individually evaluated and the best strategy selected depends on the context and specific circumstances.
随着技术的不断进步，可通过血管内介入方法治疗的动脉瘤范围有所扩大。宽颈动脉瘤的治疗仍然困难，但专用的瘤内血流阻断装置的出现，如编织型血管内桥接器（WEB，Microvention公司），越来越多地使以前破裂和未破裂的宽颈动脉瘤使用单一装置成功栓塞并从循环中隔离。我们报告了在我们机构最早使用该装置治疗的两例WEB装置治疗病例。其中一例出现部分挤出并发症，另一例出现WEB装置远距离移位并发症。我们最初的病例突出了病例选择的重要性以及准确确定WEB尺寸的必要性，这对于确保动脉瘤完全闭塞而不出现脱位或挤入母血管的并发症至关重要。从那时起，我们使用WEB装置进行了170多例手术。我们还对关于位置不当和移位的WEB装置管理的有限文献进行了全面综述。这使我们能够思考如何避免这些并发症，以及一旦出现此类并发症神经介入医生可采用的不同处理选择。我们思考的补救装置和操作包括微导管操作、鳄嘴式取出装置、支架取栓器、微型圈套器、抽吸和支架置入。最终，每个病例都需要单独评估，所选择的最佳策略取决于具体情况和特定情形。
