J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):176-180. 10.7461/jcen.2022.E2021.08.006.

Woven Endobridge (WEB) augmented by Y-stent in a shallow basilar tip aneurysm

• Nordmann NJ
• Weber MW
• Dayoub H

• KMID: 2531662
• DOI: http://doi.org/10.7461/jcen.2022.E2021.08.006

Abstract

The Woven Endobridge (WEB) device can be an effective and simple treatment modality for wide-neck bifurcation intracranial aneurysms. We present a case of a shallow basilar tip aneurysm treated with the WEB device that required stabilization with Y-stent through radial access.

Keyword

Basilar artery; Endovascular treatment; Intracranial aneurysm; Intrasaccular device; Woven Endobridge (WEB); Y-stent

Figure

• 

  Fig. 1. Three-dimensional (3D) reconstruction of basilar aneurysm in posterior (A) and left posterior oblique (B). Length 6.76 mm (arrows 1). Width 6.35 mm (arrows 2). Height 4.30 mm (arrows 3).

• 

  Fig. 2. Deployment of Woven Endobridge (WEB) (MicroVention-Terumo, Aliso Viejo, CA, USA) into basilar tip aneurysm with conformational dimensions of 6.43 mm (L)×6.45 mm (W) (A) but inadequate occlusion (B).

• 

  Fig. 3. Deployment of two 3.5×25 mm LVIS Junior stents (MicroVention-Terumo, Aliso Viejo, CA, USA) in Y-shaped fashion. First stent was deployed in the left posterior cerebral artery (A) and the second stent was placed into the right posterior cerebral artery (B).

• 

  Fig. 4. Occlusion of basilar tip aneurysm with patency to remainder of posterior cerebral circulation is confirmed on digital-subtraction angiography in anteroposterior (A) and lateral (B) views.

Reference

1. Abecassis IJ, Sen RD, Barber J, Shetty R, Kelly CM, Ghodke BV, et al. Predictors of recurrence, progression, and retreatment in basilar tip aneurysms: A location-controlled analysis. Oper Neurosurg (Hagerstown). 2019; Apr. 16(4):435–44.

2. Akgul E, Aksungur E, Balli T, Onan B, Yilmaz DM, Bicakci S, et al. Y-stent-assisted coil embolization of wide-neck intracranial aneurysms. A single center experience. Interv Neuroradiol. 2011; Mar. 17(1):36–48.

3. Cagnazzo F, Ahmed R, Dargazanli C, Lefevre P-H, Gascou G, Derraz I, et al. Treatment of wide-neck intracranial aneurysms with the Woven EndoBridge device associated with stenting: A single-center experience. AJNR Am J Neuroradiol. 2019; May. 40(5):820–6.

4. Goertz L, Liebig T, Siebert E, Herzberg M, Neuschmelting H, Borggrefe J, et al. Risk factors of procedural complications related to Woven EndoBridge (WEB) embolization of intracranial aneurysms. Clin Neuroradiol. 2020; Jun. 30(2):297–304.

5. Kan P, Duckworth E, Puri A, Velat G, Wakhloo A. Treatment failure of fetal posterior communicating artery aneurysms with the pipeline embolization device. J Neurointerv Surg. 2016; Sep. 8(9):945–8.

6. Lawson A, Goddard T, Ross S, Tyagi A, Deniz K, Patankar T. Endovascular treatment of cerebral aneurysms using the Woven EndoBridge technique in a single center: Preliminary results. J Neurosurg. 2017; Jan. 126(1):17–28.

7. Lv X, Zhang Y, Jiang W. Systematic review of Woven EndoBridge for wide-necked bifurcation aneurysms: Complications, adequate occlusion rate, morbidity, and mortality. World Neurosurg. 2018; Feb. 110:20–5.

8. Moscato G, Cirillo L, Dall’Olio M, Princiotta C, Simonetti L, Leonardi M. Management of unruptured brain aneurysms: Retrospective analysis of a single centre experience. Neuroradiol J. 2013; Jun. 26(3):315–9.

9. Papagiannaki C, Spelle L, Januel A-C, Benaissa A, Gauvrit J-Y, Costalat V, et al. WEB intrasaccular flow disruptorr—prospective, multicenter experience in 83 patients with 85 aneurysms. AJNR Am J Neuroradiol. 2014; Nov-Dec. 35(11):2106–11.

10. Park H-R, Yoon S-M, Shim J-J, Kim S-H. Waffle-cone technique using solitaire AB stent. J Korean Neurosurg Soc. 2012; Apr. 51(4):222–6.

11. Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, et al. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series. J Neurointerv Surg. 2018; Jun. 10(6):553–9.

12. Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, et al. Aneurysm treatment with Woven EndoBridge in the cumulative population of 3 prospective, multicenter series: 2-year follow-up. Neurosurgery. 2020; Aug. 1. 87(2):357–67.

13. Samaniego EA, Mendez AA, Nguyen TN, Kalousek V, Guerrero WR, Dandapat S, et al. LVIS Jr device for Y-stent-assisted coil embolization of wide-neck intracranial aneurysms: A multicenter experience. Interv Neurol. 2018; Apr. 7(5):271–83.

14. Sekhar LN, Tariq F, Morton RP, Ghodke B, Hallam DK, Barber J, et al. Basilar tip aneurysms: A microsurgical and endovascular contemporary series of 100 patients. Neurosurgery. 2013; Feb. 72(2):284–98.

15. Shima H, Nomura M, Muramatsu N, Sugihara T, Fukui I, Kitamura Y, et al. Embolization of a wide-necked basilar bifurcation aneurysm by double-balloon remodeling using HyperForm compliant balloon catheters. J Clin Neurosci. 2009; Apr. 16(4):560–2.

16. van der Kolk NM, Algra A, Rinkel GJE. Risk of aneurysm rupture at intracranial arterial bifurcations. Cerebrovasc Dis. 2010; 30(1):29–35.

17. Zhang S-M, Liu L-X, Ren P-W, Xie X-D, Miao J. Effectiveness, safety and risk factors of Woven EndoBridge device in the treatment of wide-neck intracranial aneurysms: Systematic review and meta-analysis. World Neurosurg. 2020; Apr. 136:e1–23.