Treatment of Recurrent and Residual Aneurysms with the Woven EndoBridge Device: Analysis of 11 Patients and Review of the Literature

OBJECTIVE: The Woven EndoBridge (WEB) device is an innovative tool for endovascular treatment of wide-necked bifurcation aneurysms. Numerous studies of primary aneurysm treatment with the WEB device have been reported. We analyzed the safety and efficacy of WEB embolization for recurrent and residual aneurysms. METHODS: We performed a retrospective observational study of consecutive patients with initially endovascularly or surgically treated aneurysms and an aneurysm recurrence or remnant retreated with the WEB device at 3 German high-volume neurovascular centers from May 2011 to February 2018. The technical success, complications, and angiographic outcomes were evaluated. RESULTS: Eleven patients (median age, 65 years; 5 women) with 11 aneurysms (median size, 6.8 mm) were identified. The aneurysms were located at the anterior communicating artery in 4, basilar tip in 4, internal carotid artery in 1, middle cerebral artery in 1, and posterior communicating artery in 1 patient. Three aneurysms had been previously clipped and 8 had undergone endovascular therapy. WEB embolization was feasible in 10 patients. Ancillary devices were used for 4 aneurysms. Perforation occurred in 1 aneurysm, which resolved without sequelae. Of the 9 patients available for angiographic follow-up (median follow-up, 6 months), complete and nearcomplete aneurysm occlusion was achieved in 3 (33%) and 7 patients (78%), respectively. Three patients underwent repeat treatment (33%). CONCLUSIONS: The results of the present study have indicated that WEB embolization of previously treated aneurysms is reasonably safe. However, careful aneurysm selection could be necessary to achieve adequate midterm occlusion rates