Postdoctoral Research Fellow Thomas Jefferson University Hospital Philadelphia, Pennsylvania, United States
Introduction: The treatment of wide-necked and bifurcation aneurysms has become a common indication for the Woven Endobridge device (WEB). In many instances, WEB embolization fails and retreatment strategies for the recanalized aneurysms have not been established and may be challenging. We wanted to report our experience with retreatment strategies following WEB failure in seven cases involving various aneurysm shapes, sizes, and location using multiple strategies including endovascular modalities and microsurgical clip ligation.
Methods: Data were retrospectively collected from one high-volume cerebrovascular center for seven patients treated with a WEB device for an aneurysm who subsequently required retreatment for that same aneurysm from 2015 through January 2021.
Results: We identified seven patients with WEB recurrences over a period of six years. Four patients initially presented with incidental findings, while three patients presented with subarachnoid hemorrhage. One patient was lost to follow up and presented with a re-rupture while the six other patients were diagnosed with routine follow up. Two patients received clip ligation, two had simple coil embolization, one had stent- assisted coil embolization, one had a flow diverting stent, and one patient required two retreatments; he received stent- assisted coil embolization for the first retreatment and a simple coil embolization for the second retreatment. All patients had excellent angiographic outcomes and no complications.
Conclusion : The authors conclude that aneurysm recurrence following WEB is very diverse and no single modality can properly address all recurrences. Rather, an individualized approach based on aneurysm features, neuro-interventionalist expertise, and patient preference should be implemented.
