Woven EndoBridge Indications [Neurosurgery Wiki]

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====== Woven EndoBridge Indications ======


The [[Woven EndoBridge]] (WEB) [[device]] is increasingly used for treatment of [[wide-neck bifurcation aneurysm]]s
((Essibayi MA, Altschul DJ. The impact of delivery technique on Woven EndoBridge deployment and detachment in an in vitro aneurysm model. Interv Neuroradiol. 2024 Aug 22:15910199241273984. doi: 10.1177/15910199241273984. Epub ahead of print. PMID: 39169770.)).
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While this device has had good results, there remains a subset that fail this treatment.

For the treatment of both ruptured and unruptured aneurysms. The WEB has received the CE mark and to date has been used to treat a wide variety of more than 1,400 aneurysms in Europe, Latin America and New Zealand. The WEB is not available for sale or use in the United States. 

The WEB is a self-expanding, oblate, braided nitinol mesh.

The device is composed of an inner and outer braid held together by proximal, middle, and distal radiopaque markers, creating 2 compartments: 1 distal and 1 proximal. Depending on the device diame- ter, the inner and outer braids are 108 wires or 144 wires. Therefore, blood flow into a WEB-embolized aneurysm initially encounters 2 layers of wires comprising 216 or 288 wires, with the largest interwire distance ranging from 106 to 181 􏰅m, respectively, depending on the device size. The WEB implant is deployed—or retrieved before de- tachment—in a manner similar to that in endovascular coil systems, through microcatheters with an internal diameter 􏰆0.027 inch. For devices with a diameter of 􏰇7 mm, microcatheters with an internal diameter of 0.027 inch are used; and for devices with a diameter 􏰁7 mm, microcatheters with an internal diameter 0.032 inch are used. The detachment system is electrothermal and instantaneous. 
((Pierot L, Liebig T, Sychra V, Kadziolka K, Dorn F, Strasilla C, Kabbasch C,
Klisch J. Intrasaccular flow-disruption treatment of intracranial aneurysms:
preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol. 2012 
Aug;33(7):1232-8. doi: 10.3174/ajnr.A3191. Epub 2012 Jun 7. PubMed PMID:
22678844.
)).
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In a study, there was no difference in the early clinical course between those treated with WEB embolization, coil embolization, or neurosurgical clipping. Since WEB embolization is a valuable treatment alternative to coiling, it seems not justified to exclude this procedure from upcoming clinical SAH trials, yet the clinical long-term outcome, aneurysm occlusion, and retreatment rates have to be analyzed in further studies
((Sauvigny T, Nawka MT, Schweingruber N, Mader MM, Regelsberger J, Schmidt NO,
Westphal M, Czorlich P. Early clinical course after aneurysmal subarachnoid
hemorrhage: comparison of patients treated with Woven EndoBridge, microsurgical
clipping, or endovascular coiling. Acta Neurochir (Wien). 2019 Jul 6. doi:
10.1007/s00701-019-03992-4. [Epub ahead of print] PubMed PMID: 31280480.
)).