The Woven EndoBridge: A New Aneurysm Occlusion Device

BACKGROUND AND PURPOSE: The WEB device is an intrasaccular ellipsoid braided-wire embolization device designed to provide flow disruption along the aneurysm neck. The purpose of this study was to evaluate, in an in vivo aneurysm model, the acute and chronic performance of the WEB device regarding immediacy, degree, and durability of aneurysm occlusion. MATERIALS AND METHODS: The WEB device was implanted in 24 elastase-induced aneurysms in New Zealand white rabbits and followed for 1, 3, 6, and 12 months (n = 6 at all time points). Degree of intra-aneurysmal flow disruption was graded on a 4-point scale based on DSA within 10 minutes following device implantation. Chronic aneurysm occlusion was rated by using a 3-point scale. All aneurysms were harvested for histologic analysis. RESULTS: Immediate postimplant grade 1 (complete flow cessation) was noted in 7 (29%) of 24 cases. Grade 2 (near-complete flow cessation) was noted in 13 (54%) of 24 cases. At follow-up, complete occlusion was noted in 8 (33%) of 24 cases. Near-complete aneurysm occlusion was noted in 14 (58%) of 24 cases, while incomplete occlusion was noted in 2 (8%) cases. Stable aneurysm occlusion was present in 7 (29%) of 24 cases; progressive occlusion, in 14 (58%); and recanalization, in 3 (13%) cases. Histologic findings included aneurysm cavities filled with organized thrombus with connective tissue across the aneurysm neck. CONCLUSIONS: The WEB device in experimental aneurysms demonstrated promising rates of immediate and long-term aneurysm occlusion.

[1]  H. Woo,et al.  Endovascular Reconstruction with the Neuroform Stent as Monotherapy for the Treatment of Uncoilable Intradural Pseudoaneurysms , 2006, Neurosurgery.

[2]  David F. Kallmes,et al.  A New Endoluminal, Flow-Disrupting Device for Treatment of Saccular Aneurysms , 2007, Stroke.

[3]  I. Saatci,et al.  Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. , 2004, AJNR. American journal of neuroradiology.

[4]  A. Thron,et al.  Endovascular treatment of experimentally induced aneurysms in rabbits using stents: a feasibility study , 2003, Neuroradiology.

[5]  D F Kallmes,et al.  A Second-Generation, Endoluminal, Flow-Disrupting Device for Treatment of Saccular Aneurysms , 2009, American Journal of Neuroradiology.

[6]  A. Berenstein,et al.  Endovascular treatment of intracranial aneurysms: comparative evaluation in a terminal bifurcation aneurysm model in dogs. , 2004, Journal of neurosurgery.

[7]  D. Kallmes,et al.  Platinum coil-mediated implantation of growth factor-secreting endovascular tissue grafts: an in vivo study. , 1998, Radiology.

[8]  Carlos Miranda,et al.  Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. , 2005, Journal of neurosurgery.

[9]  D. Kallmes,et al.  Endovascular Treatment of Experimental Aneurysms by Use of Fibroblast-Coated Platinum Coils: An Angiographic and Histopathologic Study , 2007, Stroke.

[10]  F Viñuela,et al.  Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. , 2000, Journal of neurosurgery.

[11]  David F. Kallmes,et al.  Creation of Saccular Aneurysms in the Rabbit , 2000 .

[12]  P. Lylyk,et al.  Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms , 2009, Journal of NeuroInterventional Surgery.

[13]  D. Kallmes,et al.  Healing response in elastase-induced rabbit aneurysms after embolization with a new platinum coil system. , 2002, AJNR. American journal of neuroradiology.

[14]  Isabel Wanke,et al.  Stents for intracranial wide-necked aneurysms: more than mechanical protection , 2008, Neuroradiology.

[15]  D. Fiorella,et al.  Usefulness of the Neuroform Stent for the Treatment of Cerebral Aneurysms: Results at Initial (3–6-mo) Follow-up , 2005, Neurosurgery.

[16]  Bernd Turowski,et al.  Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent) , 2010, Neuroradiology.

[17]  D. Kallmes,et al.  A collagen-based coil for embolization of saccular aneurysms in a New Zealand White rabbit model. , 2003, AJNR. American journal of neuroradiology.

[18]  Jimmy D Bell,et al.  Intravascular detachable balloon embolization of intracranial aneurysms. Indications and techniques. , 1986, Acta radiologica. Supplementum.

[19]  Baruch B. Lieber,et al.  Treatment of Rabbit Elastase-Induced Aneurysm Models by Flow Diverters: Development of Quantifiable Indexes of Device Performance Using Digital Subtraction Angiography , 2009, IEEE Transactions on Medical Imaging.

[20]  Endovascular Treatment of Experimental Aneurysms with Use of Fibroblast Transfected with Replication-Deficient Adenovirus Containing Bone Morphogenetic Protein-13 Gene , 2008, American Journal of Neuroradiology.

[21]  D F Kallmes,et al.  Serial angiography in an elastase-induced aneurysm model in rabbits: evidence for progressive aneurysm enlargement after creation. , 2001, AJNR. American journal of neuroradiology.

[22]  D. Kallmes,et al.  Angiographic and histologic analysis of experimental aneurysms embolized with platinum coils, Matrix, and HydroCoil. , 2005, AJNR. American journal of neuroradiology.

[23]  D. Kallmes,et al.  Histopathologic and immunohistochemical comparison of human, rabbit, and swine aneurysms embolized with platinum coils. , 2005, AJNR. American journal of neuroradiology.

[24]  D. Kallmes,et al.  Angiographic and Histologic Comparison of Experimental Aneurysms Embolized with Hydrogel Filaments , 2009, American Journal of Neuroradiology.

[25]  J. Raymond,et al.  In Situ Beta Radiation to Prevent Recanalization After Coil Embolization of Cerebral Aneurysms , 2002, Stroke.

[26]  Alejandro F Frangi,et al.  Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model--a report on the Virtual Intracranial Stenting Challenge 2007. , 2008, Journal of biomechanics.

[27]  Yuichi Murayama,et al.  Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. , 2003, Journal of neurosurgery.

[28]  D. Kallmes,et al.  New expandable hydrogel-platinum coil hybrid device for aneurysm embolization. , 2002, AJNR. American journal of neuroradiology.

[29]  D. Kallmes,et al.  Transforming Growth Factor &bgr;-coated Platinum Coils for Endovascular Treatment of Aneurysms: An Animal Study , 2001, Neurosurgery.

[30]  N. Stergiopulos,et al.  Effect of Flow Diverter Porosity on Intraaneurysmal Blood Flow , 2009, Clinical Neuroradiology.