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Advanced Neurology Woven Endobridge embolization: Indications and innovation

deployed (Table 2) . Finally, the most recently published provided a considerable predictive value in reoccurrence
[25]
independent trial is the CLARYS (NCT02687607), which for more severe aneurysms treated with coiling .
[34]
assessed the utility of the WEB embolization specifically
in patients with recently ruptured intracranial aneurysms 3.1. Association of WEB device with recurrence and
(Table 2) . rupture of aneurysm
[26]
The recurrence and rupture of wide-neck intracranial
3. Outcomes and proposed grading scale aneurysms following treatment with the WEB device are
for aneurysm recurrence not abundantly reported in the literature [35,36] . Peterson and
The most feared complication of intracranial aneurysms Cord (2021) are among the first to focus on the recurrent and
[35]
is a rupture causing a subarachnoid hemorrhage (SAH), residual aneurysms post-WEB that require treatment . Their
posing a significant risk of morbidity and mortality [1,27] . meta-analysis included 16 studies and 901 WEB cases and
Medical intervention, without surgery, is the preferred found that 18.7 ± 11.5% cases of either recurrent or residual
treatment approach to un-ruptured intracranial aneurysms. aneurysms post-initial WEB device; while 10.7 ± 11% of
[35]
Nevertheless, unruptured aneurysms may need surgical cases had to undergo some form of retreatment . A meta-
intervention, requiring a personalized approach . The analysis by Zhang et al. that focused on the efficacy of the
[1]
mainstay approach to managing unruptured cerebral WEB device in treating wide-neck intracranial aneurysms
aneurysms involves blood pressure control and smoking (36 studies, 1759 patients with 1749 aneurysms) found that
cessation to prevent further aneurysm development . the recanalization rate was 9% and intraoperative rupture
[27]
[36]
Conversely, surgical and endovascular approaches aim to rate was 3% . Factors leading to a higher recanalization rate
repair aneurysms. were older-generation WEB devices, posterior circulation,
and rupture status . Thus far, the most likely treatment for
[36]
Numerous studies in the literature have demonstrated the recurrence of an aneurysm following an operation with
safety and efficacy in the treatment options for intracranial the WEB device is stent-assisted coiling (SAC). Some other
aneurysms [28-30] . There are currently several criteria that techniques used include flow diversions, additional coiling,
evaluate the stage, structural morphology, and severity clipping, and additional WEB devices, and all have shown
of intracerebral aneurysms, such as the Hunt and Hess success [35,37] . Further investigation into long-term association
classification or Yasagril Grading Scales. However, of recurrence and rupture rates of wide-neck intracranial
there remain significant gaps in data examining the aneurysms post-treatment with the WEB devices would
long-term recurrence of aneurysms that have been provide value to the literature. The ability to keep up with the
surgically or medically treated [28-30] . Each modality used rapid pace of WEB device innovations within the literature
to treat intracerebral aneurysms individually estimates as it relates to the recurrence and rupture rate of each new
re-occurrence rates and outcomes [28-30] . Evaluating generation can also provide value for clinicians.
aneurysm re-occurrence remains a highly controversial
and active area of research in neurological surgery and 4. Discuss how pre-clinical studies are
neuroradiology. seeking to improve the devices
Several criteria have been proposed to evaluate the The WEB device has been in clinical use for over 10 years .
[38]
future reoccurrence of intracranial aneurysms. Of the The first pre-clinical study evaluated the short-term
criteria that exist, the Raymond-Roy occlusion classification performance of the WEB II device . The WEB II device
[12]
system (RROC) has shown promise. The RROC grades was improved by adding more than a single layer of nitinol
the occlusion of endovascularly-treated aneurysms in an mesh. The device was implanted in two patients to assess
angiographic classification system (Figure 2). Although
initially created to assess an aneurysm’s occlusion class, the occlusion’s short-term performance and durability. One
RROC has been modified to predict aneurysmal occurrence patient had an unruptured middle cerebral artery (MCA)
trifurcation aneurysm, while the other had a basilar tip
after surgical intervention, whereby Mascitelli et al. (2015) aneurysm. The device was successfully implanted in both
proposed their modified RROC scale (Figure 2) [31,32] . patients without complications of hemorrhage or peri or
The modified scale includes further divided class III to
signify progression to occlusion . A follow-up study in post-procedural thromboembolism. Complete aneurysm
[31]
2015 validated the modified RROC, which demonstrated occlusion was achieved within minutes of device placement.
that specific categories of aneurysms are more likely to Eight weeks later, angiography confirmed stable occlusion
[12]
reoccur than others [32,33] . A subsequent 2016 meta-analysis in both patients .
examining the predictiveness of the RROC on aneurysm A stable construct across the neck of the aneurysm
coiling consisting of 4587 patients found that the RROC is critical for achieving durable occlusion . Failure of
[39]

Volume 2 Issue 3 (2023) 5 https://doi.org/10.36922/an.293