Woven EndoBridge Embolized Aneurysm Clippings: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor for intracranial aneurysms.
• WEB devices show high rates of adequate occlusion but residual or recurrent aneurysms pose re-rupture risks.
• Optimizing retreatment strategies for WEB-treated aneurysms is crucial with increasing device utilization.

Purpose of the Study:

• To demonstrate the feasibility of surgical clip occlusion for intracranial aneurysms with recurrence after WEB device treatment.
• To highlight key surgical considerations and lessons learned during clip application in these specific cases.

Main Methods:

• Presentation of an operative video detailing surgical clip occlusion.
• Focus on previously ruptured middle cerebral artery and anterior communicating artery aneurysms treated with WEB device.
• Post-treatment follow-up angiography confirmed recurrence necessitating intervention.

Main Results:

• Surgical clipping was successfully performed in cases of WEB device-treated aneurysm recurrence.
• Key observations included the compressibility of the WEB device and potential interference from its proximal marker.
• No WEB extrusion into the subarachnoid space or excessive scarring was noted.

Conclusions:

• Surgical clipping is a feasible treatment option for recurrent or residual aneurysms initially treated with the WEB device.
• Understanding the characteristics of the WEB device is important for successful surgical retreatment.
• This technique offers an alternative for managing complex aneurysm recurrences post-WEB intervention.