WEB for recurrent aneurysms: a case series to review technical nuances

Area of Science:

• Neurosurgery
• Endovascular Therapy
• Cerebrovascular Disease

Background:

• Recurrent intracranial aneurysms (IAs) present morphological complexities, including wide necks, complicating endovascular treatment.
• Prior rupture and interventions lead to fibrotic changes, altering aneurysm configuration and limiting retreatment options.
• The Woven Endobridge (WEB) device is recognized for its efficacy, flexibility, and safety in treating wide-neck bifurcation IAs.

Discussion:

• This technical video showcases the application of the WEB device for recurrent IAs previously treated with coiling or clipping.
• The WEB device's barrel shape is advantageous for previously treated aneurysms with wide necks.
• Four cases illustrate the technical nuances of successful WEB embolization for progressive, wide-neck recurrent IAs.

Key Insights:

• The WEB device is a viable and effective option for managing complex recurrent intracranial aneurysms.
• Successful treatment of recurrent IAs with the WEB device was demonstrated in all presented cases.
• The technique addresses challenges posed by altered aneurysm morphology after initial treatment.

Outlook:

• Further evaluation of the WEB device in diverse recurrent IA anatomies is warranted.
• This approach may expand retreatment options for patients with complex intracranial aneurysms.
• Continued research will refine endovascular strategies for challenging cerebrovascular cases.