• Visish M Srinivasan, Adam A Dmytriw, Robert W Regenhardt, Juan Vicenty-Padilla, Naif M Alotaibi, Elad Levy, Muhammad Waqas, Jacob Cherian, Jeremiah N Johnson, Pascal Jabbour, Ahmad Sweid, Bradley Gross, Robert M Starke, Ajit Puri, Francesco Massari, Christoph J Griessenauer, Joshua S Catapano, Caleb Rutledge, Omar Tanweer, Parham Yashar, Gustavo M Cortez, Mohammad A Aziz-Sultan, Aman B Patel, Andrew F Ducruet, Felipe C Albuquerque, Ricardo A Hanel, Michael T Lawton, and Peter Kan.
• Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
• Neurosurgery. 2022 May 1; 90 (5): 569580569-580.

BackgroundThe Woven EndoBridge (WEB) device (Terumno Corp. [parent company of Microvention]) was approved by the U.S. Food and Drug Administration as the first intrasaccular device for intracranial aneurysm treatment in December 2018. Its use has become more common since then, but both trial results and postmarket experiences have raised questions about the efficacy in achieving complete aneurysm obliteration. Retreatment after WEB embolization has not been extensively discussed.ObjectiveTo discuss the incidence and retreatment of aneurysms after initial WEB embolization.MethodsRetrospective review across 13 institutions identified all occurrences of WEB retreatment within neurovascular databases. Details regarding demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed.ResultsThirty aneurysms were retreated in 30 patients in a cohort of 342 WEB-treated aneurysms. The retreatment rate was 8.8%. Endovascular methods were used for 23 cases, and 7 were treated surgically. Two aneurysms presented with rehemorrhage after initial WEB embolization. Endovascular treatments included stent-assisted coiling (12), flow diversion (7), coiling (2), PulseRider (Johnson & Johnson)-assisted coiling (1), and additional WEB placement (1). Surgical treatments included primary clipping (6) and Hunterian ligation (1). There were no major complications within the study group.ConclusionWEB retreatments were successfully performed by a variety of techniques, including stent-assisted coiling, clipping, and flow diversion as the most common. These procedures were performed safely with subsequent obliteration of most aneurysms. The potential need for retreatment of aneurysms should be considered during primary WEB treatments.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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