• Mario Zanaty, Jorge A Roa, Stavropoula I Tjoumakaris, Pascal Jabbour, Nikolaos Mouchtouris, Ahmad Sweid, Santiago Ortega-Gutierrez, Daizo Ishii, Kaustubh Limaye, Khaled Asi, Edgar A Samaniego, and David M Hasan.
• Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
• World Neurosurg. 2020 Feb 1; 134: e1047e1052e1047-e1052.

ObjectiveWe present our initial experience with the off-label use of the Woven EndoBridge (WEB) device.MethodsWe performed a retrospective study from 2 institutions of patients with intracranial aneurysms who underwent treatment with the WEB device alone or in conjunction with stenting and/or coiling in an off-labeled location.ResultsEleven patients with 12 aneurysms were included. Four (30.8%) aneurysms presented ruptured. Off-labeled locations included 3 aneurysms in the posterior communicating artery, 3 in the supraclinoid ophthalmic artery, 2 in the pericallosal artery, 2 in the posterior inferior cerebellar artery, 1 at the vertebrobasilar junction, and 1 in the cavernous internal carotid artery. Mean dome-to-neck ratio was 1.91 ± 0.9. Average duration of the procedure was 63.9 ± 29.6 minutes. Femoral route was used in 61.5%, and radial access in 48.5% of cases. Five procedures (41.7%) were performed under monitored anesthesia care. We had 1.33 attempts per aneurysm. WEB embolization was supplemented with coiling in 2 cases (16.67%) and stenting in 1 case (8.3%). Based on the O'Kelly-Marotta ("OKM") grading scale, we report a rate of 0% for grade 1, 33.3% for grade 2, and 33.3% for grade 3. Postprocedural occlusion was complete in 4 (33.3%) and adequate in 8 (66.6%) patients. No procedure-related deaths or symptomatic complications were reported.ConclusionsThe WEB device was successfully deployed in off-labeled locations, including posterior communicating artery, ophthalmic artery, and pericallosal aneurysms. The efficacy of this usage must be evaluated in multicenter prospective studies, but our preliminary results are promising. Correct characterization of the aneurysm size/morphology, as well as awareness of possible adjunct treatments, are crucial for successful intervention.Copyright © 2019 Elsevier Inc. All rights reserved.

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