A decade of WEB™ devices in Bicêtre hospital

The Woven EndoBridge (WEB) device (Microvention/Terumo) was specifically developed for the endovascular treatment of wide-neck bifurcation aneurysms.

Available in Europe since 2010 and the USA since 2018, five Good Clinical Practice studies have evaluated its safety and effectiveness for both ruptured and unruptured aneurysms, and including long-term clinical safety and efficacy data, making it the most studied intrasaccular device.^1–4

The WEB device has evolved from a dual-layer (DL) high-profile version to more refined single-layer (SL) and single-layer sphere (SLS) low-profile versions, with enhanced visibility. The development of the fifth-generation WEB (WEB17), deliverable through a 0.017” microcatheter (VIA 17), marked significant advancements, allowing for the treatment of smaller and more distal aneurysms. This miniaturized device has been available since 2016; The CLEVER trial confirmed similar efficacy and safety with this latest version.⁵

The simplicity of using WEB, compared to stent-assisted coiling or Y-stenting plus coiling techniques, has contributed to its growing adoption.

Several studies have confirmed that procedures were significantly shorter and resulted in fewer complications with the WEB device compared to stent assisted coiling.^6–8

Over time, the scope of indications for WEB has expanded beyond initial registries, with other location uses and an oversizing strategy becoming common (Figure 1).^9,10

 

Figure 1. Proportion of aneurysms treated with WEB at each location. Note the important rise of other locations in the second period of time. MCA: Middle Cerebral Artery, ACoA: Anterior Communicating Artery, BA: Basilar Artery.

The CLARYS trial, has confirmed the feasibility and favorable outcomes of using the WEB device in ruptured aneurysms,³ leading in our center to a progressive and continuous increase of WEB usage to treat these aneurysms (Figure 2).

Figure 2. WEB and coils usage over time in Bicêtre

Aneurysm size in WEB-treated cases has also decreased.

Analyzing our database, we showed that before 2017, the average aneurysm diameter was 8.2±2.4 mm, but with the arrival of WEB17, it dropped to 5.9±2.0 mm, thanks to the availability of smaller sizes (3, 3.5, 4, and 4.5 mm).

In fact, the shift towards smaller aneurysms began even before WEB17's introduction, as operators gained more confidence in the device (Figure 3).⁹

 

Figure 3. Evolution of WEB and aneurysm sizes over time

 

Smaller aneurysms, as small as 3 mm in diameter, are now routinely treated with WEB.¹¹

Additionally, the recent availability of new WEB sizes (SL 6x2 and SL 7x2) continues to expand treatment options for aneurysms of varying sizes and shapes.

But most importantly, the adequate and complete occlusion rates with WEB have improved over the years, even with extending indications (Figure 4).

Several factors can explain this trend for higher occlusion rates: operators experience, patient/aneurysm selection, oversizing strategy and neck apposition.^10,12,13

In conclusion, the WEB device represents a great innovation in the treatment of cerebral aneurysms, offering enhanced safety, efficacy, and versatility.

With continuous advancements in its design and size, the WEB device has become a useful tool for endovascular aneurysm management, providing more effective and minimally invasive solutions for a wider range of aneurysm cases.

 

Figure 4. Evolution of the adequate occlusion rate
in our experience at Bicêtre hospital.

References 

<sup>1. Pierot L, Szikora I, Barreau X, et al. Aneurysm treatment with the Woven EndoBridge (WEB) device in the combined population of two prospective, multicenter series: 5-year follow-up. J Neurointerv Surg https://doi.org/10.1136/neurintsurg-2021-018414 .
2. Fiorella D, Molyneux A, Coon A, et al. Safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide necked bifurcation aneurysms: final 5 year results of the pivotal WEB Intra-saccular Therapy study (WEB-IT).J Neurointerv Surg 2023;15:1175–80 .
3. Spelle L, Herbreteau D, Caroff J, et al. CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): 12-month angiographic results of a multicenter study. J Neurointerv Surg https://doi.org/10.1136/neurintsurg-2022-018749 .
4. Pierot L. Ten Years of Clinical Evaluation of the Woven EndoBridge: A Safe and Effective Treatment for Wide-Neck Bifurcation Aneurysms. Neurointervention 2021;16:211–21 .
5. Spelle L, Costalat V, Caroff J, et al. CLinical EValuation of WEB 17 device in intracranial aneuRysms (CLEVER): 1-year effectiveness results for ruptured and unruptured aneurysms. J Neurointerv Surg https://doi.org/10.1136/jnis-2024-021918 .
6. Baek J, Jeong HW, Han J-Y, et al. Assessing Radiation Exposure and Contrast Agent Utilization: A Comparative Analysis of the Woven EndoBridge Device and Stent-Assisted Coil Embolization for Managing Unruptured Wide-Neck Bifurcation Aneurysms. Neurointervention https://doi.org/10.5469/neuroint.2024.00143 .
7. Maroufi SF, Fallahi MS, Waqas M, et al. Comparison between Woven EndoBridge and coiling with and without stent assistance for intracranial bifurcation and wide-neck aneurysms: a comprehensive systematic review and meta-analysis. J Neurosurg https://doi.org/10.3171/2024.2.JNS232531 .
8. Rodriguez-Calienes A, Vivanco-Suarez J, Lu Y, et al. Woven EndoBridge versus stent-assisted coil embolization for the treatment of ruptured wide-necked aneurysms: A multicentric experience. Interv Neuroradiol https://doi.org/10.1177/15910199231223538 .
9. Sabuzi F, Cortese J, Da Ros V, et al.How a decade of aneurysms embolization with the Woven EndoBridge haschanged our understanding and practices? J Neuroradiol https://doi.org/10.1016/j.neurad.2023.02.006 .
10. Cortese J, Caroff J, Chalumeau V, et al. Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up. J Neurointerv Surg https://doi.org/10.1136/neurintsurg-2022-018780 .
11. Girot J-B, Caroff J, Cortese J, et al. Endovascular Treatment of Small and Very Small Intracranial Aneurysms with the Woven EndoBridge Device. AJNR Am J Neuroradiol https://doi.org/10.3174/ajnr.A7115 .
12. Goyal N, Hoit D, Di Nitto J, et al. How to WEB: a practical review of methodology for the use of the Woven EndoBridge. J Neurointerv Surg 2020;12:512–20 .
13. Cortese J, Juhasz J, Rodriguez-Erazú F, et al. Neck apposition is a key factor for aneurysm occlusion after Woven EndoBridge device embolization. J Neurointerv Surg https://doi.org/10.1136/jnis-2024-022155</sup>

Important safety information and product indications

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