Purpose

Treatment of wide-necked intracranial aneurysms using the Woven Endobridge (WEB) device has become broadly accepted. Feared complications with the potential of increased poor clinical outcome include dislocations and migration of the device. This study was carried out to determine the effectiveness of a variety of different strategies to rescue migrated WEB devices.

Methods

In a porcine model, WEB devices of different sizes (SL [single layer] 3.5 × 2mm and SL 4.0 × 3 mm, SL 8 × 5 mm and SLS 8 mm [single layer spherical]) were placed into both the subclavian and axillary arteries. A total of 32 rescue maneuvers (8 per rescue device) were performed. Small WEBs were rescued using reperfusion catheters (RC) (SOFIA Plus and JET 7), larger WEBs were rescued using dedicated rescue devices (Microsnare and Alligator). Rescue rates, times, attempts and complications were assessed.

Results

Rescue attempts of migrated WEBs were successful in all cases (100%). Rescue time (p = 0.421) and attempts (p = 0.619) of small WEBs using RCs were comparable without significant differences. Aspiration alone was not successful for larger WEBs. Rescue of larger WEBs was slightly faster (122.75 ± 41.15 s vs. 137.50 ± 54.46 s) with fewer attempts (1 vs. 1.37) when using the Microsnare compared to the Alligator device. Complications such as entrapment of the WEB in the RCs, vasospasm, perforation, or dissection were not observed.

Conclusion

Rescue of migrated WEB devices is a feasible and effective method and 100% successful rescue rates and appropriate rescue times can be achieved for small WEBs using RCs and for larger WEBs using dedicated rescue devices (Microsnare and Alligator).

中文翻译：

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迁移的编织内桥 (WEB) 设备的不同救援方法：一项动物研究

目的

使用编织内桥 (WEB) 设备治疗宽颈颅内动脉瘤已被广泛接受。可能会增加不良临床结果的令人担忧的并发症包括装置的脱位和移动。进行这项研究是为了确定各种不同策略对迁移的 WEB 设备进行救援的有效性。

方法

在猪模型中，将不同尺寸的 WEB 装置（SL [单层] 3.5 × 2mm 和 SL 4.0 × 3 mm、SL 8 × 5 mm 和 SLS 8 mm [单层球形]）放入锁骨下动脉和腋动脉. 总共进行了 32 次救援操作（每个救援装置 8 次）。使用再灌注导管 (RC)（SOFIA Plus 和 JET 7）抢救小 WEB，使用专用抢救设备（Microsnare 和 Alligator）抢救较大的 WEB。评估了救援率、时间、尝试和并发症。

结果

迁移 WEB 的救援尝试在所有情况下都成功 (100%)。 使用 RC 的小型 WEB 的救援时间 ( p  = 0.421) 和尝试 ( p = 0.619) 具有可比性，没有显着差异。对于较大的 WEB 来说，仅靠 Aspiration 是不成功的。与 Alligator 设备相比，使用 Microsnare 时，较大 WEB 的救援速度略快（122.75 ± 41.15 s 对 137.50 ± 54.46 s），尝试次数更少（1 对 1.37）。未观察到 RC 中 WEB 被卡住、血管痉挛、穿孔或夹层等并发症。

结论

对迁移后的WEB设备进行救援是一种可行且有效的方法，对于使用RC的小型WEB和使用专用救援设备（Microsnare和Alligator）的大型WEB可以实现100%的成功救援率和适当的救援时间。