December 20, 2019
In the treatment of brain aneurysms, endovascular options continue to evolve. Recently, the U.S. Food and Drug Administration approved a device known as the Woven EndoBridge® (WEB), which can offer a new minimally invasive option that can deliver a curative treatment for some of the most challenging aneurysm cases.
Not all brain aneurysms are the same. For a particularly complex subset of aneurysms, minimally invasive treatments have not proven as successful as classic open surgery. Coil devices have long been the mainstay of minimally invasive brain aneurysm treatment. However, many patients require multiple coils – often 5-8 – to fill the aneurysm and, in complex cases, use additional devices to support coils. This can lead to a need for repeat procedures over time and increases patients' risk.
Flow-diverting devices offer another option utilizing a single implant. But these can be ineffective when the aneurysm's distinct anatomy doesn't perfectly suit that device.
The WEB is a unique device that both fills the aneurysm and provides flow-diversion properties in a single implant. It is a sphere of woven wires – appearing a bit like a basket and about the size of an eraser head on a pencil – that is inserted by a minimally invasive catheter and threaded up into the aneurysm. Unlike traditional coil devices, the WEB forms to the shape of the aneurysm, preventing blood flow into it and allowing the vessel wall to heal.
The future of aneurysm treatment
As a uniquely minimally invasive procedure, the WEB signals a significant advancement in endovascular surgery treatments. The key to the safety profile shown by clinical trial results is in the single implant approach. Instead of having to repeat a maneuver multiple times as with coils, WEB requires a single maneuver to deliver and deploy. This is a glimpse into the future of aneurysm treatment: a single catheter and a single implant.
In a recent case we treated at The University of Kansas Health System, the patient had undergone attempted coil-based treatment at another healthcare facility. The aneurysm opening was too wide for the coils to effectively prevent blood flow, and the procedure was aborted with no treatment applied. The patient was transferred to the health system, where she was evaluated for the PulseRider® self-expanding stent, a device that can support coils in complex aneurysm treatment. During this process, the WEB was approved by the FDA and appeared to be a good fit for this patient.
The WEB allowed us to insert a single device via a single catheter, and, upon delivery to the aneurysm, expand the WEB inside to fit perfectly. The entire procedure took approximately 50 minutes – an unheard of timeframe for traditional surgical interventions of this kind. With increased experience, we completed a subsequent WEB procedure in about 25 minutes.
Debbie Green: I feel fantastic. I feel like I've been healed.
Narrator: That's today, but just 24 hours ago, Debbie Green had an aneurysm in her brain. Previous attempts to treat it had failed.
Debbie: I've already been through the coiling and it didn't work. Then I was scheduled for the PulseRider and it didn't fit, so I'm praying that this is the right fit.
Narrator: Here at The University of Kansas Hospital, specialists believe an FDA-approved treatment called the WEB is considered the most advanced and safest solutions for aneurysms.
Dr. Koji Ebersole: This is the aneurysm right here. It's about a medium-sized aneurysm, so this is greatly magnified. In real life this thing is about the size of an eraser head.
Debbie: The aneurysm is in a place that if it ruptures, then I wouldn't be able to speak and I wouldn't be able to use my right side, so that worries me a lot because God knows I need to speak.
Dr. Alan Reeves: The WEB device represents a very unique opportunity for us to treat aneurysms basically in a single shot.
Dr. Koji Ebersole: It's kind of like a woven basket, so that if you get it sized just right it will fit inside the aneurysm with a single device. That's different than coils. A coil to treat a similar aneurysm oftentimes requires more than the coils itself; for example, a stent, which requires you to be on blood thinners. This is a single device that goes inside of an aneurysm, and when you detach it, it remains inside the aneurysm, and in successful cases leads to a closure of the aneurysm, so a minimally invasive cure for brain aneurysms.
Dr. Koji Ebersole: How are you, good?
Narrator: Debbie is just happy to have her peace of mind back.
Debbie: I was willing to go through it, and hopefully it'll do what it's supposed to do, and it did. I had it done a little over 24 hours ago and I'm going home.
Reduced risk and improved outcomes
One of the WEB's greatest advantages is its ability to decrease procedure time, elevating patient safety. We are able to minimize patients' time under anesthesia, shorten radiation and contrast exposure, and deploy the device to the brain with a single entry, reducing risk of complications. Patients' hospital stay and recovery time are also reduced, with patients often able to return home about 24 hours after surgery.
The University of Kansas Health System is the first healthcare provider in the region to perform the WEB procedure. It's another way we're offering our patients the full complement of available treatments. Over time, we will continue to expand our arsenal of minimally invasive endovascular aneurysm treatment methods. The WEB device is an important addition.
In addition to receiving comprehensive training in neurosurgery, Dr. Ebersole has completed 2 years of fellowship training in minimally invasive endovascular treatments using the latest technologies. This background, unique in the Kansas City area, allows him to offer each patient a complete set of treatment options. His clinical practice is focused on brain aneurysms, brain cancer, brain tumors and carotid artery disease.
Dr. Reeves focuses on conditions of the brain, head, neck and spine. He treats complex intracranial aneurysms using flow-diversion technology. His extensive experience with several neurologically advanced devices and procedures allows him to educate other physicians on how to use innovative treatments in their own practices.
Both doctors are active senior members of the Society of Neurointerventional Surgery.