Multiple intra-aneurysmal WEB devices: Case discussions and operative technique

The Woven Endobridge (WEB, Sequent Medical, Aliso Viejo, California) device has emerged as an FDA approved endosaccular flow diverting alternative for patients with complex aneurysm morphology. We describe for the first time, in patients with dual anti platelet therapy (DAPT) non compliance, two cases during which multiple WEB devices were deployed within the aneurysm sac to achieve flow disruption. Two ophthalmic segment internal carotid artery aneurysms are treated by the deployment of an additional WEB device within the sac. We subsequently discuss the techniques utilized to ensure parent vessel patency. We demonstrate that patients with contraindications to endovascular modalities requiring DAPT may be candidates for a multi WEB intra-aneurysmal construct.

编织型腔内桥接装置（WEB，由美国加利福尼亚州阿利索维耶荷的先趋医疗公司生产）已作为一种经美国食品药品监督管理局批准的用于复杂动脉瘤形态患者的囊内血流导向替代装置出现。我们首次描述了在双重抗血小板治疗（DAPT）不依从的患者中，有两例在动脉瘤囊内放置多个WEB装置以实现血流阻断的情况。通过在瘤囊内额外放置一个WEB装置治疗了两例眼段颈内动脉瘤。随后我们讨论了用于确保载瘤血管通畅的技术。我们证明，对于存在禁忌证无法采用需要双重抗血小板治疗的血管内治疗方式的患者，可能适合采用多个WEB装置在动脉瘤内构建的方法。