November 29, 2019 by John Fernandez
First in S. Florida: New ‘WEB’ Device Closes, Heals Brain Aneurysms
It’s called WEB, short for Woven EndoBridge, and it’s a self-expanding mesh ball made of nickel titanium that is implanted within aneurysms located in the arteries of the brain.
For patients with potentially dangerous aneurysms, it is also a new life-saving device approved just months ago by the U.S. Food and Drug Administration. Interventional neuroradiologist Guilherme Dabus, M.D., with Baptist Health Neuroscience Center, this month performed the first minimally invasive surgery in South Florida using the WEB on a woman in her 70s who is recovering well.
When brain aneurysms need repair, experts at Baptist Health Neuroscience Center and Miami Cardiac & Vascular Institute work together to fix them in a minimally invasive manner, without cutting open the skull. In the recent past, they’ve done this with the help of another innovated device, the flow diverter. Before the flow diverter was approved, more commonly used balloons, stents and platinum coils induce clotting (embolization), and hopefully preventing blood from continuing to grow the bulge- or balloon-like aneurysms.
WEB Benefits for Patients
Now the WEB devices (pictured at left) offers many advantages for the patient, including a shorter recovery time, less or no dependence on blood-thinning drugs and potentially fewer complications during a procedure that runs just an hour or less, says Dr. Dabus. Procedures involving coiling and the flow diverter can be more complicated, can take much longer and require the patient to stay on antiplatelet therapy for the rest of their lives.
The WEB implant (pictured above in an illustration) is designed to stop blood flow entering the aneurysm and help promote clotting (thrombosis). Like in other minimally invasive aneurysm procedures, the device is delivered to the aneurysm by snaking a catheter from a blood vessel in the groin or wrist to the brain. Once there, the WEB detaches from the catheter and is placed into the sac of the intracranial aneurysm. Dr. Dabus was able to deploy and control the mesh device after it is deployed into the aneurysm.
“The WEB basically redirects the blood flow away from the aneurysm,” says Dr. Dabus. “At the same time, it closes the aneurysm from the inside. And it potentially also serves as a scaffold for tissue healing at the neck of the aneurysm.”
After Stroke Treatment
The female patient at Baptist Hospital who underwent one of the first WEB implants was actually taken to the ER after suffering an ischemic stroke, the most common type of stroke. During an ischemic stroke, the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The woman underwent a “mechanical thrombectomy,” in which doctors remove blood clots using a device threaded through a blood vessel.
The thrombectomy was successful, but then doctors made a surprise discovery — a wide-neck, unruptured bifurcation aneurysm on the other side of her brain.
“She had the (stroke) procedure done, and then they diagnosed an aneurysm on the other side of her brain, which was a very wide-neck and irregular,” explains Dr. Dabus. “So, she recovered very well from the stroke. We gave her about ten days and we treated the aneurysm on the other side.”
The patient may be spared having to rely on blood-thinning medication from the aneurysm treatment perspective, he added.
“When the patient undergoes the procedure with the flow diverter or stent and coils, we keep them on dual antiplatelet therapy, for six months or so, and then on aspirin forever,” explains Dr. Dabus. “With the WEB, sometimes we give the patient both, but it’s usually for a very limited amount of time. Most of the time, because everything goes well, the patient does not need to be on any (blood thinner) in the future.”