E-073 Case series of WEB device usage in non-aneurysmal neurovascular conditions
Bibliographic record
Abstract
Introduction The Woven EndoBridge (WEB) device has gained widespread acceptance for the treatment of intracranial aneurysms, offering a safe and effective endosaccular alternative to traditional endovascular techniques. However, its application beyond aneurysm treatment remains largely underexplored. Leveraging its design, the WEB device offers reversible temporary or permanent occlusion with a precise landing spot. Its precision and minimally invasive nature enhance most single hole AV-fistulae treatment, such as Vertebral Venous fistula, usually without the need for additional embolic agents. Its deployment for parent vessel sacrifice offers a balloon-like occlusion method, with full control of landing adjacent to important branches. Additionally, in Vein of Galen malformations (VOGM) management, the WEB can be deployed across the AV-Fistula site in a retrograde manner via venous approach and avoid large arterial access, which can be extremely challenging in the pediatric age group. An example of this application in VOGM is included in the figure. The nature of jugular bulb diverticulum anatomy mimics that of a wide neck aneurysm and treatment can be performed without the need for adjunct stents or DAPT. The Spherical WEB (SLS) may be used to treat Direct CC Fistulae, like erstwhile Latex balloons in a similar trans-arterial approach, to cork the fistula. Another promising area for the WEB device application is in the transvenous embolization of AVMs. Here, the WEB could complement the ‘pressure cooker technique,’ serving to a create a controlled, high-pressure environment within the AVM nidus. Methods This pictorial case series (figure 1) aims to illuminate the novel use of the WEB device in managing non-aneurysmal neurovascular pathologies to demonstrate potential benefits in this uncharted territory. We retrospectively analyzed six patients successfully treated at our institution, encompassing three vein of Galen malformations, one vertebral-venous fistula, and two cases of jugular bulb diverticulae. Results Of the 6 patients treated with novel applications of the WEB device in managing non-aneurysmal neurovascular pathologies, there was no aborted or failed procedures and no procedural complications. Conclusions The findings from this case series suggest alternative uses to for the WEB device outside of aneurysms alone. By showcasing its application in a variety of non-aneurysmal settings, we aim to stimulate further investigation and adoption of this technique in managing complex neurovascular disorders. Disclosures B. Ghodke: None. J. Clarke: None. R. Meyer: None. M. Anderson: None. M. Levitt: 1; C; Medtronic, Stryker. 6; C; Proprio, Stroke Diagnostics, Synchron, Hyperion Surgical, Fluid Biomed, Apertur, Metis Innovative, Aeaean Advisers, Stereotaxis, Arsenal Medical. L. Kim: 2; C; Phillips North America. 4; C; Spi Surgical. S. Chen: None. M. Walker: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.020 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".