WEB Treatment of Ruptured Intracranial Aneurysms

Fellows’ Journal Club

This observational cohort study evaluated 32 patients with 32 acutely ruptured aneurysms endovascularly treated with the Woven EndoBridge (WEB) device. The mean aneurysm size was 4.9 mm, with 14 less than or equal to 4 mm, and most had a wide neck. All aneurysms were adequately occluded, and there were no procedural ruptures or complications related to the WEB device. No adjunctive stents or balloons were needed. Seven patients with poor clinical grade died during hospital admission due to the sequelae of their subarachnoid hemorrhage. The authors conclude that WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons.

Abstract

Figure 3 from paper
A 57-year-old woman with a ruptured anterior communicating artery aneurysm. A, 3D angiogram shows a small anterior communicating artery aneurysm. Note the spasm in the left A1. B, Measurement of the height (3.9 mm) and neck width (2.3 mm). C, Angiogram directly after placement of a 4-mm WEB-SLS. Note some opacification inside the WEB. D, Angiogram at 3 months demonstrates complete occlusion of the aneurysm.

BACKGROUND AND PURPOSE

The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.

MATERIALS AND METHODS

During 11 months, 32 of 71 (45%) endovascularly treated acutely ruptured aneurysms were treated with the WEB. The patients were 12 men and 20 women, with a mean age of 61 years (range, 34–84 years). The mean aneurysm size was 4.9 mm, and 14 were ≤4 mm. Of 32 aneurysms, 24 (75%) had a wide neck.

RESULTS

All 32 aneurysms were adequately occluded after WEB placement. There were no procedural ruptures and no complications related to the WEB device. No adjunctive stents or balloons were needed. In 3 patients, thromboembolic complications occurred. One patient developed an infarction, and 2 patients were asymptomatic. The procedural complication rate was 3%. Seven patients admitted in poor clinical grade conditions died during hospital admission due to the sequelae of SAH. In 18 patients with angiographic follow-up at 3 months, 16 aneurysms remained adequately occluded. Two aneurysms showed slight compression of the WEB without reopening. Clinical follow-up in the 25 patients who survived the hospital admission period revealed mRS 1–2 in 24 and mRS 4 in 1. There were no rebleeds from the ruptured aneurysms during follow-up.

CONCLUSIONS

WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons. Our preliminary experience indicates that the WEB may be a valuable alternative to coils in the treatment of acutely ruptured aneurysms.

 

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WEB Treatment of Ruptured Intracranial Aneurysms
Jeffrey Ross
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