Neuroradiology

, Volume 56, Issue 9, pp 755–761

Woven Endobridge (WEB) Device for endovascular treatment of ruptured intracranial wide-neck aneurysms: a single-center experience

  • Jildaz Caroff
  • Cristian Mihalea
  • Francesco Dargento
  • Hiroaki Neki
  • Léon Ikka
  • Nidhal Benachour
  • Jacques Moret
  • Laurent Spelle
Interventional Neuroradiology

Abstract

Introduction

Endovascular treatment of ruptured wide-neck bifurcation aneurysms presents a challenge. While still under evaluation, the Woven Endobridge (WEB) aneurysm embolization system has so far shown promising results in the treatment of complex bifurcation aneurysms. We aimed to evaluate the feasibility and short-term follow-up of endovascular treatment of ruptured wide-neck aneurysm with the WEB device.

Methods

Six patients referred to our institution for acute symptomatic subarachnoid hemorrhage (SAH) and treated with the WEB device were enrolled in this study. Clinical presentations, technical details, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 3-month angiographic results were also evaluated.

Results

Three middle cerebral artery (MCA) and three anterior communicating artery aneurysms were treated between 1 and 14 days after rupturing. Average dome width was 5.8 mm (range 5–7), average neck size was 4.5 mm (range 4–5), and average dome-to-neck ratio was 1.3 (range 1–1.7). The WEB system was the exclusive treatment and was successfully deployed in all cases. Per procedural thromboembolic events occurred in two cases and were treated with intra-arterial administration of antiplatelet agents without any clinical consequences. The modified Rankin Scale (mRS) score at discharge was 0 for all patients. The 3-month angiographic follow-up showed adequate occlusion in four of our six patients (67 %).

Conclusion

From this preliminary study, the high feasibility rate and lack of need for systematic antiplatelet agents favor the WEB device providing a solution for endovascular treatment of ruptured wide-neck bifurcation aneurysms during the acute phase. However, further studies are needed to evaluate the complication rate and long-term efficiency.

Keywords

Endovascular treatment Ruptured aneurysm Subarachnoid hemorrhage WEB Wide-neck bifurcation aneurysm 

Abbreviations

EVT

Endovascular treatment

WEB

Woven Endobridge

SAH

Subarachnoid hemorrhage

MCA

Middle cerebral artery

mRS

Modified Rankin Scale

References

  1. 1.
    Molyneux AJ, Kerr RSC, Yu L-M et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817PubMedCrossRefGoogle Scholar
  2. 2.
    Cognard C, Pierot L, Anxionnat R et al (2011) Results of embolization used as the first treatment choice in a consecutive nonselected population of ruptured aneurysms: clinical results of the Clarity GDC Study. Neurosurgery 69:837–842PubMedCrossRefGoogle Scholar
  3. 3.
    Moret J, Cognard C, Weill A et al (1997) Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results.Apropos of 56 cases. J Neuroradiol J Neuroradiol 24:30–44Google Scholar
  4. 4.
    Pierot L, Cognard C, Spelle L et al (2012) Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 33:12–15PubMedCrossRefGoogle Scholar
  5. 5.
    Shapiro M, Babb J, Becske T et al (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777–1781PubMedCrossRefGoogle Scholar
  6. 6.
    Rodríguez-Hernández A, Sughrue ME, Akhavan S et al (2013) Current management of middle cerebral artery aneurysms: surgical results with a "clip first" policy. Neurosurgery 72:415–427PubMedCrossRefGoogle Scholar
  7. 7.
    Gaughen JR, Hasan D, Dumont AS et al (2010) The efficacy of endovascular stenting in the treatment of supraclinoid internal carotid artery blister aneurysms using a stent-in-stent technique.AJNR. Am J Neuroradiol 31:1132–1138PubMedCrossRefGoogle Scholar
  8. 8.
    De Barros FM, Castro RN, Lundquist J et al (2011) The role of the pipeline embolization device for the treatment of dissecting intracranial aneurysms. Am J Neuroradiol 32:2192–2195CrossRefGoogle Scholar
  9. 9.
    Consoli A, Nappini S, Renieri L et al (2012) Treatment of two blood blister-like aneurysms with flow diverter stenting. J Neurointerventional Surgery 4:e4CrossRefGoogle Scholar
  10. 10.
    Meckel S, Singh TP, Undrén P et al (2011) Endovascular treatment using predominantly stent-assisted coil embolization and antiplatelet and anticoagulation management of ruptured blood blister-like aneurysms. AJNR Am J Neuroradiol 32:764–771PubMedCrossRefGoogle Scholar
  11. 11.
    Ding YH, Lewis DA, Kadirvel R et al (2011) The Woven EndoBridge: a new aneurysm occlusion device. AJNR Am J Neuroradiol 32:607–611PubMedCrossRefGoogle Scholar
  12. 12.
    Klisch J, Sychra V, Strasilla C et al (2011) The Woven EndoBridge cerebral aneurysm embolization device (WEB II): initial clinical experience. Neuroradiology 53:599–607PubMedCrossRefGoogle Scholar
  13. 13.
    Pierot L, Liebig T, Sychra V et al (2012) Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol 33:1232–1238PubMedCrossRefGoogle Scholar
  14. 14.
    Pierot L, Klisch J, Cognard C et al (2013) Endovascular WEB Flow disruption in middle cerebral artery aneurysms: preliminary feasibility, clinical, and anatomical results in a multicenter study. Neurosurgery 73:27–35PubMedCrossRefGoogle Scholar
  15. 15.
    Lubicz B, Mine B, Collignon L et al (2013) WEB device for endovascular treatment of wide-neck bifurcation aneurysms. AJNR Am J Neuroradiol 34:1209–1214PubMedCrossRefGoogle Scholar
  16. 16.
    Caroff J, Mihalea C, Neki H, et al 2014 Role of C-Arm VasoCT in the use of endovascular WEB flow disruption in intracranial aneurysm treatment. AJNR American journal of neuroradiology Google Scholar
  17. 17.
    Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke; J Cerebral Circulation 34:1398–1403CrossRefGoogle Scholar
  18. 18.
    Pierot L, Cognard C, Anxionnat R et al (2010) Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 256:916–923PubMedCrossRefGoogle Scholar
  19. 19.
    McDonald JS, McDonald RJ, Fan J et al (2014) Comparative effectiveness of ruptured cerebral aneurysm therapies: propensity score analysis of clipping versus coiling. AJNR Am J Neuroradiol 35:164–169PubMedCrossRefGoogle Scholar
  20. 20.
    Lubicz B, Klisch J, Gauvrit J-Y, et al 2014 WEB-DL Endovascular treatment of wide-neck bifurcation aneurysms: short- and midterm results in a european study. AJNR American journal of neuroradiology Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jildaz Caroff
    • 1
    • 2
  • Cristian Mihalea
    • 1
  • Francesco Dargento
    • 1
  • Hiroaki Neki
    • 1
  • Léon Ikka
    • 1
  • Nidhal Benachour
    • 1
  • Jacques Moret
    • 1
    • 2
  • Laurent Spelle
    • 1
    • 2
  1. 1.Beaujon Medical CenterNEURI - Interventional NeuroradiologyClichyFrance
  2. 2.University Paris Diderot - Paris 7ParisFrance

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