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

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.

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Abbreviations

EVT:

Endovascular treatment

WEB:

Woven Endobridge

SAH:

Subarachnoid hemorrhage

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

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Ethical standards and patient consent

We declare that all human studies have been approved by the AP-HP Ethical Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

LS and JM consult for Sequent Medical.

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Correspondence to Jildaz Caroff.

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Caroff, J., Mihalea, C., Dargento, F. et al. Woven Endobridge (WEB) Device for endovascular treatment of ruptured intracranial wide-neck aneurysms: a single-center experience. Neuroradiology 56, 755–761 (2014). https://doi.org/10.1007/s00234-014-1390-7

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  • DOI: https://doi.org/10.1007/s00234-014-1390-7

Keywords

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