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Early clinical course after aneurysmal subarachnoid hemorrhage: comparison of patients treated with Woven EndoBridge, microsurgical clipping, or endovascular coiling

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

The Woven EndoBridge (WEB) device has been increasingly used for the treatment of intracranial aneurysms after aneurysmal subarachnoid hemorrhage (SAH). Still, recent major clinical trials on patient management after SAH have defined WEB embolization as an exclusion criterion. In an analysis of an unselected patient cohort, we evaluate the early clinical course of SAH patients after WEB treatment compared to those treated with endovascular coiling or surgical clipping.

Methods

Data of all patients with proven SAH who were either treated with a WEB device, coil embolization, or neurosurgical clipping between March 2015 and August 2018 was systematically reviewed. Clinical parameters on intensive care unit (ICU), medical history and mortality rates were evaluated and compared between the different treatment approaches.

Results

Of all 201 patients included, 107 patients received endovascular coil embolization, 56 patients were treated with clipping and in 38 cases a WEB device was placed. The overall mortality was 17.9%. Thirteen patients (34.2%) in the WEB group had a Hunt and Hess grade > 3. Essential medical factors showed no clinically relevant differences between the treatment groups, and the analyzed blood parameters were predominantly within physiological limits without any relevant outliers. The Hunt and Hess grade but not the treatment modality was identified as independent risk-factor associated with ICU-mortality in the overall cohort (p < 0.001).

Conclusion

In this study, there was no difference in the early clinical course between those treated with WEB embolization, coil embolization, or neurosurgical clipping. Since WEB embolization is a valuable treatment alternative to coiling, it seems not justified to exclude this procedure from upcoming clinical SAH trials, yet the clinical long-term outcome, aneurysm occlusion, and retreatment rates have to be analyzed in further studies.

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Abbreviations

ACA:

Anterior cerebral artery complex

ACOM:

Anterior communicating artery

aPTT:

Activated partial thromboplastin time

ASA:

Acetylsalicylic acid

CSF:

Cerebrospinal fluid

DCI:

Delayed cerebral ischemia

IA:

Intracranial aneurysm

ICA:

Internal carotid artery

ICU:

Intensive care unit

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

SAH:

Subarachnoid hemorrhage

SD:

Standard deviation

TISS :

Therapeutic Intervention Scoring System

VP :

Ventricular-peritoneal

WEB :

Woven EndoBridge

WFNS :

World Federation of Neurosurgical Societies

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Authors and Affiliations

  1. Departments of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Thomas Sauvigny, Marius Marc-Daniel Mader, Jan Regelsberger, Nils Ole Schmidt, Manfred Westphal & Patrick Czorlich

  2. Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Marie Teresa Nawka

  3. Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Nils Schweingruber

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  1. Thomas Sauvigny
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Correspondence to Patrick Czorlich.

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Sauvigny, T., Nawka, M.T., Schweingruber, N. et al. Early clinical course after aneurysmal subarachnoid hemorrhage: comparison of patients treated with Woven EndoBridge, microsurgical clipping, or endovascular coiling. Acta Neurochir 161, 1763–1773 (2019). https://doi.org/10.1007/s00701-019-03992-4

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