WEB device for treatment of posterior communicating artery aneurysms

Abstract

BackgroundWoven EndoBridge (WEB) device treatment of wide-neck bifurcation aneurysms has proved to be safe and effective, but the use of these devices in sidewall aneurysms has been reported only in a small number of case series.ObjectiveTo report our results in a cohort of consecutive patients in whom a WEB device was used as first-line treatment for posterior communicating artery (PComA) aneurysms.MethodsWe conducted a retrospective analysis of a prospectively maintained database of PComA aneurysms treated with a WEB device in our institution from June 1, 2012 to November 15, 2020. Clinical and radiological findings were evaluated at immediate and last follow-up.ResultsA total of 219 aneurysms were treated with a WEB device, including 15 PComA aneurysms in 15 patients, 10 of which were ruptured. Aneurysms were wide necked, with a mean aspect ratio of 1.6 (range 0.7–3.0) and a mean neck size of 4.2 mm (range 2.6–7.4 mm). No intraoperative rupture occurred and only one thromboembolic event was noted. Among the group with at least a 3-month digital subtraction angiography (DSA) follow-up, complete and adequate occlusion were obtained in 54% and 72%, respectively (average follow-up 13 months). Re-treatment was needed for two initially ruptured aneurysms. No procedure-related morbidity or mortality was reported.ConclusionThis series suggests the high safety profile of WEB devices even when used in off-label indications. Treatment with these devices seems to be a valuable strategy for ruptured wide-neck PComA aneurysms, avoiding the need for antiplatelet medication. However, occlusion rates should be investigated in further larger studies.

Identifying risk factors for perioperative thromboembolic complications in patients treated with the Woven EndoBridge device

“…These two aneurysms were treated with the WEB device because they were wide necked aneurysms whose size was suitable for WEB and case reports of successfully treating PCOM and sidewall aneurysms with WEB currently exist in the literature. 11,12 Another explanation for a high rate of thromboembolic complications is if a patient population is not on sufficient antiplatelet therapy, leading to early platelet aggregation with the WEB device. However, all of our patients were prescribed dual antiplatelet therapy one week prior to the procedure.…”

Determinants of cerebral aneurysm occlusion after embolization with the WEB device: a single-institution series of 215 cases with angiographic follow-up

“…Since then indications for WEB have been widened—for example, to ruptured aneurysms, side-wall aneurysms. or in association with other devices 2–4…”

Aneurysm Treatment with Woven EndoBridge-17: Angiographic and Clinical Results at 12 Months from a Retrospective, 2-Center Series

“…[2][3][4][5][6][7][8][9][10] Because the device is strictly endosaccular, there is no need for dual-antiplatelet treatment after WEB treatment, making it possible to treat unruptured and recurrent aneurysms as well as ruptured aneurysms. [11][12][13][14][15][16][17][18][19][20] The Clinical Assessment of the WEB Device in the Ruptured Aneurysms (CLARYS) study recently confirmed the effectiveness of the WEB device in preventing aneurysm re-rupture in ruptured aneurysms. 18 In parallel to the technical evolution of the WEB device, its indications progressively enlarged to distal and sidewall aneurysms.…”

“…18 In parallel to the technical evolution of the WEB device, its indications progressively enlarged to distal and sidewall aneurysms. [11][12][13] Several multicenter prospective series, including WEB Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST), 3 WEBCAST 2, 5 French Observatory, 6 WEB Intrasaccular Therapy (WEB-IT), 10 and CLARYS, 21 have demonstrated favorable safety and efficacy of EVT with the WEB device; however, these studies were conducted before the introduction of the 17 system.…”