Intrasaccular flow disruption for ruptured aneurysms: an international multicenter study

Abstract

BackgroundThe Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status.MethodsOur data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up.ResultsThe study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation.ConclusionThere was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.

Woven EndoBridge Device for Unruptured Wide-Neck Bifurcation Aneurysm: A Multicenter 5-Year Follow-up

“…21,22 However, the meta-analysis by Asnafi et al 8 demonstrated similar midterm AO rates between ruptured and unruptured aneurysms, suggesting that the efficacy of WEB treatment may not significantly differ based on the rupture status of the aneurysm. Similarly, Diestro et al 23 reported a comparable AO rate in unruptured aneurysms to our data (94.4%), whereas the rate for ruptured aneurysms was 83.3%, but this difference was not statistically significant (P = .066). Overall, existing literature supports the high safety and efficacy of WEB treatment for WIBAs in the short and mid term.…”

Management of aneurysmal recurrence after Woven EndoBridge (WEB) treatment

“…The retreatment rate was significantly higher in the ruptured versus the unruptured group (13% vs 3.9%, respectively, P<0.0001). However, since multiple analysis5 18–20 found no statistical association between recurrence and ruptured aneurysm, we can hypothesize that operators were more prompt to treat initially ruptured recurrences, assuming a higher re-rupture risk. Similar observations have been made concerning aneurysms initially treated with coils in some series 15…”

Endovascular treatment of intracranial internal carotid artery bifurcation region aneurysms

“…After deployment in the aneurysm sac, the device provides immediate flow disruption, leading to aneurysm thrombosis and endothelialization across the aneurysm neck over time. Because the device leaves the parent artery unaffected, long-term antiaggregant therapy is not necessary ( 51 ). Several previous landmark studies, including WEBCAST, WEBCAST-2, WEB-IT, and the French Observatory, have confirmed the safety and efficacy of the WEB device ( 52–56 ).…”

“…For EVT for intracranial ICA bifurcation region aneurysms, a good clinical outcome can be defined as a modified Rankin scale (mRS) score ≤2 or a Glasgow Outcome Scale (GOS) score of 4 or 5 ( 74 , 75 ). Angiographic aneurysm occlusion after traditional coiling or WEB device deployment can be assessed by the Raymond–Roy occlusion scale (RROS) ( 51 , 76 ). Adequate angiographic outcomes of aneurysm occlusion were defined as RROS class I (complete occlusion) or class 2 (near complete occlusion with a small residual neck).…”