The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center

Abstract

Background and purpose The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. Materials and methods Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37–80). Results Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3–13 mm). In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01–6.5%) and mortality was 0% (0 of 93, 95%CI 0.0–4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7–13.6%). Conclusion WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.

Long-term efficacy and safety of WovenEndoBridge (WEB)-assisted cerebral aneurysm embolization

“…Periprocedural complication, technical success, treatment-related morbidity, and mortality rates were in line with previously published data. 3,5,8,10–12,15,16 Postprocedural subarachnoid hemorrhage was not seen in our patients through a follow-up period consistent with some studies. 11,14 Our additional device usage rate was 10% for the WEB-assisted treatments in the range of the literature.…”

“…Adequate occlusion rates of the WEB implantations were reported as 56–97% for 1-year follow-up. 2–8,10–16 Our first year and latest adequate occlusion rates (87% for both) are within the range of previously published papers and higher than other therapies for wide neck or bifurcation aneurysms. 2,7,8,10–16 The recurrence rate of WEB implantations in our study was low (13%).…”

“…bifurcation/sidewall/irregular, ruptured/unruptured, narrow-necked, clipped, and/or complex large aneurysms) as an alternative for stent-assisted coiling or flow diverters. 5,7,15,18 The WEB was successfully deployed in off-labeled locations, including PCOM, pericallosal aneurysms or distal locations, and paraophthalmic areas, as we did. 2…”

“…2,18 Also, we found that aneurysm height is associated with recurrences as described in the literature. 5,19 These situations may be additional reasons for the recurrences.…”

“…Short- and midterm rebleeding rates were reported as 0–3.5% in the literature. 5,7,12,16 Long-term rebleeding or rupture rates of recurrent aneurysms treated by WEB device are not known. The technical success rate was 86% in our study.…”