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Acta Neurochirurgica
Published in: Acta Neurochirurgica 8/2019

01-08-2019 | Intracranial Aneurysm | Original Article - Vascular Neurosurgery - Aneurysm

WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms

Authors: Yigit Ozpeynirci, Michael Braun, Andrej Pala, Melanie Schick, Bernd Schmitz

Published in: Acta Neurochirurgica | Issue 8/2019

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Abstract

Background

WEB (Woven EndoBridge) device is an intrasaccular flow diverter designed for endovascular treatment of intracranial aneurysms. Recent clinical trials showed good feasibility, safety, and efficacy profiles. In most of the published studies however, aneurysms treated with adjunctive devices other than WEB such as coils or stents were included which might make it difficult to reflect the real potential of this device. The purpose of this single-center study was to present the results of ruptured and unruptured aneurysms treated only with WEB device.

Method

Between April 2013 and July 2018, 47 (ruptured, 12; 25.5%) intracranial aneurysms treated only with WEB and a follow-up of at least 3 months were included in the study. Angiographic outcome at follow-up, peri-procedural complication rate, and rate of retreatment were recorded.

Results

Of the 47 aneurysms, 12 (25.5%) were ruptured. The mean size of the aneurysms was 6.3 mm (ruptured, 5.4 mm; unruptured, 6.6 mm). Median follow-up period was 9 months. Complete occlusion was observed in 26/47 aneurysms (55.3%; ruptured, 66.6%; unruptured, 51.4%). Thirteen aneurysms (27.6%; ruptured, 16.6%; unruptured, 31.4%) showed a neck remnant. In 4/47 aneurysms (8.5%; ruptured, 8%; unruptured, 8.5%), persistent contrast enhancement inside the WEB was recorded. In 4/47 patients (8.5%; ruptured, 8%; unruptured, 8.5%), an aneurysm remnant was noted. Adequate occlusion (complete occlusion and neck remnant) was observed in 43/47 aneurysms (91.4%; ruptured, 91.6%; unruptured, 91.4%). Retreatment rate was 6.3% (ruptured, 8%; unruptured, 5.7%). Six (12.7%; ruptured, 25%; unruptured, 8.5%) thromboembolic events were recorded. Hemorrhagic complications occurred in two patients (4.2%; ruptured, 16.6%; unruptured, 0%).

Conclusions

WEB enables adequate occlusion of ruptured and unruptured intracranial aneurysms mostly without requirement of long-term antiplatelet therapy. The benefit is seen especially by the wide-necked aneurysms, but indications should be extended to include narrow-necked, smaller, and side-wall aneurysms.
Literature
1.
Armoiry X, Turjman F, Hartmann DJ, Sivan-Hoffmann R, Riva R, Labeyrie PE, Aulagner G, Gory B (2016) Endovascular treatment of intracranial aneurysms with the WEB device: a systematic review of clinical outcomes. AJNR Am J Neuroradiol 37(5):868–872CrossRefPubMed
2.
Arthur AS, Molyneux A, Coon AL et al (2019) The safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal WEB Intrasaccular Therapy (WEB-IT) Study. J Neurointerv Surg. https://​doi.​org/​10.​1136/​neurintsurg-2019-014815
3.
Asnafi S, Rouchaud A, Pierot L, Brinjikji W, Murad MH, Kallmes DF (2016) Efficacy and safety of the Woven EndoBridge (WEB) device for the treatment of intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol 37(12):2287–2292CrossRefPubMed
4.
Fiorella D, Molyneux A, Coon A, Szikora I, Saatci I, Baltacioglu F, Sultan A, Arthur A, WEB-IT Study Investigators (2017) Demographic, procedural and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT). J Neurointerv Surg 9(12):1191–1196CrossRefPubMed
5.
Lv X, Zhang Y, Jiang W (2018) Systematic review of Woven EndoBridge for wide-necked bifurcation aneurysms: complications, adequate occlusion rate, morbidity, and mortality. World Neurosurg 110:20–25CrossRefPubMed
6.
Muskens IS, Senders JT, Dasenbrock HH, Smith TR, Broekman ML (2017) The Woven Endobridge device for treatment of intracranial aneurysms: a systematic review. World Neurosurg 98:809–817CrossRefPubMed
7.
Pierot L, Moret J, Barreau X et al (2018) Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series. J Neurointerv Surg 10:553–559CrossRefPubMed
8.
Tau N, Sadeh-Gonik U, Aulagner G, Turjman F, Gory B, Armoiry X (2018) The Woven EndoBridge (WEB) for endovascular therapy of intracranial aneurysms: update of a systematic review with meta-analysis. Clin Neurol Neurosurg 166:110–115CrossRefPubMed
9.
Gawlitza M, Soize S, Januel AC et al (2018) Treatment of recurrent aneurysms using the Woven EndoBridge (WEB): anatomical and clinical results. J Neurointerv Surg 10:629–633CrossRefPubMed
10.
11.
Leyon JJ, Chavda S, Lamin S (2016) Corking the WEB and coiling through a jailed microcatheter: WEB assisted coiling, a useful technique avoiding the use of stents in treating wide-necked large intracranial aneurysms. J Neurointerv Surg 8(5):e18CrossRefPubMed
12.
Pierot L, Biondi A, Narata AP et al (2017) Should indications for WEB aneurysm treatment be enlarged? Report of a series of 20 patients with aneurysms in “atypical” locations for WEB treatment. J Neuroradiol 44:203–209CrossRefPubMed
13.
14.
van Rooij WJ, Sluzewski M, Bechan R, Peluso JP (2016) Therapeutic internal carotid or vertebral artery occlusion using the WEB device. Interv Neuroradiol 22:365–367CrossRefPubMedPubMedCentral
15.
Mihalea C, Caroff J, Pagiola I et al (2019) Safety and efficiency of the fifth generation Woven EndoBridge device: technical note. J Neurointerv Surg 11(5):511–515CrossRefPubMed
16.
Mine B, Goutte A, Brisbois D, Lubicz B (2018) Endovascular treatment of intracranial aneurysms with the Woven EndoBridge device: mid term and long term results. J Neurointerv Surg 10(2):127–132CrossRefPubMed
17.
van Rooij SB, van Rooij WJ, Peluso JP, Sluzewski M (2018) The Woven EndoBridge (WEB) as primary treatment for unruptured intracranial aneurysms. Interv Neuroradiol 24:475–481CrossRefPubMed
18.
van Rooij SBT, Peluso JP, Sluzewski M, Kortman HG, van Rooij WJ (2018) The new low-profile WEB 17 system for treatment of intracranial aneurysms: first clinical experiences. AJNR Am J Neuroradiol 39:859–863CrossRefPubMed
19.
van Rooij SBT, van Rooij WJ, Peluso JP, Sluzewski M, Bechan RS, Kortman HG, Beute GN, van der Pol B, Majoie CB (2017) WEB treatment of ruptured intracranial aneurysms: a single-center cohort of 100 patients. AJNR Am J Neuroradiol 38:2282–2287CrossRefPubMed
20.
Caroff J, Mihalea C, Klisch J et al (2015) Single-layer WEBs: intrasaccular flow disrupters for aneurysm treatment—feasibility results from a European study. AJNR Am J Neuroradiol 36(10):1942–1946CrossRefPubMed
21.
Liebig T, Kabbasch C, Strasilla C et al (2015) Intrasaccular flow disruption in acutely ruptured aneurysms: a multicenter retrospective review of the use of the WEB. AJNR Am J Neuroradiol 36(9):1721–1727CrossRefPubMed
22.
Papagiannaki C, Spelle L, Januel AC et al (2014) WEB intrasaccular flow disruptor-prospective, multicenter experience in 83 patients with 85 aneurysms. AJNR Am J Neuroradiol 35(11):2106–2111CrossRefPubMed
23.
Pierot L, Klisch J, Liebig T et al (2015) WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: long-term results in a European series. AJNR Am J Neuroradiol 36(12):2314–2319CrossRefPubMed
24.
Mihalea C, Escalard S, Caroff J et al (2019) Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms. J Neurointerv Surg 11(4):386–389CrossRefPubMed
Metadata
Title
WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms
Authors
Yigit Ozpeynirci
Michael Braun
Andrej Pala
Melanie Schick
Bernd Schmitz
Publication date
01-08-2019
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 8/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-03988-0

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