Abstract 106: Intra-aneurysmal Flow Disruption: A New Approach For The Endovascular Treatment Of Intracranial Aneurysms. Preliminary Clinical Experience.

Abstract

Purpose: Standard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalizations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Preliminary clinical experience in French centers is presented. Materials and Methods: Computational fluid dynamics and pre-clinical testing (canine cross-over carotid bifurcation model) were used to develop an intra-saccular flow disrupter design, designated as WEB (Sequent, Aliso Viejo, CA). The WEB is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal. Clinically, 19 patients (15F/4M, age: 42-66 years) harbouring unruptured or recanalized aneurysms were treated between June 2011 and July 2012 in four French centers, using an intra-aneurysmal flow-disrupter (WEB). Aneurysm location was middle cerebral artery (9 aneurysms), basilar artery (4), internal carotid artery (3), and anterior communicating artery (3). Aneurysm size was 5-10mm in all but one aneurysm. Neck size was < 4mm in 3 aneurysms and ≥4mm in 16 cases. Results: Clinically, the device was successfully deployed in all but one case. In one anterior communicating artery aneurysm, superselective catheterization of the aneurysm sac was impossible. Two thromboembolic events were observed with favorable outcome in both cases (mRS ≤2). No intraoperative rupture was observed. In two cases, the device was not appropriately selected (too small) and additional coiling was performed. In all cases, disruption of the intra-aneurysmal flow was rapidly obtained. Mid-term follow-up results are presented. Conclusion: Intra-saccular flow disruption using WEB is a completely new endovascular approach to treat some types of aneurysm, particularly wide-neck bifurcation aneurysms. This preliminary clinical experience shows the safety and efficacy of the device when used in appropriately selected cases.