Extending the Indication of Woven EndoBridge (WEB) Embolization to Internal Carotid Artery Aneurysms: A Multicenter Safety and Feasibility Study

Abstract

Woven Endobridge (WEB) embolization is an approved technique for endovascular treatment of wide-necked and bifurcation aneurysms. However, the WEB has not yet been routinely used for internal carotid artery (ICA) sidewall aneurysms. In this multicenter study, we evaluate the safety and efficacy of WEB for treatment of these aneurysms. We reviewed all patients with ICA sidewall aneurysms who were treated with WEB at 3 German neurovascular centers between 2011 and 2018. Technical success, complication rates, and angiographic outcome were retrospectively assessed. Twenty patients (mean age, 56.3 ± 13.0 years) with 20 ICA aneurysms (6 ruptured) were identified. The aneurysms were located at the paraophthalmic segment (n= 10), the posterior communicating artery segment (n=9), and the anterior choroidal artery segment (n= 1). The mean aneurysm size was 8.1 ± 5.2 mm and 60% were wide-necked. The aneurysms were treated with a single WEB (n= 11) or in combination with coiling and/or stent implantation (n= 7). WEB implantation failed in 2 aneurysms because of a sharp aneurysm angle. There were 1 periprocedural thromboembolic event and 1 in-stent stenosis at follow-up, which remained asymptomatic in both cases. There was no procedure-related morbidity and mortality. At follow-up, complete occlusion was achieved in 76.5%, neck remnants in 17.6%, and aneurysms remnants in 5.9%. The WEB device can be used for treatment of ICA sidewall aneurysms with a high level of procedural safety and a high degree of technical success.