Abstract
The endovascular treatment of intracranial aneurysms with unfavorable anatomy (large aneurysms, wide-neck) is frequently challenging and is also associated with a high incidence of significant recurrences. The WEB, an intrasaccular flow disrupter, was designed for use in this type of aneurysm. We report our early experience with this device in this multicenter study. Twenty patients with 21 aneurysms were treated by using the WEB in 3 European centers. The ability to successfully deploy the WEB, immediate posttreatment angiographic results, adverse events, clinical outcome, and angiographic follow-up results were recorded. Aneurysm location was the ICA (4/21, 19.1%), MCA (8/21, 38.1%), AcomA (5/21, 23.8%), and BA (4/21, 19.1%). No treatment failures were reported. Treatment was performed exclusively with the WEB in 16/21 (76.2%) patients. Additional treatment (coiling and/or stent placement) was used in 5/21 (23.8%) patients. One patient (4.8%) experienced transient clinical worsening (mRS 1 at 1 month, mRS 0 at 3 months) related to a thromboembolic event. Inadvertent detachment of the WEB was observed, and the WEB was retrieved in 1 patient, without adverse effects. In the short-term follow-up (2-8 months), adequate occlusion (total occlusion or neck remnant) was observed in 80.0% of aneurysms. Intrasaccular flow disruption is a new endovascular approach for aneurysm treatment. In our preliminary experience, this treatment was feasible and mostly used in bifurcation aneurysms (MCA, BA, ICA) with unfavorable anatomy. Further studies are needed to precisely evaluate the indications, safety, and efficacy of this new technique.
Highlights
AND PURPOSE: The endovascular treatment of intracranial aneurysms with unfavorable anatomy is frequently challenging and is associated with a high incidence of significant recurrences
Aneurysm coiling has an important place in the management of both ruptured and unruptured aneurysms
Aneurysms with a complex anatomy are, in some cases, untreatable or difficult to treat with standard coiling
Summary
Twenty patients with 21 aneurysms were treated by using the WEB in 3 European centers. The ability to successfully deploy the WEB, immediate posttreatment angiographic results, adverse events, clinical outcome, and angiographic follow-up results were recorded. The study was approved by the institutional review board of Reims University Hospital. In the 3 participating centers, indications for treatment and the technique (surgery or endovascular treatment) were decided on a case-by-case basis by a local multidisciplinary team including neurosurgeons, neuroanesthesiologists, neurologists, and neuroradiologists. No inclusion or exclusion criteria were precisely defined. The selection of aneurysms treated with the WEB device was performed autonomously in each center by the interventional neuroradiologists according to aneurysm characteristics (aneurysm status, location and size, and neck size). Informed consent was obtained from all patients. Benefits, alternatives, and potential complications involved with the WEB embolization procedure were discussed
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