Treatment of Ruptured and Unruptured Intracranial Aneurysms with WEB17 Versus WEB21 Systems : Comparison of Indications and Early Angiographic Outcomes.

Abstract

The concept of intrasaccular flow diversion using the Woven EndoBridge (WEB) device changed the traditional endovascular concept for wide-necked bifurcation aneurysms. The latest technical advancement resulted in the WEB17 system, asofter device composed of fewer wires which enables treatment of smaller more distally located aneurysms by using smaller microcatheters as compared to the WEB21 system. This retrospective observational study aimed to evaluate and compare the angiographic and clinical results achieved with WEB21 and WEB17 in aneurysm morphologies eligible for both systems (maximum width 3-6 mm). Between August 2014 and August 2019 atotal of 63and 130 aneurysms with amaximum width of 3-6 mm were treated with either WEB21 and WEB 17, respectively, at 2neurovascular centers. Cases were analyzed based on acomparison regarding aneurysm size, location and rupture status. The technical success, the periprocedural complication rate and the rate of additional devices used showed no relevant differences between the two groups. Aneurysms treated with the WEB17 system were smaller and more frequently distally located. The overall complete occlusion rate at 3months was higher in the WEB17 group (65.5% versus 55.1%). The superiority of complete aneurysm occlusion achieved with WEB17 was statistically significant in the subgroup of unruptured middle cerebral artery aneurysms. The use of WEB17 expands the treatment indications for intrasaccular flow-diversion towards smaller and more distally located aneurysms with asafety profile comparable with that of the WEB21.