WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: short- and midterm results in a European study

Abstract

Background and purpose: Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL.

Materials and methods: Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant.

Results: Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations were the middle cerebral artery in 26 patients, the posterior circulation in 13 patients, the anterior communicating artery in 5 patients, and the internal carotid artery terminus in 1 patient. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion was observed in 2/28 patients (7.1%) at midterm follow-up.

Conclusions: The results suggest that the WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnants.

Fig 1.

The drawings show the scale used for the anatomic results. A, Complete occlusion (grade A). There is no contrast inside the aneurysm. B, Complete occlusion with opacification of the proximal recess (grade AB). There is no contrast inside the aneurysm but contrast fills in the central area below the WEB-DL. C, Neck remnant (grade B). There is contrast at the aneurysmal wall but no contrast in the aneurysm or WEB-DL. D, Aneurysm remnant (grade C). There is contrast in the neck and in the aneurysm or WEB-DL.

Fig 2.

A 71-year-old woman with an unruptured right MCA. A, Preoperative DSA shows the wide-neck MCA aneurysm.. B, Postoperative DSA shows no more intra-aneurysmal flow. C, Six-month follow-up DSA shows the complete occlusion of the aneurysm. D, Twelve-month follow-up DSA shows the stability of the complete occlusion.

Fig 3.

A 57-year-old man with an unruptured anterior communicating artery aneurysm. A, Preoperative DSA shows the wide-neck anterior communicating artery aneurysm. B, Six-month DSA shows an opacification of the proximal recess of the device. C, Twelve-month DSA shows the stability of this opacification.

Fig 4.

A 71-year-old woman with an unruptured right MCA aneurysm. A, Preoperative DSA shows the MCA aneurysm with a wide neck. B, Postoperative DSA shows a small residual opacification of the aneurysm neck with complete disappearance of flow in the dome. C, Seven-month 3D-DSA shows an opacification of the proximal recess of the device. D, Twelve-month 3D-DSA shows that this opacification is quite stable.

Fig 5.

A 60-year-old woman with an unruptured basilar artery aneurysm. A, Preoperative 3D-DSA shows the aneurysm, which is wide-neck. B, Postoperative DSA shows contrast stagnation in the WEB and aneurysm; C, 3-month DSA shows a neck remnant. D, 9-month DSA shows the reopening of the aneurysm with a remnant.