Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

Abstract

Background: The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL.

Methods: Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated.

Results: Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4-10.7 mm), and average neck size was 4.9 mm (range 2.6-6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm.

Conclusions: From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

Keywords: Intracranial aneurysms; WEB device; endovascular treatment; outcome.

Figure 1.

Left unruptured MCA aneurysm in a 59-year-old man (patient 2). (a) Right internal carotid angiograms, working projection, demonstrating the aneurysm arising from the right middle cerebral artery bifurcation. (b) Plain X-ray, working projection, showing the WEB SL device with proximal and distal markers. (c) Immediate control angiogram, working projection, showing the total occlusion of the MCA aneurysm. (d) Plain X-ray, working projection, showing the compaction of the device. (e) 6-month control angiogram demonstrating residual aneurysm.

Figure 2.

Anterior communicating artery aneurysm in a 65-year-old man (patient 7). (a) Left internal carotid angiogram, working projection, showing the aneurysm arising from the anterior communicating artery. (b, c) Immediate control angiogram, working projection, demonstrating good position of the device and adequate occlusion of the aneurysm (neck remnant). (d) 6-month control angiogram demonstrating complete aneurysm occlusion.

Figure 3.

Right unruptured MCA aneurysm in a 53-year-old woman (patient 4). (a) Right internal carotid angiogram, working projection, showing the aneurysm with unfavorable anatomy for standard endovascular treatment. (b, c) Final control angiogram, working projection, showing the adequate occlusion of the aneurysm (neck remnant). (d, e) 6-month follow up angiogram demonstrating significant neck remnant secondary to compaction of the device.