WEB Treatment of Ruptured Intracranial Aneurysms

Abstract

Background and purpose: The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.

Materials and methods: During 11 months, 32 of 71 (45%) endovascularly treated acutely ruptured aneurysms were treated with the WEB. The patients were 12 men and 20 women, with a mean age of 61 years (range, 34-84 years). The mean aneurysm size was 4.9 mm, and 14 were ≤4 mm. Of 32 aneurysms, 24 (75%) had a wide neck.

Results: All 32 aneurysms were adequately occluded after WEB placement. There were no procedural ruptures and no complications related to the WEB device. No adjunctive stents or balloons were needed. In 3 patients, thromboembolic complications occurred. One patient developed an infarction, and 2 patients were asymptomatic. The procedural complication rate was 3%. Seven patients admitted in poor clinical grade conditions died during hospital admission due to the sequelae of SAH. In 18 patients with angiographic follow-up at 3 months, 16 aneurysms remained adequately occluded. Two aneurysms showed slight compression of the WEB without reopening. Clinical follow-up in the 25 patients who survived the hospital admission period revealed mRS 1-2 in 24 and mRS 4 in 1. There were no rebleeds from the ruptured aneurysms during follow-up.

Conclusions: WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons. Our preliminary experience indicates that the WEB may be a valuable alternative to coils in the treatment of acutely ruptured aneurysms.

Fig 1.

Flow chart of all treated patients with aneurysms between February and December 2015. PVO indicates parent vessel occlusion.

Fig 2.

A 61-year-old man with a ruptured basilar tip aneurysm treated with the WEB and coils. A, CT scan with subarachnoid blood. B, 3D angiogram reveals a 13-mm basilar tip aneurysm. C, Neck measurement on a 3D angiogram. D and E, After placement of coils in the dome and a WEB-SL, 6 × 3 mm, in the neck. F, Three-month follow-up angiogram with complete occlusion.

Fig 3.

A 57-year-old woman with a ruptured anterior communicating artery aneurysm. A, 3D angiogram shows a small anterior communicating artery aneurysm. Note the spasm in the left A1. B, Measurement of the height (3.9 mm) and neck width (2.3 mm). C, Angiogram directly after placement of a 4-mm WEB-SLS. Note some opacification inside the WEB. D, Angiogram at 3 months demonstrates complete occlusion of the aneurysm.

Fig 4.

A 42-year-old man with a ruptured anterior communicating artery aneurysm. A, 3D angiogram shows a small anterior communicating artery aneurysm with a bleb pointing upward. Angiogram before (B) and after (C) placement of a 4-mm WEB-SLS inside the aneurysm. Note complete aneurysm occlusion with slight protrusion of the WEB into the parent vessel (arrow). D, Angiogram at 3 months demonstrates persistent complete occlusion.

Fig 5.

A 60-year-old woman with a ruptured small-neck posterior communicating artery aneurysm. A, CT scan shows subarachnoid hemorrhage. B, 3D angiogram reveals a 6-mm posterior communicating artery aneurysm with a small neck. Angiogram before (C) and after (D and E) placement of a 6-mm WEB-SLS shows complete aneurysm occlusion.