The New Low-Profile WEB 17 System for Treatment of Intracranial Aneurysms: First Clinical Experiences

Abstract

Background and purpose: The Woven EndoBridge (WEB) is an intrasaccular flow diverter intended to treat wide-neck aneurysms. The latest generation WEBs needed a 0.021-inch microcatheter in the small sizes. Recently, a lower profile range of WEBs compliant with a 0.017-inch microcatheter (WEB 17) has been introduced. We present the first clinical results of treatment of both ruptured and unruptured aneurysms with the WEB 17.

Materials and methods: Between December 2016 and September 2017, forty-six aneurysms in 40 patients were treated with the WEB 17. No supporting stents or balloons were used. Twenty-five aneurysms were ruptured (54%). There were 6 men and 34 women (mean age, 62 years; median, 63 years; range, 46-87 years). The mean aneurysm size was 4.9 mm (median, 5 mm; range, 2-7 mm).

Results: There were 2 thromboembolic procedural complications without clinical sequelae and no ruptures. The overall permanent procedural complication rate was 0% (0 of 40; 97.5% CI, 0%-10.4%). Imaging follow-up at 3 months was available in 33 patients with 39 aneurysms (97.5% of 40 eligible aneurysms). In 1 aneurysm, the detached WEB was undersized and the remnant was additionally treated with coils after 1 week. This same aneurysm reopened at 3 months and was again treated with a second WEB. One other aneurysm showed persistent WEB filling at 3 months. Complete occlusion was achieved in 28 of 39 aneurysms (72%), and 9 aneurysms (23%) showed a neck remnant.

Conclusions: The WEB 17 is safe and effective for both ruptured and unruptured aneurysms. The WEB 17 is a valuable addition to the existing WEB size range, especially for very small aneurysms.

Fig 1.

WEB sizes and shapes used in 46 aneurysms treated with WEB 17.

Fig 2.

A 71-year-old woman (patient 32) with a ruptured posterior communicating artery aneurysm. A, CT scan shows diffuse subarachnoid blood. B, Lateral right internal carotid angiogram reveals a small posterior communicating artery aneurysm pointing downward. C, VIA 17 in a hairpin configuration after deployment of the WEB 17 SLS 6 mm inside the aneurysm. D, Immediate aneurysm occlusion after WEB 17 placement. E and F. Three-month follow-up angiogram demonstrates persistent complete aneurysm occlusion.

Fig 3.

A 62-year-old woman (patient 36) with an unruptured small basilar tip aneurysm. A, Basilar tip aneurysm measuring 1.6 × 3.1 mm. B, Immediately after placement of WEB 17 (2 × 3 mm). C, Complete occlusion at 3 months follow-up.