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. 2022 Aug;45(4):2717-2722.
doi: 10.1007/s10143-022-01781-9. Epub 2022 Apr 11.

Microsurgical clipping vs Woven EndoBridge (WEB) device for the management of unruptured wide-neck bifurcation aneurysms

Tatiana Chacón-Quesada  1 , Dorothee Mielke  1 , Veit Rohde  1 , Silvia Hernández-Durán  2
Affiliations

Microsurgical clipping vs Woven EndoBridge (WEB) device for the management of unruptured wide-neck bifurcation aneurysms

Tatiana Chacón-Quesada et al. Neurosurg Rev. 2022 Aug.

Abstract

The Woven EndoBridge device (WEB) was introduced in 2010 to treat wide-neck bifurcation aneurysms (WNBAs). Three landmark studies have been conducted to assess its safety and efficacy: WEBCAST, WEBCAST 2, and French Observatory Study. However, these studies have not compared its safety and efficacy to other treatment modalities. In this study, we compare WEB versus microsurgical clipping in the management of unruptured WNBA. We conducted a retrospective study of unruptured WNBA meeting the morphological criteria to be amenable for WEB treatment operated on at our institution. Surgical morbidity, mortality, and occlusion rates were assessed. We compared our results to those reported in the cumulative population of the three WEB landmark studies at 1 year. A total of 84 patients with 89 WNBA were included. The most common aneurysm location was the middle cerebral artery bifurcation (n = 67/89, 75%). No operative mortality was observed. Morbidity comprised small-vessel vasospasm (n = 1/89, 1%) resulting in hemiparesis vs. 3% morbidity for WEB (p = .324). All but one (n = 1/89, 1%) WNBA were completely occluded vs WEB occlusion rate of 53% at 1 year, statistically significantly worse (p < .001). In our analysis, we were not able to show superiority of WEB in terms of procedural morbidity in comparison to microsurgical clipping, defined as worsening in mRS. Microsurgical clipping achieves statistically significantly higher rates of complete aneurysm occlusion, thus posing the question of whether the WEB should be presented as a viable, comparable alternative to patients amenable to surgical treatment.

Keywords: Clipping; Intracranial aneurysm; Wide-neck aneurysms; Woven EndoBridge device.

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Conflict of interest statement

Veit Rohde receives personal fees from Aesculap and Storz outside this work.

Figures

Fig. 1
Fig. 1
Clipped aneurysm showing neck remnant. Postoperative 3D reconstruction of CTA showing suspicion of a small neck remnant: A AP projection, B lateral projection, which was then confirmed by conventional angiography, C AP projection, D oblique projection. The remnant was subsequently coiled; E 3D reconstruction, F oblique projection, achieving complete occlusion
See this image and copyright information in PMC

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