Comparison of angiographic outcomes and complication rates of WEB embolization and coiling for treatment of unruptured basilar tip aneurysms

Abstract

Endovascular coiling represents the standard treatment for basilar tip aneurysms. Some of these aneurysms are not amenable to conventional coiling due to a complex aneurysm geometry, hence, novel devices such as the Woven Endobridge (WEB) have been developed. We retrospectively compared WEB embolization and coiling for the treatment of unruptured basilar tip aneurysms. Patients treated with WEB or coiling at four centers were reviewed. Procedure-related complications, clinical outcome and angiographic results were retrospectively evaluated and compared. Forty patients treated with the WEB and 35 patients treated by coiling were included. Stent-assistance was more often necessary for coiling than for WEB embolization (71% vs 2.5%, p < 0.001). The technical success rates were 100% for both methods. The overall complication rates were not significantly different between groups (WEB: 5%, coil: 11%, p = 0.409). Procedural morbidity rates were 9% in the coiling group and 2.5% in the WEB group (p = 0.334). There was no mortality. Treatment duration was shorter for WEB implantation than for coiling (p = 0.048). At mid-term follow-up, complete occlusion, neck remnants and aneurysm remnants were observed in 89%, 4% and 7% for the WEB, respectively, and in 100%, 0% and 0% for coiling. While complication rates and mid-term angiographic outcome was comparable between the groups, the WEB was associated with a shorter treatment duration and required stent-assistance less frequently. The choice of the treatment modality should be made based on the specific aneurysm characteristics, the individual experience of the neurointerventionalist and patient preference.

Figure 1

Patient’s selection flow chart.

Figure 2

Unruptured aneurysm at the basilar tip (A + B). Stent-assisted coiling was intended. A stent (barrel-3550) with a barrel-shaped central segment was inserted to bridge the aneurysm neck in such a way that both the aneurysm base and the doubled superior cerebellar artery on the left are secured. The aneurysm sac is then probed through the stent mesh with a SL10-MC and closed with a total of 6 platinum micro-spirals. (C) Two-years angiographic control shows complete aneurysm occlusion (D).

Figure 3

Unruptured aneurysm at the basilar tip (A + B). Due to the broad-based geometry and the unruptured aneurysm status, intrasaccular flow-disruption was envisaged. A WEB SL (7 × 3 mm) was placed within the aneurysm sac, achieving immediate contrast stasis (C). Two-years angiographic control shows complete aneurysm occlusion (D).