WEB Treatment of Ruptured Intracranial Aneurysms: Long-Term Follow-up of a Single-Center Cohort of 100 Patients

Abstract

Background and purpose: The Woven EndoBridge device (WEB) was introduced for the intrasaccular treatment of wide-neck aneurysms without the need for adjunctive devices. We used the WEB as a primary treatment for 100 ruptured aneurysms regardless of neck size or location. In this study, we present the long-term follow-up of 78 surviving patients.

Materials and methods: Between February 2015 and April 2017, one hundred ruptured aneurysms were treated with the WEB. For surviving patients, angiographic and clinical follow-up was scheduled at 3 months, and 3T MRA and clinical follow-up, at 6, 12, 36, and 60 months. Of 100 patients, 18 died during hospital admission, and in 4, the ruptured aneurysm was additionally treated. The remaining 78 patients had a mean follow-up of 51 months (median, 52 months; range, 5-84 months). There were 57 women and 21 men, with a mean age of 58.5 years (median, 59 years; range, 24-80 years). Of 78 aneurysms with long-term follow-up, 52 (66%) had a wide neck.

Results: Of 78 ruptured aneurysms, 56 (72%) remained completely occluded and 17 (22%) had a stable small neck remnant. Five of 78 aneurysms (6%; 95% CI, 2.4%-14.5%) reopened during follow-up and were additionally treated. There were no rebleeds during follow-up.

Conclusions: Treatment of ruptured aneurysms with the WEB was safe and effective and has long-term results comparable with those of simple coiling of small-neck aneurysms. The WEB proved to be a valuable alternative to coils for both wide- and small-neck ruptured aneurysms without the need for stents, balloons, or antiplatelet therapy.

FIG 1.

A 58-year-old woman presenting with an SAH, Hunt and Hess grade 3, from a pericallosal aneurysm. The patient had 2 additional aneurysms (not shown). A–D, Treatment of the aneurysm with a WEB-SL 6 × 4. A small neck remnant was accepted to keep the pericallosal artery patent. E–H, Long-term follow-up with DSA and MRA up to 72 months demonstrates stable aneurysm occlusion and patency of the pericallosal artery. VasoCT (Phillips Healthcare).

FIG 2.

A 52-year-old woman presenting with SAH, Hunt and Hess grade 3, from an 8-mm anterior communicating artery aneurysm. A–D, WEB-SL 9 × 3 placement in the aneurysm. After detachment, there was unintended impaction of the proximal portion of the WEB (D), indicating potential undersizing and resulting in a small neck remnant that was accepted in the acute phase of the SAH. E–H, Follow-up angiography demonstrates WEB impaction and a growing 5-mm neck remnant, which was retreated with a WEB-SL 6 × 3 mm. I–L, A 12-month DSA and 48-month MRA demonstrate a small neck remnant that remains stable on long-term follow-up (white arrowheads).