Intrasaccular Treatment of Intracranial Aneurysms: A Comprehensive Review

Abstract

Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful tool for the neurointerventionalist. Methods: Here, we discuss landmark studies and provide a comprehensive, narrative review of the Woven EndoBridge (WEB; Microvention, Alisa Viejo, CA, USA), Artisse (Medtronic, Irvine, CA, USA), Contour (Stryker, Kalamazoo, MI, USA), Saccular Endovascular Aneurysm Lattice Embolization System (SEAL; Galaxy Therapeutics Inc, Milpitas, CA, USA), Medina (Medtronic, Irvine, CA, USA), and Trenza (Stryker, Kalamazoo, MI, USA) devices. Results: Intrasaccular devices have proven to be effective in treating complex aneurysms like WNAs. Conclusions: Intrasaccular flow disruptors have emerged as a new class of effective endovascular therapy, and results of ongoing clinical studies for the newer devices (e.g., SEAL and Trenza) are much anticipated.

Keywords: Contour; LUNA/Artisse Embolization Device; Medina Embolization Device (MED); Saccular Endovascular Aneurysm Lattice Embolization System (SEAL); Trenza; Woven EndoBridge device (WEB); intrasaccular flow disruption.

Figure 1

Illustration of intrasaccular flow disruptor devices for the treatment of WBAs and WNBAs. A—WEB. B—LUNA/Artisse. C—MED. D—Contour. E—SEAL. The illustrated SEAL device is the configuration that includes both the ovoid upper loop and base bridging component. F—Trenza.