Purpose The WEB device was recently introduced for intrasaccular treatment of wide-necked aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.
Materials and Methods From Feb 2015 to Nov 2016, 132 acutely ruptured aneurysms were treated endovascularly. Of those, 78 (59%) were treated with the WEB. There were 25 men and 53 women, mean age 59 years (range 23–82 years). Mean aneurysm size was 4.9 mm and 26 were ≤4 mm. Two aneurysms were treated with WEB and coils and 1 with WEB and stent. Clinical follow up was assessed at 3 and 6 months according to mRS. Imaging follow up consisted of angiography at 3 months and MRA at 6 months.
Results Of 78 aneurysms, 77 were adequately occluded after WEB placement. One aneurysm was deliberately partially occluded and was later clipped. There was 1 procedural rupture without clinical sequelae. In 5 patients, thromboembolic complications occurred followed by thrombectomy in 4. Three patients developed an infarction. Of those, 1 poor grade patient died, 1 patient had mild hemiparesis and 1 patient had no symptoms. One thromboembolic complication was caused by WEB protrusion in the parent artery. Procedural permanent morbimortality was 3% (2 of 77).
Angiographic and clinical follow-up at 3 months was available in 54 patients: 11 poor grade patients died during hospital admission due to sequelae of SAH, 1 of a thromboembolic complication and 12 patients are scheduled for angiographic follow up. Of 54 aneurysms, 45 (83%) were completely occluded, 8 (15%) were adequately occluded with a small neck remnant and 1 (2%) had a deliberate aneurysm remnant.
Clinical follow up at 3 months was mRs 0–2 in 53, mRs 3 in 2 and mRs 4–5 in 1. There were no rebleeds from the ruptured aneurysm during follow up. One aneurysm was additionally clipped.
Conclusions WEB treatment of small ruptured aneurysms was safe and effective. Adjunctive stent support was needed only once. One patient required additional clipping after deliberate initial partial occlusion. No rebleeds occurred during follow up. Our preliminary experience indicates that the WEB may be a valuable alternative to coils in the treatment of acutely ruptured aneurysms.
Disclosures J. Peluso: 2; C; Sequent Medical. W. Van Rooij: 2; C; Sequent Medical. M. Sluzewski: 2; C; Sequent Medical.
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