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WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms

  • Original Article - Vascular Neurosurgery - Aneurysm
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Abstract

Background

WEB (Woven EndoBridge) device is an intrasaccular flow diverter designed for endovascular treatment of intracranial aneurysms. Recent clinical trials showed good feasibility, safety, and efficacy profiles. In most of the published studies however, aneurysms treated with adjunctive devices other than WEB such as coils or stents were included which might make it difficult to reflect the real potential of this device. The purpose of this single-center study was to present the results of ruptured and unruptured aneurysms treated only with WEB device.

Method

Between April 2013 and July 2018, 47 (ruptured, 12; 25.5%) intracranial aneurysms treated only with WEB and a follow-up of at least 3 months were included in the study. Angiographic outcome at follow-up, peri-procedural complication rate, and rate of retreatment were recorded.

Results

Of the 47 aneurysms, 12 (25.5%) were ruptured. The mean size of the aneurysms was 6.3 mm (ruptured, 5.4 mm; unruptured, 6.6 mm). Median follow-up period was 9 months. Complete occlusion was observed in 26/47 aneurysms (55.3%; ruptured, 66.6%; unruptured, 51.4%). Thirteen aneurysms (27.6%; ruptured, 16.6%; unruptured, 31.4%) showed a neck remnant. In 4/47 aneurysms (8.5%; ruptured, 8%; unruptured, 8.5%), persistent contrast enhancement inside the WEB was recorded. In 4/47 patients (8.5%; ruptured, 8%; unruptured, 8.5%), an aneurysm remnant was noted. Adequate occlusion (complete occlusion and neck remnant) was observed in 43/47 aneurysms (91.4%; ruptured, 91.6%; unruptured, 91.4%). Retreatment rate was 6.3% (ruptured, 8%; unruptured, 5.7%). Six (12.7%; ruptured, 25%; unruptured, 8.5%) thromboembolic events were recorded. Hemorrhagic complications occurred in two patients (4.2%; ruptured, 16.6%; unruptured, 0%).

Conclusions

WEB enables adequate occlusion of ruptured and unruptured intracranial aneurysms mostly without requirement of long-term antiplatelet therapy. The benefit is seen especially by the wide-necked aneurysms, but indications should be extended to include narrow-necked, smaller, and side-wall aneurysms.

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Abbreviations

WEB :

Woven EndoBridge

DL :

Dual layer

SL :

Single layer

SLS :

Single layer sphere

DSA :

Digital subtraction angiography

CT :

Computed tomography

ASA :

Acetylsalicylic acid

SAH :

Subarachnoid hemorrhage

PICA :

Posterior inferior cerebellar artery

Acom :

Anterior communicating artery

MCA :

Middle cerebral artery

ICA :

Internal carotid artery

Pcom :

Posterior communicating artery

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Correspondence to Yigit Ozpeynirci.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The study protocol was approved by the local ethics committee. For this type of study, formal consent is not required.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Ozpeynirci, Y., Braun, M., Pala, A. et al. WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms. Acta Neurochir 161, 1507–1513 (2019). https://doi.org/10.1007/s00701-019-03988-0

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  • DOI: https://doi.org/10.1007/s00701-019-03988-0

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