WEB Treatment of Ruptured Intracranial Aneurysms

BACKGROUND AND PURPOSE:The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.MATERIALS AND METHODS:During 11 months, 32 of 71 (45%) endovascularly treated acutely ruptured aneurysms were treated with the WEB. The patients were 12 men and 20 women, with a mean age of 61 years (range, 34–84 years). The mean aneurysm size was 4.9 mm, and 14 were ≤4 mm. Of 32 aneurysms, 24 (75%) had a wide neck.RESULTS:All 32 aneurysms were adequately occluded after WEB placement. There were no procedural ruptures and no complications related to the WEB device. No adjunctive stents or balloons were needed. In 3 patients, thromboembolic complications occurred. One patient developed an infarction, and 2 patients were asymptomatic. The procedural complication rate was 3%. Seven patients admitted in poor clinical grade conditions died during hospital admission due to the sequelae of SAH. In 18 patients with angiographic follow-up at 3 months, 16 aneurysms remained adequately occluded. Two aneurysms showed slight compression of the WEB without reopening. Clinical follow-up in the 25 patients who survived the hospital admission period revealed mRS 1–2 in 24 and mRS 4 in 1. There were no rebleeds from the ruptured aneurysms during follow-up.CONCLUSIONS:WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons. Our preliminary experience indicates that the WEB may be a valuable alternative to coils in the treatment of acutely ruptured aneurysms.

Endovascular treatment with coils of wide-neck intracranial aneurysms remains a technical challenge. To prevent extrusion of coils from the aneurysmal sac, a temporary protection balloon or a stent can be used. However, this makes the procedure more complicated with a higher chance of complications.^1,2 With the use of stents, periprocedural dual-antiplatelet therapy is required and has to be prolonged for 3–6 months. With this anticoagulation, stent-assisted coiling in ruptured aneurysms has a higher inherent risk for early rebleed or hemorrhage in the postoperative period.³Recently, an intrasaccular flow disruptor, Woven EndoBridge (WEB; Sequent Medical, Aliso Viejo, California), has been developed. The primary use of the WEB is the treatment of bifurcation or wide-neck aneurysms without the need of adjunctive devices. There is a growing body of literature on the use of the WEB device with excellent safety and efficacy profiles. Most of the published series comprised wide-necked, unruptured aneurysms.^4–16 When the WEB became available in our hospital, our initial results in unruptured aneurysms were encouraging, and we decided to expand the indications to both ruptured and unruptured aneurysms suitable for accommodating a WEB device, regardless of neck size. Our intention was to avoid using stents or balloons in ruptured aneurysms. In this article, we present our first results of the use of the WEB device in small ruptured aneurysms.