Intrasaccular Flow Disruption in Acutely Ruptured Aneurysms: A Multicenter Retrospective Review of the Use of the WEB

• Published in: American journal of neuroradiology : AJNR Vol. 36; no. 9; pp. 1721 - 1727
• Main Authors: Liebig, T, Kabbasch, C, Strasilla, C, Berlis, A, Weber, W, Pierot, L, Patankar, T, Barreau, X, Dervin, J, Kuršumović, A, Rath, S, Lubicz, B, Klisch, J
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.09.2015
• Subjects: Adult; Aged; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Angiography; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Female; Humans; Interventional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Middle Aged; Postoperative Complications - epidemiology; Retrospective Studies; Treatment Outcome
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A4347

Use of the WEB intra-aneurysmal flow-disruption device in unruptured wide-neck bifurcation aneurysms has proven safety and efficacy. However, ruptured aneurysms are underrepresented in existing studies. This retrospective multicenter study describes the use of the WEB in patients with a ruptured intracranial aneurysm. Ten centers contributed to this study. Clinical and procedural data of 47 patients with 52 aneurysms were analyzed retrospectively together with follow-up angiographies. There were 37 anterior and 15 posterior circulation aneurysms with a neck size of ≥4 mm in 49 of 52 (94%) aneurysms; 45 (87%) aneurysms were <10 mm, and 2 were partially thrombosed. Successful placement of the WEB was possible in every case. Adjunctive devices were used in 8 of 52 (15%) aneurysms. Thromboembolic events were observed in 4 of 52 (8%) patients. Adverse events occurred in 15 patients with 16 aneurysms, 9 of which were potentially related to the WEB procedure (3 thromboembolic events, 5 protrusions, and 1 perforations; 2 perforations were caused by the wire or catheter), but none had a clinical impact. Four patients were retreated. Short-term follow-up in 25 of 39 patients revealed complete occlusion in 15 of 25 (60%), 5 of 25 (20%) with residual neck, and 5 of 25 (20%) with residual aneurysm filling. Short- to midterm imaging in 9 of 25 patients revealed complete occlusion in 5 (55.6%), residual neck in 2 (22%), and residual aneurysm filling in 2 (22%). Of 47 patients, 23 (49%) had an mRS score of 0, 1, or 2; 13 (28%) had an mRS score of 3 or 4; and none had an mRS score of 5 at discharge. This retrospective series showed good procedural safety, feasibility, and stability of midterm occlusion in ruptured wide-neck bifurcation aneurysms.