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Research ArticleINTERVENTIONAL
Open Access

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

T. Liebig, C. Kabbasch, C. Strasilla, A. Berlis, W. Weber, L. Pierot, T. Patankar, X. Barreau, J. Dervin, A. Kuršumović, S. Rath, B. Lubicz and J. Klisch
American Journal of Neuroradiology September 2015, 36 (9) 1721-1727; DOI: https://doi.org/10.3174/ajnr.A4347
T. Liebig
aFrom the Department of Radiology (T.L., C.K.), Universitätsklinikum Köln, Cologne, Germany
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C. Kabbasch
aFrom the Department of Radiology (T.L., C.K.), Universitätsklinikum Köln, Cologne, Germany
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C. Strasilla
bDepartment of Diagnostic and Interventional Radiology and Neuroradiology (C.S., J.K.), Helios General Hospital, Erfurt, Germany
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A. Berlis
cDepartment of Diagnostic Imaging and Neuroradiology (A.B.), Klinikum Augsburg, Augsburg, Germany
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W. Weber
dDepartment of Neuroradiology (W.W.), Knappschaftskrankenhaus, Recklinghausen, Germany
eDepartment of Neuroradiology (W.W.), Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
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L. Pierot
fDepartment of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
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T. Patankar
gLeeds General Infirmary (T.P.), Leeds, United Kingdom
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X. Barreau
hDepartment of Neuroimaging (X.B.), CHU Pellegrin, Bordeaux, France
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J. Dervin
iSouthern General Hospital (J.D.), Glasgow, United Kingdom
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A. Kuršumović
jDepartment of Neuroradiology (A.K., S.R.), Klinikum Deggendorf, Deggendorf, Germany
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S. Rath
jDepartment of Neuroradiology (A.K., S.R.), Klinikum Deggendorf, Deggendorf, Germany
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B. Lubicz
kDepartment of Neuroradiology (B.L.), Erasme University Hospital, Brussels, Belgium.
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J. Klisch
bDepartment of Diagnostic and Interventional Radiology and Neuroradiology (C.S., J.K.), Helios General Hospital, Erfurt, Germany
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  • Fig 1.
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    Fig 1.

    A, WEB-DL, a double-layer microbraid, used in 37 of the 52 aneurysms in this series. B, WEB-SL, a single-layer implant, used in 15 of the 52 aneurysms in this series.

  • Fig 2.
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    Fig 2.

    Ruptured basilar tip aneurysm before (A) and immediately after (B) deployment of the WEB device. After the WEB is placed, no contrast filling can be seen inside the dome, including the bleb that is presumed to be the rupture site; furthermore, there is stasis of contrast inside the WEB beyond the venous phase, indicating sufficient hemodynamic decoupling.

Tables

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    Table 1:

    Periprocedural events

    Patient No.AN LocationComplicationDevice RelatedOutcome (mRS Score)Clinical Consequence
    1MCATEYes0 at 8 moNone
    2MCATEYes3 (same as before SAH)None
    3PcomATEYes0 at 3 moNone
    4BATENo4 at dischargeaNone
    5MCATENo3 at 2 moYes
    AcomAAN perforationNoYes
    6Pericallosal arteryAN perforationYes0 at 1 wkNone
    7MCAAN perforationNo6 from initial SAHUnknownb
    8AcomAInduced spasmUnknown6 from initial SAHUnknownb
    9MCAInduced spasmUnknownUnknownUnknown
    10PcomAInfarctionNo2 at 6 moTransient
    11AcomAWEB protrusionYes0 at 6 moNone
    12BAWEB protrusionYes0 at 8 moNone
    13MCAWEB protrusionYes0 at 3 moNone
    14AcomAWEB protrusionYes0 at 25 moNone
    15rMCA, lMCA, Dissect VertrMCA branch partial occlusionYes0 at 3 wkNone
    • Note:—AcomA indicates anterior communicating artery; AN, aneurysm; BA, basilar artery; Dissect Vert, dissecting vertebral; lMCA, left MCA; PcomA, posterior communicating artery; rMCA, right MCA; TE, thromboembolic event.

    • ↵a Clinical outcome related to ventriculitis.

    • ↵b Death during hospitalization secondary to the SAH, not during the procedure.

    • View popup
    Table 2:

    Nonfatal complications during hospitalization

    Patient No.AN LocationType of EventSAH RelatedOutcome (mRS Score)
    1AcomAVasospasmYes0 at discharge
    2MCAVasospasm on day 14Yes2 at 6 mo
    3MCAVasospasm on day 7Yes0 at discharge
    4BAVasospasmYes4 at 12 mo
    5AcomAInfarct on MRIYes2 at 6 moa
    6MCAStroke on MRINo0 at discharge
    7BAVentriculitisYes4 at discharge
    8AcomARehemorrhage; additional treatment with coilsNo0 at 6 mo
    9BANew infarct on day 3 with vasospasm and stenosis visibleYes0 at 8 mo
    10MCAStroke on MRINo3 at discharge
    11rMCA, lMCA, Dissect VertBrain stem edema on day 23No0 at 3 wk
    • Note:—AcomA indicates anterior communicating artery; AN, aneurysm; BA, basilar artery; Dissect Vert, dissecting vertebral; lMCA, left MCA; rMCA, right MCA.

    • ↵a Clinical status restored to pre-SAH value in a patient with multiple sclerosis.

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American Journal of Neuroradiology: 36 (9)
American Journal of Neuroradiology
Vol. 36, Issue 9
1 Sep 2015
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Intrasaccular Flow Disruption in Acutely Ruptured Aneurysms: A Multicenter Retrospective Review of the Use of the WEB
T. Liebig, C. Kabbasch, C. Strasilla, A. Berlis, W. Weber, L. Pierot, T. Patankar, X. Barreau, J. Dervin, A. Kuršumović, S. Rath, B. Lubicz, J. Klisch
American Journal of Neuroradiology Sep 2015, 36 (9) 1721-1727; DOI: 10.3174/ajnr.A4347

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Intrasaccular Flow Disruption in Acutely Ruptured Aneurysms: A Multicenter Retrospective Review of the Use of the WEB
T. Liebig, C. Kabbasch, C. Strasilla, A. Berlis, W. Weber, L. Pierot, T. Patankar, X. Barreau, J. Dervin, A. Kuršumović, S. Rath, B. Lubicz, J. Klisch
American Journal of Neuroradiology Sep 2015, 36 (9) 1721-1727; DOI: 10.3174/ajnr.A4347
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