Elsevier

World Neurosurgery

Volume 123, March 2019, Pages e709-e716
World Neurosurgery

Original Article
Treatment of Ruptured Intracranial Aneurysms Using the Woven EndoBridge Device: A Two-Center Experience

https://doi.org/10.1016/j.wneu.2018.12.010Get rights and content

Background

The Woven EndoBridge (WEB) device is a new treatment modality developed for broad-necked unruptured intracranial aneurysms (IAs) but shows potential for the treatment of ruptured IAs as well. Our aim was to describe 6-month aneurysm obliteration rates, clinical outcomes, and procedure-related complications after WEB treatment for ruptured IAs from 2 academic centers.

Methods

We conducted a retrospective observational study, including all consecutive patients treated with the WEB device (WEB single layer and single-layer sphere) for a ruptured IA causing acute subarachnoid hemorrhage between 2014 (start of use) and 2017. Primary outcome was angiographic aneurysm obliteration (Beaujon Occlusion Scale Score) rate. Secondary outcomes were early re-bleedings, complications, and patient outcome (death and modified Rankin Scale).

Results

A total of 33 patients with ruptured IAs were treated 0–4 days from IA rupture. Of 27 survivors, 6-month angiographic follow-up was available for 26 patients, of whom 81% showed complete occlusion. Of the 27 survivors, 24 patients (89%) had a favorable neurologic outcome at 6 months after subarachnoid hemorrhage. Two aneurysms were retreated (8% of all). There was 1 fatal procedure-related complication. No early aneurysm re-bleedings were noted.

Conclusions

For anatomically suitable ruptured IAs, WEB device treatment seems to be safe and results in acceptable occlusion rates. Still, larger studies with long-term results are needed before recommendations can be made.

Introduction

In the past decade, after the International Subarachnoid Aneurysm Trial, there has been a trend toward the endovascular treatment of ruptured intracranial aneurysms (IAs).1, 2, 3, 4 The mainstay endovascular treatment of ruptured IAs is coiling. Still, there have been concerns regarding long-term results of ruptured IAs treated with coiling.5, 6, 7 Other techniques used for unruptured IAs, such as sent-assisted coiling and the use of flow diverters, are associated with higher obliteration rates, but their use in ruptured IAs is limited due to the risk of thromboembolic and hemorrhagic complications.8, 9, 10, 11

In 2010, the Woven EndoBridge (WEB) device (Sequent Medical, Aliso Viejo, California, USA), an intrasaccular flow diversion device, was introduced into the European market.12, 13 Since its introduction, numerous studies have shown very high obliteration rates for unruptured IAs.14, 15, 16, 17, 18 A major benefit of the WEB device is that it does not require dual antiplatelet therapy. Thus, lately the WEB device has also been used for ruptured IAs in the acute phase of subarachnoid hemorrhage (SAH). Although there is extensive evidence supporting the use of the WEB device in unruptured IAs, only few studies have looked at ruptured IAs.19, 20, 21, 22, 23

The primary aim of this study was to assess aneurysm obliteration rates after endovascular treatment using the WEB device for ruptured IAs. We hypothesized that occlusion rates of WEB-treated ruptured IAs would be similar to previous reports of coiled ruptured IAs. The secondary aim was to assess the frequency of early aneurysm re-bleedings, procedure-related complications, and patient neurologic outcome.

Section snippets

Methodology

We obtained local research approvals from the 2 hospitals, and the need for informed consent was waived by respective research committee because of the retrospective nature of the study (HUS/125/2017 and T011/014/18).

We conducted an open-cohort retrospective study, including all consecutive patients treated endovascularly with the WEB device for a ruptured intracranial aneurysm at 2 university hospitals in Finland (Helsinki University Hospital [HUS], Turku University Hospital) from November

Results

Of a total of 331 endovascularly treated patients with aneurysmal SAH, 33 patients (HUS, N = 12 treated with the WEB of 166 endovascularly treated patients with SAH; Turku University Hospital, N = 21 treated with the WEB of 165 endovascularly treated patients with SAH) were treated between November 2014 and December 2017. Only in 1 patient a help device (stent) was used and was administered dual antiplatelet therapy (stent used due to protrusion of the WEB into the parent artery). Three

Key Findings

In this 2-center retrospective study, we showed that complete angiographic occlusion rate for WEB device-treated ruptured IAs to be 81%. Two aneurysms (8%) required retreatment. No early re-bleedings were noted, but there was 1 fatal procedure-related complication. Of patients surviving the acute phase of SAH, the rate of favorable neurologic outcome was 89%.

Comparison with Previous Studies

There are some previous studies investigating the use of the WEB device for the treatment of ruptured IAs. In 2014, Caroff et al.19

Conclusions

In this selected patient cohort of anatomically suitable ruptured IAs, WEB device treatment seems to be safe and results in acceptable occlusion rates. Still, larger studies with long-term results are needed before recommendations can be made.

Acknowledgments

All authors contributed to the manuscript through data collection, analysis, manuscript composition, and critical review. All authors provided final approval for publication.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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