Long-Term Outcomes of the WEB Device for Treatment of Wide-Neck Bifurcation Aneurysms

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Fig 1.
A, Angiogram shows right MCA bifurcation aneurysm with a wide neck. B, The WEB device protruding into the parent artery is causing flow reduction in the M2 segment. C, Radiograph demonstrating an LVIS stent (MicroVention) placed in the MCA elevates the distal edge of the WEB device.
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Fig 2.
Occlusion state at each period in the midterm follow-up group.
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Fig 3.
Occlusion state at each period in the long-term follow-up group.

Table 1:

Results of treatment at each follow-up

	Initial Follow-Up% (n = 21)	Short-Term (<6 Months)% (n = 24)	Midterm (6–24 Months)% (n =28)	Long-Term (>24 Months)% (n = 8)
Complete occlusion	71.4 (15)	62.5 (15)	57.1 (16)	62.5 (5)
Residual neck	28.5 (6)	16.8 (4)	17.8 (5)	25.0 (2)
Residual aneurysm	0.0 (0)	20.8 (5)	25.0 (7)	12.5 (1)
Retreatment	0.0 (0)	0.0 (0)	17.8 (6)	25.0 (2)

Table 2:

Characteristics of patients and aneurysms of retreatment cases

Patient No.	Sex	Age (yr)	Location	W (mm)	H (mm)	D/N Ratio	WEB Type	Follow-Up Period of Retreatment	Additional Device
1	F	54	MCA	10.1	10.5	1.7	DL	Midterm	Y stent and coils
2	F	62	MCA	5.4	5.6	1.2	DL	Midterm	Stent and coils
3	F	65	AcomA	11	10	1.5	DL	Midterm	Stent and coils
4	F	71	AcomA	9	8	1.3	DL	Midterm	Stent and coils
5	F	63	MCA	10	9	1.7	DL	Long-term	pCONus and coils
6	F	67	AcomA	9	8	1.5	DL	Midterm	Stent and coils
7	F	67	AcomA	11	8	1.3	DL	Midterm	pCANvas
8	F	55	MCA	5	6	1.3	DL	Long-term	Stent and coils

Note:—D/N ratio indicates dome-to-neck ratio; H, aneurysm height; W, aneurysm width.

Table 3:

Comparison of patients, aneurysms, and device characteristics according to the presence of retreatment

Retreatment
	Present	Absent	P Value
Number of patients (n)	8	23
Patient characteristics
Age, y (average ± SD)	63.0 ± 5.9	62.2 ± 8.0	.929
Male/female	0/8	7/28	.31
Hypertension	4/8 (50%)	16/33 (48%)	.938
Family history	1/8 (12.5%)	2/33 (6%)	.488
Aneurysm characteristics
Height (mm)	8.13 ± 1.72	6.36 ± 1.85	.026
Width (mm)	8.81 ± 2.35	6.73 ± 1.83	.029
Neck (mm)	6.03 ± 1.36	5.34 ± 1.36	.112
Dome-to-neck ratio	1.44 ± 0.19	1.28 ± 0.19	.132
Aneurysm location
AcomA	4/8 (50%)	5/33 (15%)	.054
MCA	4/8 (50%)	25/33 (75%)	.202
Device characteristics
Height difference from the aneurysm	−2.39 ± 0.86	−1.40 ± 1.20	.038
Width difference from the aneurysm	−0.69 ± 1.35	0.36 ± 0.92	.055
DL/SL&SLS	8/0	23/10	.162