Ruptured Intracranial Aneurysms Treated with Woven Endobridge Intrasaccular Flow Disruptor: A Multicenter Experience

Background: The woven endobridge intrasaccular flow disruptor (WEB) device for ruptured broad-based intracranial aneurysm (rBBA) remains underrepresented in existing studies. In this case series, the safety and efficacy results of the use of WEB in rBBA were evaluated from a multi-center experience.

Materials and methods: Between November 2014 and October 2017, data of all patients with rBBA (≥4 mm and/or dome/neck ratio ≥1 and ≤1.6) treated with WEB were prospectively collected and retrospectively analyzed from 3 Italian neurointerventional centers. The interventional procedures and the clinical and angiographic outcomes are reported for the periprocedural phase with midterm follow-up.

Results: 33 patients were included in this series (10 patients with Hunt-Hess scores 4-5; 23 patients with Hunt-Hess scores 1-3). Technical success was obtained for all 33 patients (100%). The mean fluoroscopy time was 24 minutes (range, 8-40 minutes). Adjunctive devices were used in 6% of patients (2 stents). At the 1-month follow-up visit, the overall mortality was 33%. The overall rate of WEB-related complications was 27% (5 device protrusion, 2 sac perforation, 2 thromboembolism), with a WEB-related mortality of 12% and permanent neurologic deficit of 3%. Of the surviving patients, 1 was lost to follow-up. At 14 months, the mean follow-up (range, 2-35 months), no early or delayed reruptured aneurysms were observed; complete occlusion was obtained in 7/21 patients (33%), neck remnant in 8/21 (38%), and residual aneurysm filling in 6/21 (29%) patients, with a modified Rankin Scale of 0sto 2 observed in 17/21 patients (80%).

Conclusions: The WEB device for rBBA is a fast and effective treatment, with a low rate of aneurysm rebleeding; however, procedure-related complications seem not negligible. Further evaluation comparing this device with other treatment options should be performed.