Article
Woven EndoBridge (WEB®)-Device for the endovascular therapy of wide necked cerebral aneurysms, initial experience with 24 cases
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Authors
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Daniel Behme
- Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest – Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
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Anushe Weber
- Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest – Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
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Anastasios Mpotsaris
- Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest – Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
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Christian Loehr
- Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest – Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
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Werner Weber
- Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest – Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
| Published: | May 13, 2014 |
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Outline
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Objective: The endovascular treatment of cerebral aneurysms with unfavorable anatomy can be challenging. The WEB®-Device is a novel technique allowing for an intrasaccular endovascular treatment of ruptured or unruptured wide-necked aneurysms with complex anatomy. Our aim is to report our single-center experience since April 2012.
Method: We screened our prospective neuro-interventional database for all consecutive patients between April 2012 and November 2013 using an intention to treat approach concerning the WEB®-Device. We retrospectively analyzed all technical and clinical data, including procedure related adverse events and morbidity and mortality on discharge and during follow-up.
Results: We identified 24 Patients (male:female ratio: 1:1). 4/24 (16.7%) aneurysms were ruptured, 20/24 (83.3%) were unruptured. The WEB®-Device was successfully deployed and implanted in 19/24 (79.2%) patients; in 5/24 (20.8%) the device could be deployed but not implanted. Aneurysm locations were as follows: ICA in 2/24 (8.3%) cases; ACA in 1/24 (4.2%) cases; ACOM in 5/24 (20.8%) cases; MCA in 5/24 (20.8%) cases; MCA bifurcation in 3/24 (12.5%) cases; PCOM in 3/24 (12.5%) cases and BA in 5/24 (20.8%) cases. Pertaining to the 19 aneurysms with technically successful implantation of the WEB®-Device the immediate postinterventional total occlusion (TO) rate amounted to 12/19 cases (63.2%). In 3/19 (15.8%) cases a neck remnant (NR) was present after implantation and an aneurysm remnant (AR) was observed in the remaining 4/19 patients (21%). In 6/19 (31.6%) cases the respective follow-up angiographies revealed an aneurysm remnant; whereby 4 of them were classified as indication for re-treatment (follow-up is scheduled for 8/19 patients). Anti-platelet therapy with acetylsalicylic acid (ASA) was administered in 13/19 (68.4%) patients, 2/19 (10.5%) patients received a dual anti-platelet therapy. In those patients with ruptured aneurysms ASA was administered in 1/4 (25%) of cases. Procedural adverse events occurred in 4/19 (21%) but had no persistent clinical sequelae.
Conclusions: The deployment procedure of the WEB®-Device is technically feasible and safe. It may though not be appropriate for all aneurysms in spite of a successful deployment. In the setting of a ruptured wide-necked aneurysm it allows for a rapid intra-aneurysmal flow disruption without the need of a (dual) anti-platelet therapy and might therefore be a promising technique for the emergency treatment.
