Valerio Da Ros1, Alessio Bozzi2, Chiara Comelli3, Vittorio Semeraro2, Simone Comelli4, Nicola Lucarelli5, Nicola Burdi5, Roberto Gandini2. 1. Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University Hospital, Rome, Italy. Electronic address: darosvalerio@gmail.com. 2. Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University Hospital, Rome, Italy. 3. S.C. Radiodiagnostica, Ospedale San Giovanni Bosco, Torino, Italy. 4. S. C. Neuroradiologia ed Interventistica Vascolare, Ospedale S. Michele, Cagliari, Italy. 5. Department of Interventional Radiology and Neuroradiology, SS Annunziata Hospital, Taranto, Italy.
Abstract
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.
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.
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