Endovascular WEB Flow Disruption in Middle Cerebral Artery Aneurysms: Preliminary Feasibility, Clinical, and Anatomical Results in a Multicenter Study

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Abstract

BACKGROUND:

The endovascular treatment of middle cerebral artery (MCA) aneurysms with unfavorable anatomy (wide neck, unfavorable morphology) is frequently challenging. Flow disruption with the WEB is a potentially interesting endovascular treatment for this type of aneurysm.

OBJECTIVE:

To report in a multicenter series the preliminary treatment experience of MCA aneurysms with flow disruption by the WEB.

METHODS:

Thirty-three patients with 34 MCA aneurysms were treated with the WEB in 5 European centers. The ability to successfully deploy the WEB, procedure- and device-related adverse events, morbidity and mortality of the treatment, and short-term angiographic follow-up results were analyzed.

RESULTS:

Most treated aneurysms were unruptured (85.3%) and were between 5 and 10 mm (85.3%) with a neck size ≥ 4 mm (88.2%). The treatment failed in 1 of the 34 aneurysms (2.9%) owing to a lack of appropriate device size. Treatment was performed exclusively with the WEB in 29 of 33 aneurysms (87.9%). Additional treatment (coiling and/or stenting) was used in 4 of 33 aneurysms (12.1%). Mortality of the treatment was 0.0% and morbidity was 3.1% (intraoperative rupture with modified Rankin Scale score of 3 at the 1-month follow-up). In short-term follow-up (range, 2-12 months), adequate occlusion (total occlusion or neck remnant) was observed in 83.3% of aneurysms.

CONCLUSION:

WEB flow disruption seems to be a promising technique for the treatment of complex MCA aneurysms, particularly those with a wide neck or unfavorable dome-to-neck ratio.

ABBREVIATIONS:

ATENA, Analysis of Treatment by Endovascular Approach of Nonruptured Aneurysms

ABBREVIATIONS:

BRAT, Barrow Ruptured Aneurysm Trial

ABBREVIATIONS:

CLARITY, Clinical and Anatomical Results in the Treatment of Ruptured Intracranial Aneurysms

ABBREVIATIONS:

DSA, digital subtraction angiography

ABBREVIATIONS:

ISAT, International Subarachnoid Trial

ABBREVIATIONS:

MCA, middle cerebral artery

ABBREVIATIONS:

mRS, modified Rankin Scale

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