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

Pierot, Laurent MD, PhD*; Klisch, Joachim MD, PhD; Cognard, Christophe MD, PhD§; Szikora, Istvan MD, PhD; Mine, Benjamin MD; Kadziolka, Krzysztof MD*; Sychra, Vojtech MD; Gubucz, Istvan MD; Januel, Anne-Christine MD§; Lubicz, Boris MD, PhD

doi: 10.1227/01.neu.0000429860.04276.c1
Research-Human-Clinical Studies

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

BRAT, Barrow Ruptured Aneurysm Trial

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

DSA, digital subtraction angiography

ISAT, International Subarachnoid Trial

MCA, middle cerebral artery

mRS, modified Rankin Scale

*Department of Radiology, Maison Blanche Hospital, University of Reims, Reims, France;

Department of Diagnostic and Interventional Radiology & Neuroradiology, Helios General Hospital, Erfurt, Germany;

§Department of Neuroradiology, Purpan Hospital, University of Toulouse, Toulouse, France;

Department of Neuroradiology, National Institute of Neurosciences, Budapest, Hungary;

Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium

Correspondence: Laurent Pierot, MD, PhD, Department of Radiology, Maison Blanche Hospital, 45 Rue Cognacq Jay 51092 Reims, France. E-mail:

Received November 27, 2012

Accepted February 25, 2013

Copyright © by the Congress of Neurological Surgeons