From the Guidelines
Web device treatment for brain aneurysms achieves complete occlusion in approximately 60-80% of cases at 12 months follow-up, with adequate occlusion observed in about 80-90% of cases. The WEB (Woven EndoBridge) device is specifically designed for wide-neck bifurcation aneurysms and works by disrupting blood flow within the aneurysm, promoting thrombosis and eventual occlusion. According to the guidelines for the management of patients with unruptured intracranial aneurysms, the degree of aneurysm occlusion after initial treatment is a strong predictor of the risk of rehemorrhage 1. Factors affecting occlusion rates include aneurysm size, neck width, and proper device sizing during placement. Patients typically receive dual antiplatelet therapy (usually aspirin 81-325mg daily and clopidogrel 75mg daily) for 1-3 months following the procedure, then continue with aspirin alone for 3-6 months. Regular follow-up imaging at 6 and 12 months is essential to monitor occlusion status. Retreatment rates for WEB-treated aneurysms range from 5-15%, which is comparable to or better than traditional coiling techniques for similar complex aneurysms.
Some key points to consider when evaluating the effectiveness of web device treatment for brain aneurysms include:
- The importance of complete occlusion in reducing the risk of rehemorrhage, as highlighted in the study by Higashida et al 1
- The need for regular follow-up imaging to monitor occlusion status and adjust treatment as necessary
- The potential benefits of web device treatment, including improved occlusion rates and reduced retreatment rates compared to traditional coiling techniques
- The importance of proper device sizing and placement to ensure optimal occlusion rates and minimize complications.
It is also worth noting that the guidelines for the management of patients with unruptured intracranial aneurysms emphasize the importance of considering the degree of aneurysm occlusion after initial treatment when evaluating the risk of rehemorrhage 1. Overall, web device treatment for brain aneurysms appears to be a promising option, with high occlusion rates and low retreatment rates, making it a viable alternative to traditional coiling techniques.
From the Research
Brain Aneurysm Occlusion Rates with WEB Treatment
- The Woven EndoBridge (WEB) device is used for the treatment of intracranial aneurysms, with studies showing its efficacy in achieving occlusion rates 2.
- A study published in 2023 reported an overall occlusion rate of 88% at 12-month follow-up, with 59 out of 67 patients showing complete occlusion on dual-energy CTA 2.
- Factors associated with occlusion status included ruptured presentation, undersized WEB, WEB shape change, aneurysm neck diameter, and angle between the parent artery and the aneurysm dome 2.
- Another study published in 2020 discussed the methodology for using the WEB device, including indications for use, aneurysm/device selection strategies, and potential complications 3.
- A systematic review published in 2015 reported an overall occlusion rate of 81.5% for flow-diverter devices, including the WEB device, with a non-negligible rate of ischemic and hemorrhagic complications 4.
- A technical note published in 2019 described the use of the WEB device in conjunction with stenting and/or coiling to achieve successful angiographic results for complex aneurysms 5.
- A meta-analysis published in 2024 compared the outcomes of flow diverter and stent-assisted coiling treatment for dissecting intracranial aneurysms, finding similar rates of follow-up complete aneurysm occlusion and complications between the two groups 6.