Chrisanthi Papagiannaki
Intrasaccular flow disruption is an innovative endovascular aneurysm treatment. The WEB-DL (Woven EndoBridge Dual-Layer; Sequent Medical, Aliso Viejo, California) is an intra-aneurysmal flow disruption device developed to modify the blood flow at the aneurysm neck and, therefore, to promote thrombosis of the aneurysm sac. It has been used mainly to treat complex wide-neck bifurcation aneurysms, and the feasibility of this treatment, as well as its safety and efficacy, have so far been demonstrated in small retrospective series conducted in highly specialized centers.
Our aim was to examine the feasibility and the short-term anatomic and clinical results of this technique in a large prospective series of patients treated in several neurointerventional centers.
Our results show a feasibility of 92.9%, with low permanent morbidity (1.3%) and no mortality, and confirm the previously published findings. Endovascular treatment with the WEB can be applied to unruptured, ruptured, and recanalized aneurysms without the need to pretreat patients with double antiaggregation, and this is an advantage compared with other techniques, especially in the context of a subarrachnoid hemorrage. WEB intrasaccular flow disruption seems to be a promising technique, due mainly to its technical feasibility.
There are drawbacks of the WEB, namely the large size of the microcatheters needed and the low visibility of the device — issues that have been addressed and improved in its newer version and which, nonetheless, don’t increase the treatment failure rates or the morbi-mortality rates compared with large series of simple coiling or other endovascular treatment published in the literature.