van Rooij W J, Peluso J P, Bechan R S, Sluzewski M
From the Department of Radiology, Sint Elisabeth Ziekenhuis, Tilburg, the Netherlands.
AJNR Am J Neuroradiol. 2016 Sep;37(9):1679-83. doi: 10.3174/ajnr.A4811. Epub 2016 Apr 21.
The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.
During 11 months, 32 of 71 (45%) endovascularly treated acutely ruptured aneurysms were treated with the WEB. The patients were 12 men and 20 women, with a mean age of 61 years (range, 34-84 years). The mean aneurysm size was 4.9 mm, and 14 were ≤4 mm. Of 32 aneurysms, 24 (75%) had a wide neck.
All 32 aneurysms were adequately occluded after WEB placement. There were no procedural ruptures and no complications related to the WEB device. No adjunctive stents or balloons were needed. In 3 patients, thromboembolic complications occurred. One patient developed an infarction, and 2 patients were asymptomatic. The procedural complication rate was 3%. Seven patients admitted in poor clinical grade conditions died during hospital admission due to the sequelae of SAH. In 18 patients with angiographic follow-up at 3 months, 16 aneurysms remained adequately occluded. Two aneurysms showed slight compression of the WEB without reopening. Clinical follow-up in the 25 patients who survived the hospital admission period revealed mRS 1-2 in 24 and mRS 4 in 1. There were no rebleeds from the ruptured aneurysms during follow-up.
WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons. Our preliminary experience indicates that the WEB may be a valuable alternative to coils in the treatment of acutely ruptured aneurysms.
编织型血管内桥接（WEB）装置最近被用于宽颈动脉瘤的囊内治疗，无需辅助支撑。我们介绍使用WEB治疗小型破裂动脉瘤的首例经验。
在11个月期间，71例接受血管内治疗的急性破裂动脉瘤中有32例（45%）采用WEB治疗。患者中男性12例，女性20例，平均年龄61岁（范围34 - 84岁）。动脉瘤平均大小为4.9mm，其中14个≤4mm。32个动脉瘤中，24个（75%）为宽颈。
放置WEB后，所有32个动脉瘤均实现充分栓塞。无术中破裂，也无与WEB装置相关的并发症。无需辅助支架或球囊。3例患者发生血栓栓塞并发症。1例患者发生梗死，2例患者无症状。手术并发症发生率为3%。7例入院时临床分级较差的患者因蛛网膜下腔出血后遗症在住院期间死亡。18例在3个月时接受血管造影随访的患者中，16个动脉瘤仍保持充分栓塞。2个动脉瘤显示WEB有轻微受压但未再通。对25例住院存活患者的临床随访显示，24例改良Rankin量表（mRS）评分为1 - 2分，1例为4分。随访期间破裂动脉瘤无再出血。
WEB治疗小型破裂动脉瘤安全有效，无需抗凝、辅助支架或球囊。我们的初步经验表明，在治疗急性破裂动脉瘤方面，WEB可能是弹簧圈的一种有价值的替代方法。
