Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
Department of Neuroradiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
Acta Neurochir (Wien). 2023 Jul;165(7):1881-1889. doi: 10.1007/s00701-023-05596-5. Epub 2023 May 13.
Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping.
A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified.
Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms.
Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.
自 2018 年美国食品和药物管理局（FDA）批准以来，编织式腔内血管重建装置（WEB）已越来越多地用于未破裂和破裂脑动脉瘤的血管内治疗。然而，与其他治疗方法相比，其闭塞率似乎较低，再治疗率较高。对于最初破裂的动脉瘤，已有 13%的再治疗率的报道。已经提出了各种再治疗策略；然而，关于 WEB 预处理动脉瘤的显微夹闭，特别是先前破裂的动脉瘤，数据很少。因此，我们报告了一个单中心的五例破裂动脉瘤的系列病例，这些动脉瘤先用 WEB 装置治疗，然后用显微夹闭进行再治疗。
对 2019 年至 2021 年在我们机构接受 WEB 治疗的所有破裂性动脉瘤患者进行回顾性研究。随后，确定了所有用显微夹闭对动脉瘤残余或目标动脉瘤复发进行再治疗的患者。
共有五例用 WEB 治疗后破裂的动脉瘤患者，并用显微夹闭进行再治疗，其中一例基底动脉尖动脉瘤除外。所有动脉瘤均位于前交通动脉（AComA）复合体，均为宽颈动脉瘤，平均瘤颈比为 1.5。所有动脉瘤的夹闭均可行且安全，5 个动脉瘤中有 4 个完全闭塞。
对于最初破裂的 WEB 治疗后的动脉瘤，在选择合适的患者中，显微夹闭是一种可行、安全且有效的治疗方法。
