Evaluation of the effectiveness of woven endobridge therapy in ruptured intracranial aneurysm

Purpose: There are various alternatives in the treatment of patients who develop subarachnoid hemorrhage due to a ruptured intracranial aneurysm. In our study, we aimed to present our experience by evaluating the clinical results and occlusion rates of patients with ruptured aneurysm treated with a woven endobridge device. Materials and Methods: Between December 2015 and May 2022, 42 aneurysms belonging to 41 patients who applied to our hospital with subarachnoid hemorrhage due to intracranial aneurysm and were treated with WEB in the interventional radiology department were included in the study. The occlusion rates of the patients, who were followed up for an average of 15 months (range 1-83 months) after treatment, were evaluated with Magnetic Resonance angiography and digital subtraction angiography and their clinical improvement was evaluated with the modified Rankin Score at the 1st year follow-up. Results: 42 ruptured aneurysms of 18 male and 23 female (mean age: 53; range: 33 to 83) patients included in the study were treated with WEB. The mean diameter of the aneurysms is 5.3 mm and the diameter range is 3-10 mm. The mean neck width was 3.94 mm and the range was 2-7 mm. All of the aneurysms had wide necks (aneurysms with a neck of 4 mm and larger and/or a dome/neck ratio ≤1.6). Of the aneurysms, 17 (40%) AComA, 14 (33%) MCA, 6 (14%) basilar tip, 2 (5%) ACA, 1 (2%) ICA crest, 1' i (2%) PICA was located in 1 (2%) PComA localization. The device was successfully placed in all patients. Adequate occlusion was detected in 23 (92%) of 25 patients with follow-up examinations. Aneurysm remnants were detected in two patients and treatment was recommended to the patients. In the long-term follow-up, 13 patients died. 17 patients continue their lives asymptomatically (mRS 0). 7 patients had good clinical results (mRS 1-2). No treatment-related morbidity or mortality was detected in the patients. Conclusion: The WEB device seems to be an effective treatment option in ruptured, wide-necked aneurysms as it creates acute occlusion, does not require post-procedure antiplatelet therapy, provides adequate occlusion in short and long-term follow-ups and has low recanalization rates. Low morbidity-mortality rates, low incidence of intraoperative rupture and thromboembolic complications confirm that it is a safe treatment method. Keywords: Intracranial aneurysm, Woven endobridge (WEB), Subarachnoid hemorrhage (SAH), Endovascular treatment.