Woven EndoBridge (WEB) Device Found Effective in Treating Sidewall Brain Aneurysm

A braided wire device known as the Woven EndoBridge (WEB) that has been approved by the U.S. Food and Drug Administration (FDA) for wide-neck intracranial bifurcation aneurysms has also been used off-label by some specialists for the treatment of sidewall aneurysms. Research on the WEB device's use in wide-necked sidewall aneurysms has been limited to studies with a small number of cases. Now, a new study has found that the novel mesh plug that has been traditionally used to treat brain aneurysms occurring where the blood vessels branch out can be equally effective in treating aneurysms on the side of the vessel.

The new study conducted by researchers at the Louisiana State University (Shreveport, LA, USA) will help drive a discussion about expanding the indications for the WEB device to include certain sidewall aneurysms. Aneurysms result from a weakness in the blood vessel wall that typically occurs where the vessel branches or bifurcates—where the vessel divides or forks into two branches. Untreated, an aneurysm can grow and rupture. A common treatment involving the placement of tiny platinum coils into the aneurysm has limitations. The WEB device was developed to overcome those limitations. The device is placed inside the aneurysm under angiographic guidance, where it causes a clot to form, closing off the aneurysm and reducing the risk of bleeding without requiring supporting stents or blood thinners. Sidewall aneurysms are a type of wide-necked aneurysm that occurs at the side of a blood vessel rather than its bifurcation tip.

For the new study, the researchers compared the WEB device in bifurcation and sidewall aneurysms using a large database spanning more than 10 years from the WorldWideWEB consortium, a group of 23 academic institutions in North America, South America, Australia and Europe. A total of 683 intracranial aneurysms were treated using the WEB device in 671 patients. Of those, 572 were bifurcation aneurysms, and 111 were sidewall aneurysms. Propensity score matching, a way to increase the power of a study by accounting for differences in patients, resulted in 91 bifurcation and sidewall aneurysms pairs. The complication rate was very similar between the two approaches. The researchers are continuing the research comparing the WEB device with other treatments for different types and locations of aneurysms. They also plan to track changes that happen to device shape and compaction over time and its relationship to aneurysm occlusion status.

"We found out that there is no significant difference using the WEB device in sidewall aneurysms compared with bifurcation aneurysms," said study lead author Nimer Adeeb, M.D., from the Department of Neurosurgery and Interventional Neuroradiology at Louisiana State University. "The results show that the WEB device is safe and effective to use for sidewall aneurysms."

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