Preliminary data regarding the use of the Web Aneurysm Embolization System (Sequent Medical) were shared at LINNC 2012 in Paris, France, and published in a recent study in the American Journal of Neuroradiology. The early evidence suggests that this device represents a feasible and promising treatment for wide-neck bifurcation aneurysms, and that further study and clinical experience is warranted.
Web, according to the company, is designed to bridge the aneurysm neck and promote rapid, periprocedural stasis in both ruptured and unruptured aneurysms via an intrasaccular approach.
Laurent Pierot, Maison Blanche Hospital, Reims, France, presented on the use of both computational flow dynamics and preclinical models in the development of the Web device. He also reported on his own clinical experience. Initial results from the treatment of twenty-one aneurysms with the Web in France and Germany were recently published in the American Journal of Neuroradiology and found that intrasaccular flow disruption was a feasible treatment, particularly in bifurcation aneurysms with unfavourable anatomy. The authors of the study noted that further studies were needed to evaluate the indications, safety, and efficacy of this new technique.
Pierot made the point that the endovascular treatment of large aneurysms with wide-necks is often challenging and associated with a high incidence of significant recurrences. “The Web, an intrasaccular flow disrupter, was designed for use in this type of aneurysm. We report our early experience with this device in this multicentre study,” he said.
Pierot and colleagues reported that 20 patients with 21 aneurysms were treated by using the Web in three European centres. The team made a note of successful deployment of the Web, immediate post-treatment angiographic results, adverse events, clinical outcome, and angiographic follow-up results.
The majority of aneurysms were located in the middle cerebral artery (8/21, 38.1%). Five were located on the anterior communicating artery (23.8%), and four (19.1%) each on the basilar artery and internal carotid artery.
The investigators did not report any treatment failures. Over 75% of patients were treated exclusively with the Web device. The other patients required additional coiling and/or stent placement. The team noted that one patient (4.8%) experienced transient clinical worsening (mRS 1 at one month and mRS 0 at three months) related to a thromboembolic event. They noted a detachment of the Web device which was subsequently retrieved without adverse effects.
Pierot told LINNC delegates that short-term follow-up (2–8 months) had revealed total occlusion or neck remnant in 80% of aneurysms.
At LINNC 2012, Boris Lubicz, Hôpital Erasme, Brussels, Belgium also presented his as-yet unpublished initial clinical experience with the Web for treatment of twenty-one wide neck unruptured bifurcation aneurysms, which represents that largest single centre experience to date.
Sequent Medical told NeuroNews that the company intends to continue with a controlled, gradual introduction of the Web at centres in Europe. The company is also initiating a number of Europe-based clinical studies in order to collect formal multicentre clinical data.
