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Research ArticleNeurointervention

Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility

L. Goertz, T. Liebig, E. Siebert, M. Herzberg, L. Pennig, M. Schlamann, J. Borggrefe, B. Krischek, F. Dorn and C. Kabbasch
American Journal of Neuroradiology September 2019, DOI: https://doi.org/10.3174/ajnr.A6183
L. Goertz
aFrom the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
bCenter for Neurosurgery (L.G., B.K.), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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T. Liebig
cDepartment of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
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E. Siebert
dDepartment of Neuroradiology (E.S.), University Hospital of Berlin (Charité), Berlin, Germany.
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M. Herzberg
cDepartment of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
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L. Pennig
aFrom the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
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M. Schlamann
aFrom the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
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J. Borggrefe
aFrom the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
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B. Krischek
bCenter for Neurosurgery (L.G., B.K.), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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F. Dorn
cDepartment of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
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C. Kabbasch
aFrom the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
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Article Figures & Data

Tables

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    Table 1:

    Baseline patient and aneurysm characteristicsa

    WEB 17 (n = 38)pWEB (n = 70)P ValueAdjusted P Value
    Patient age (yr)55.7 ± 12.757.3 ± 12.2.54.72
    Female sex25 (65.8%)52 (74.3%).35.61
    Rupturedaneurysms10 (26.3%)24 (34.3%).39.59
     WFNS I2 (5.3%)10 (14.3%).82.06
     WFNS II2 (5.3%)3 (4.3%)
     WFNS III2 (5.3%)4 (5.7%)
     WFNS IV1 (2.6%)2 (2.9%)
     WFNS V3 (7.9%)5 (7.1%)
     Fisher 11 (2.6%)2 (2.9%).77.30
     Fisher 20 (0%)2 (2.9%)
     Fisher 33 (7.9%)5 (7.1%)
     Fisher 46 (15.8%)13 (18.6%)
    Aneurysm location
     AcomA14 (36.8%)15 (21.4%).08.92
     Pericallosal0 (0%)1 (1.4%)1.0.24
     MCA4 (10.5%)15 (21.4%).19.60
     ICA
      Paraophthalmic1 (2.6%)7 (10.0%).26.06
      PcomA4 (10.5%)5 (7.1%).72.55
      Terminus3 (7.9%)0 (0%).04.25
     BA9 (23.7%)24 (34.3%).25.82
     SUCA1 (2.6%)0 (0%).35.01
     PICA2 (5.3%)3 (4.3%)1.0.53
    Anterior circulation26 (68.4%)43 (61.4%).47.63
    Posteriorcirculation12 (31.6%)27 (38.6%)
    Bifurcation location27 (71.1%)54 (77.1%).49.72
    Aneurysmsize(mm)4.9 ± 1.55.6 ± 1.4.007.55
    Neck width (mm)3.6 ± 1.14.2 ± 1.3.04.95
    D/N ratio1.4 ± 0.51.4 ± 0.4.56.90
    Wide neck35 (92.1%)65 (92.9%)1.0.66
    • Note:—WFNS indicates World Federation of Neurosurgical Societies grading scale; D/N ratio, dome-to-neck ratio; PcomA, posterior communicating artery; BA, basilar apex; SUCA, superior cerebellar artery.

    • ↵a Data are number and percentage of means.

    • View popup
    Table 2:

    Procedural specificsa

    WEB 17 (n = 38)pWEB (n = 70)P ValueAdjusted P Value
    WEB type
     DL0 (0%)6 (8.6%).09.003
     SL31 (81.6%)46 (65.7%).08.001
     SLS7 (18.4%)18 (25.7%).39.02
    WEB only36 (94.7%)62 (88.6%).49.02
    Additional coiling1 (2.6%)1 (1.4%)1.01.0
    Additional stents1 (2.6%)7 (10.0%).26.005
    Treatmentduration(min)122 ± 67133 ± 67.48.007
    Fluoroscopy time (min)25.4 ± 20.127.6 ± 23.3.77.02
    Radiation dose (cGy × cm2)10,319 ± 710811,899 ± 9142.55.03
    Contrast (mL)151 ± 68145 ± 72.59.70
    • Note:—DL indicates Dual-Layer; SLS, Single-Layer Sphere.

    • ↵a Data are number and percentage of means.

    • View popup
    Table 3:

    Immediate angiographic results

    WEB 17 (n = 38)pWEB (n = 70)P ValueAdjustedP Value
    Complete occlusion (RROC 1)22 (57.9%)38 (54.3%).55.21
    Neck remnant (RROC 2)8 (21.1%)11 (15.7%)
    Aneurysm remnant (RROC 3)8 (21.1%)21 (30.0%)
    • Note:—RROC indicates Raymond-Roy occlusion classification.

    • View popup
    Table 4:

    Procedure-related complications

    WEB 17 (n = 38)pWEB (n = 70)P ValueAdjusted P Value
    Thromboembolic events2 (5.3%)10 (14.3%).21.002
     Ischemic stroke1 (2.6%)5 (7.1%).42.06
    Hemorrhagic complications2 (5.3%)1 (1.4%).28.37
    Neurologic complications1 (2.6%)2 (2.9%)1.01.0
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L. Goertz, T. Liebig, E. Siebert, M. Herzberg, L. Pennig, M. Schlamann, J. Borggrefe, B. Krischek, F. Dorn, C. Kabbasch
Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility
American Journal of Neuroradiology Sep 2019, DOI: 10.3174/ajnr.A6183

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Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility
L. Goertz, T. Liebig, E. Siebert, M. Herzberg, L. Pennig, M. Schlamann, J. Borggrefe, B. Krischek, F. Dorn, C. Kabbasch
American Journal of Neuroradiology Sep 2019, DOI: 10.3174/ajnr.A6183
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