Aneurysm plugging device proven safe, effective in real-world study

A device for treating aneurysms or balloon-like swelling of blood vessels due to weakened artery walls has passed muster in real world, showing a favourable efficacy and safety profile, according to data from the WorldWideWEB Consortium.

Known as Woven EndoBridge (WEB), the device features a tiny mesh plug that can be inserted through a vessel and placed into an aneurysm to block or occlude blood from traveling into the swelling region—helping stabilize the vessel and preventing the aneurysm from rupturing, which can cause life-threatening bleeding.

The WEB device has other merits, according to lead study author Dr Adam Dmytriw, an interventional neuroradiology and endovascular neurosurgery fellow at Massachusetts General Hospital in the US.

Dmytriw explained that WEB can also be used to stabilize acutely ruptured aneurysms and that it bypasses the need for blood thinning medication as other therapies do.

“The WEB has recently become available in the United States, and elsewhere across the globe the device has been available for a longer time—but no large-scale study of its efficacy had been performed until now,” Dmytriw said.

“Thus, we founded the WorldWideWEB Consortium uniting the experience of 22 tertiary/quaternary institutions across North America, Europe, South America, and Australia,” he added.

WEB impresses in real-world setting

The WorldWideWEB Consortium included 671 patients with 683 brain aneurysms, of which 26.2 percent were previously ruptured. These patients underwent treatment with the WEB device and were followed for a median of 11 months.

Majority (85.7 percent) of aneurysms achieved adequate occlusion with the device, while 57.8 percent had complete occlusion. Retreatment was required in 7.8 percent of aneurysms. [Stroke 2021;doi:10.1161/STROKEAHA.121.037609]

Blood clot-related complications occurred in 7.5 percent of procedures, of which 4.0 percent were symptomatic and 2.0 percent were permanent. Bleeding complications were reported in 3.0 percent of procedures. None of the patients with previously ruptured aneurysm experienced rerupture after treatment.

WEB is specifically developed for wide-neck bifurcation aneurysms, which can be difficult to treat due to its predisposition to coil herniation into the parent artery and the bifurcation location posing challenges to the use of assist devices, as Dmytriw pointed out.

“Patients who are not suitable for open aneurysm surgery or who have recently had a life-threatening rupture and would be at high risk for additional bleeding if treated with conventional endovascular techniques due to the need for blood thinners now have a viable treatment option,” according to Dmytriw.

“We hope that our results will help guide interventionalists in the appropriate use of the WEB so that patients with challenging brain aneurysms will have a safe option for care,” he said.

Dmytriw stated that wide-ranging studies to assess the use of the WEB for diverse types of aneurysms are already in the works. These studies will additionally evaluate potential challenges to the use of the device.