title: Endovascular WEB flow disruption in middle cerebral artery aneurysms: preliminary feasibility, clinical, and anatomical results in a multicenter study.
abstract: BACKGROUND
  The endovascular treatment of middle cerebral artery (MCA) aneurysms with unfavorable anatomy (wide neck, unfavorable morphology) is frequently challenging. Flow disruption with the WEB is a potentially interesting endovascular treatment for this type of aneurysm.
  
  
  OBJECTIVE
  To report in a multicenter series the preliminary treatment experience of MCA aneurysms with flow disruption by the WEB.
  
  
  METHODS
  Thirty-three patients with 34 MCA aneurysms were treated with the WEB in 5 European centers. The ability to successfully deploy the WEB, procedure- and device-related adverse events, morbidity and mortality of the treatment, and short-term angiographic follow-up results were analyzed.
  
  
  RESULTS
  Most treated aneurysms were unruptured (85.3%) and were between 5 and 10 mm (85.3%) with a neck size ≥  4 mm (88.2%). The treatment failed in 1 of the 34 aneurysms (2.9%) owing to a lack of appropriate device size. Treatment was performed exclusively with the WEB in 29 of 33 aneurysms (87.9%). Additional treatment (coiling and/or stenting) was used in 4 of 33 aneurysms (12.1%). Mortality of the treatment was 0.0% and morbidity was 3.1% (intraoperative rupture with modified Rankin Scale score of 3 at the 1-month follow-up). In short-term follow-up (range, 2-12 months), adequate occlusion (total occlusion or neck remnant) was observed in 83.3% of aneurysms.
  
  
  CONCLUSIONS
  WEB flow disruption seems to be a promising technique for the treatment of complex MCA aneurysms, particularly those with a wide neck or unfavorable dome-to-neck ratio.
authors.affiliation: Department of Radiology, Maison Blanche Hospital, University of Reims, Reims, France. lpierot@gmail.com
authors.forename: Laurent
authors.initials: L
authors.lastname: Pierot
authors.forename: Joachim
authors.initials: J
authors.lastname: Klisch
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.forename: Istvan
authors.initials: I
authors.lastname: Szikora
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mine
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kadziolka
authors.forename: Vojtech
authors.initials: V
authors.lastname: Sychra
authors.forename: Istvan
authors.initials: I
authors.lastname: Gubucz
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Januel
authors.forename: Boris
authors.initials: B
authors.lastname: Lubicz
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000401:mortality*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome