Page 37 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Antiplatelet treatments in neurological patients

Sizing of the WEB is selected according to measurements 21.2% of SAC patients; however, these results were not
of the aneurysm on 2D digital subtraction angiography statistically significant. Of note, 18.2% of SAC patients
(DSA). The WEB should be oversized to properly fill and 12.1% of WEB embolization patients developed
the aneurysm sac while allowing it to completely cover thromboembolic complications. The authors conclude that
its neck. Afterward, the device is delivered through a WEB embolization is a viable alternative for the treatment
microcatheter [101,102] . of wide-neck bifurcation aneurysms, given that it limits
long-term DAPT [101] .
A review published in 2021 by Crinnion et al.
[93]
summarized 11 articles encompassing 405 aneurysms Another review performed in 2022 by Monteiro et al.
in 398 patients diagnosed with ruptured aneurysms or analyzed nine articles with 377 acutely ruptured aneurysms
subarachnoid hemorrhages that were treated with WEB treated with WEB embolization. Of the samples, 85.9%
embolization. Aneurysm characteristics included a range were anterior circulation aneurysms and 82.7% of them
of 45%–92% anterior circulation and 7 – 56% with severe were wide-necked. Adequate occlusion occurred in 84.8%
SAH. They found that the rate of success varied between of cases and 4.5% of the patients required retreatment
95.8% and 100%, and the number of aneurysms requiring at follow-up. During catheterization, there were seven
additional techniques for occlusion was from 0% to cases of perforation in the dome of the aneurysm. In all
15%. Adequate occlusion was achieved in 71 – 96% of circumstances, once the WEB was deployed, the bleeding
patients [107-114] . halted. The rate of post-procedural complications was 1%
and was all thromboembolic .
[99]
The safety profile of WEB embolization demonstrated
that thromboembolic event rates range from 0% to 25% A study performed by Stanca et al. characterized
and overall, a thromboembolic event rate of 9.8% in all the long-term effects of WEB device. They included 35
398 patients. The authors cite two prominent studies, the ruptured WNBAs in 21 patients treated with WEB. They
CLARITY trial and the ARETA study which characterized examined patients at the 3-year mark using DSA. After
thromboembolic event rates in CE. The CLARITY trial 3 years of follow-up, three death cases were recorded,
demonstrated a thromboembolic event rate of 20.8% for which were not related to aneurysms. They also found
wide-necked aneurysms and the ARETA study showed a complete occlusion in 61.1% of patients, 0% rebleeding
thromboembolic event rate of 10.4% in 753 aneurysms; both rate, and 0% morbidity (no neurological signs). Although
of the studies used coiling for treatment. Based on this, the there was incomplete occlusion in 11.1% of patients, in this
TE rates of coiling and WEB embolization approaches are case, the neck showed no growth or minimal size increase
similar [93,115,116] . Other important safety endpoints included (<2 mm); therefore, treatment was not required. The
a 4% of morbidity, 1.8% of mortality, and rebleeding in 1.2% authors conclude that there is high stability 2 and 3 years
of patients. The authors concluded that WEB has proven to after the procedure [117] .
be safe and efficient in treating ruptured aneurysms when Overall, the WEB device demonstrates feasibility, a
comparing it to other endovascular therapies . high rate of occlusions, and a low rate of complications.
[93]
In a retrospective review by Kabbasch et al. in 2019, The clear advantages of this device include a reduction in
around 66 patients that underwent WEB embolization long-term DAPT and fewer perioperative complications.
were compared to 66 patients that underwent SAC. The risk for thromboembolic events remains a challenge
In the WEB group, 65 patients were treated with only with using the WEB device, but compared with traditional
WEB embolization, and the remaining one was treated coiling methods, the rates of these events are much lower.
with a combination of both WEB embolization and The WEB device should be considered a viable option in
additional coiling. In the SAC group, both single stent and the treatment of WNBA.
double stents were used in 80.3% and 19.7% of patients,
respectively. Out of all of the patients, those that achieved 8. Conclusion
complete occlusion immediately were 59.1% of WEB For decades, numerous studies have contributed to
embolization patients and 92.4% of SAC patients. Halfway diversifying treatment options of aneurysms. This review
through their studies, complete occlusion was achieved in presents a detailed amount of information concerning
83.3% of WEB embolization patients and 84.8% of SAC the modern techniques of aneurysm treatment, including
patients. Favorable outcomes were found in 86.4% of WEB pharmaceuticals, SAC, coiling, and WEB embolization.
embolization patients and 86.4% of SAC patients. The Different techniques demonstrate varying levels of
average treatment time was significantly longer for SAC feasibility, safety, and patient satisfaction. The ability
when compared to WEB embolization. Complications of WEB to disrupt intrasaccular flow is circumstantial
occurred in 12.1% of the WEB embolization patients and evidence that it could be used to manage thrombotic

Volume 7 Issue 1 (2024) 9 https://doi.org/10.36922/itps.1202