Off-Label Use of The WEB Device

Abstract Introduction We present our initial experience with the off-label use of the WEB device. Methods We performed a retrospective study from 2 institutions of patients with intracranial aneurysms who underwent treatment with WEB device alone or in conjunction with stenting and/or coiling in an off-labeled location. Results Eleven patients with 12 aneurysms were included. Four (30.8%) aneurysms presented ruptured. Off-labeled locations included 3 aneurysms in the posterior communicating artery (PCOM), 3 supraclinoid ophthalmic artery (OA), 2 pericallosal artery, 2 posterior inferior cerebellar artery (PICA), 1 vertebrobasilar junction, and 1 cavernous internal carotid artery (ICA). Mean dome-to-neck ratio was 1.91±0.9. Average duration of the procedure was 63.9±29.6 min. Femoral route was used in 61.5% and radial access in 48.5% of cases. Five procedures (41.7%) were performed under monitored anesthesia care. We had 1.33 attempts per aneurysm. WEB embolization was supplemented with coiling in 2 cases (16.67%) and stenting in 1 case (8.3%). Based on the ‘OKM’ grading scale, we report a rate of 0% for grade 1, 33.3% for grade 2 and 33.3% for grade 3. Post-procedural occlusion was complete in 4 (33.3%) and adequate in 8 (66.6%) patients. No procedure-related deaths or symptomatic complications were reported. Conclusion The WEB device was successfully deployed in off-labeled locations, including PCOM, OA and pericallosal aneurysms. The efficacy of this usage must be evaluated in multicenter prospective studies, but our preliminary results are promising. Correct characterization of the aneurysm size/morphology, as well as awareness of possible adjunct treatments, are crucial for successful intervention.