Abstract 122: Intra-aneurysmal Flow Disruption: A New Approach for the Endovascular Treatment of Intracranial Aneurysms. Clinical Experience in a Multicenter Series of 66 Patients with 68 Aneurysms.

Purpose: Standard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalizations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Clinical experience with this new technique is analyzed in a series collected in 11 French centers. Materials and Methods: The WEB (Sequent, Aliso Viejo, CA) is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal. 66 patients (49F/17M, age: 36-75 years) harbouring 68 aneurysms (ruptured: 5, unruptured: 57 or recanalized: 6) were treated between June 2011 and July 2013. Aneurysm location was middle cerebral artery (39 aneurysms), basilar artery (16), anterior communicating artery (7), and internal carotid artery (6). Results: The device was successfully deployed in all but 4 cases (failure rate: 5.9%). Additional coiling was performed in 6 aneurysms, remodeling in 2 cases, and stenting in 1 case. One intraoperative rupture was observed in a ruptured aneurysm (1.5%). Six thromboembolic events (8.8%) were observed with transient clinical worsening and good clinical outcome in 5 cases (mRS ≤2). No delayed rupture or remote hematoma was observed. Finally mortality was 0.0% and morbidity 1.5% (in a patient who both had intraoperative rupture and thromboembolic complication). Anatomical follow-up was obtained in 32 patients 3 to 15 months after the treatment. Total occlusion was obtained in 15/32 aneurysms (46.9%), neck remnant in 14/32 aneurysms (43.8%), and aneurysm remnant in 3/32 aneurysms (9.4%). Conclusion: In the present series reporting the initial clinical experience with intra-saccular flow disruption using WEB in 11 French centers, the feasibility of treatment is high, the safety profile similar to coiling, and anatomical results are quite satisfactory knowing that some neck remnants are in fact just opacification of the proximal recess of the device.