田邉 淳

BACKGROUND: This study evaluated the safety and efficacy of a treatment strategy for Posterior communicating artery (PCOM) aneurysms using first-line Woven EndoBridge (WEB), supplemented by Flow diverter (FD) in selected cases. METHODS: This retrospective study included patients who underwent endovascular treatment for PCOM aneurysms between January 2021 and March 2025. Aneurysms were categorized as fetal or non-fetal. A first-line WEB strategy was adopted when morphology was suitable. Radiological and clinical outcomes were assessed. RESULTS: Forty-six PCOM aneurysms met the criteria: 14 fetal-type and 32 non-fetal-type. All previously untreated fetal-type aneurysms were treated with WEB (n = 9). In the non-fetal group, the initial treatments included WEB (n = 14), FD (n = 10), and coiling (n = 4). All recurrent fetal-type aneurysms were retreated with FD (n = 5), whereas non-fetal recurrences were managed with FD (n = 3) or coiling (n = 1), depending on prior treatment. At a median follow-up of 21 months, complete occlusion was achieved in 66.7% of fetal-type and 59.4% of non-fetal-type aneurysms (P = 0.739), and adequate occlusion was achieved in 75.0% and 90.6%, respectively (P = 0.321). Retreatment was required in two cases (4.3%): one in the fetal group (7.1%) and one in the non-fetal group (3.1%) (p = 0.512). No modified Rankin Scale worsening or major complications occurred. No significant differences in treatment efficacy were observed among modalities selected under the WEB first-line strategy. CONCLUSION: A first-line WEB strategy is safe and effective for PCOM aneurysms, including fetal-type variants, with outcomes for fetal-type aneurysms comparable to non-fetal-type aneurysms.

PURPOSE: The Woven EndoBridge (WEB) was introduced in Japan in January 2021 and approved for all subtypes of wide-neck bifurcation aneurysms (WNBA). This retrospective study evaluated the safety and efficacy of the WEB device for all subtypes of WNBA. MATERIALS AND METHODS: All patients treated with the WEB at our facility between January 2021 and May 2024 was reviewed. We selected the WEB device according to an oversizing policy, based on cumulative clinical evidence from global experience. RESULTS: We analyzed 120 aneurysms in 117 patients (56 males and 61 females with a mean age of 65.5±12.7 years). There were 45 anterior communicating artery aneurysms, 27 middle cerebral artery aneurysms, 17 internal carotid artery-posterior communicating artery aneurysms, 15 basilar artery top aneurysms, and 16 aneurysms in other locations. Aneurysm characteristics included a maximum diameter of 6.5 [5.3, 7.7] mm, height of 4.9 [3.9, 6.0] mm, width of 4.8 [4.0, 6.2] mm, and dome/neck ratio of 1.2 [1.1, 1.4]. All data are expressed in median [interquartile range]. Angiographic follow-up at 12 months in 96 cases showed complete obliteration in 68.8% and adequate obliteration in 90.6% of cases. Intraoperative ischemic events occurred in 5 cases (4.2%). Hemorrhagic events occurred in 2 cases (1.7%), with symptoms resolving by discharge, except for 1 case of mild paralysis. During follow-up, 1 patient developed a major stroke, resulting in morbidity (0.8%). Retreatment was required in 3 cases (2.5%). On multivariate analysis for complete occlusion at 12 months following WEB treatment, age was statistically associated with the outcome (odds ratio, 0.957 per year; 95% confidence interval, 0.919-0.996; P=0.033). CONCLUSION: WEB is safe and effective for all subtypes of WNBA, with a low retreatment rate using an oversizing policy. This is the first report in a Japanese population.