Microsurgical clipping of ruptured wide-neck Aneurysms: A comparative analysis with Woven EndoBridge data

Due to their complex configuration, wide-neck aneurysms (WNAs) present significant challenges. The intrasaccular Woven EndoBridge (WEB) device was introduced in 2010. However, complete occlusion rates with WEB remain relatively low (40-60 %). The aim of this study was therefore to evaluate our institutional experience with microsurgical clipping of ruptured WNAs and to compare these results with a cohort of WNAs treated with the WEB device.

A retrospective study of consecutive adult patients with ruptured WNAs who underwent microsurgical clipping at our institution between 2010 and 2020 was performed. Primary outcome measure was the complete occlusion of the aneurysm equivalent to a Raymond Roy Occlusion Classification (RROC) Class I. Subsequently, our institutional results were then compared with outcomes from the U.S. multicenter WEB study by Cortez et al.

87 patients with ruptured WNBAs were included. The most common aneurysm location was the anterior communicating artery (45/87, 52 %), followed by the middle cerebral artery bifurcation (38/87, 44 %), internal carotid artery terminus (2/87, 2 %), and basilar artery apex (2/87, 2 %). Mean follow-up in our cohort was 22.7 (±29.1) months. The procedure-related morbidity was low in both cohorts, 3.3 % (3/91) in the WEB cohort and 2.3 % (2/87) in our cohort (p = 1.00). However, the complete occlusion rate after microsurgical clipping was significantly higher (94 % (82/87)) compared to WEB (48 % (24/50) (p < 0.001)).

The study demonstrates that microsurgical clipping is a safe and effective treatment method for ruptured WNAs aneurysms and that it is superior to WEB in terms of complete aneurysm occlusion.