Treatment of ruptured intracranial aneurysms with the Woven EndoBridge device: one-year angiographic and clinical follow-up in a single-center cohort

Objective: The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor used to treat wide-neck bifurcation aneurysms without adjunctive stents or dual antiplatelet therapy.Evidence supporting its use in ruptured aneurysms remains limited.This study evaluated 1-year angiographic and clinical outcomes in a singlecenter cohort of patients with ruptured aneurysms treated with the WEB device.Methods: Thirteen patients with aneurysmal subarachnoid hemorrhage treated with the WEB device between January 2023 and December 2024 were retrospectively analyzed.WEB sizing, Hunt-Hess grade, modified Fisher grade, and 12-month modified Rankin Scale (mRS) scores were recorded.All patients underwent magnetic resonance angiography at 6 months and digital subtraction angiography (DSA) at 12 months.Aneurysm occlusion was graded using the WEB Occlusion Scale (WOS), with adequate occlusion defined as WOS A or B.Results: The cohort included 11 men and two women, with a mean age of 49.4 years (range, 41-82 years).Hunt-Hess grades were II in nine patients (69%), IV in three (23%), and V in one (8%); modified Fisher grades were 3 in five patients (38%) and 4 in eight (62%).At 12-month DSA, adequate occlusion was achieved in nine of 13 aneurysms (69%): three (23%) were WOS A and six (46%) were WOS B. Three aneurysms (23%) had a neck remnant, and one (8%) had an aneurysm remnant, which was retreated with stent-assisted coiling.At 12 months, the mRS score was 0 in nine patients (69%), 3 in two (15%), and 4 in two (15%).No procedure-related complications, rebleeding, or deaths occurred.Conclusion: Primary WEB treatment of ruptured intracranial aneurysms achieved adequate occlusion in most cases at 1 year without rebleeding.These findings suggest that the WEB device may be a feasible alternative to conventional coiling or stent-assisted coiling in selected ruptured aneurysms, particularly when avoiding adjunctive stents and dual antiplatelet therapy is desirable.