Aneurysms can have different shapes, sizes and locations. The microsurgical and endovascular treatment techniques used to treatment individual aneurysms vary depending on these aneurysm characteristics. Traditionally, broad-based aneurysms have been better treated with microsurgical clipping. While there have been tools available to treat broad-based aneurysms via an endovascular approach, this usually has required the placement of one, or multiple, stents to improve the aneurysm base for coiling (‘stent-assisted coiling’) or placing a special type of stent promoting flow away from aneurysms (‘flow-diverting stent’). Both these techniques require life-long blood thinning medications, (e.g. aspirin, clopidogrel or prasugrel) and at least 2 of these medications in the first 6 – 12 months.
The WEB device (Sequent Medical Ltd, CA, USA) has been produced for broad-based aneurysms. It is designed using stent weaving technology to be delivered inside the aneurysm (‘intrasaccular device’) leading to almost instant closure of the aneurysm. The WEB device has been used in Europe in over 4000 patients. Currently, the WEB device is yet to be FDA-approved for general use in USA, but was used in a recent trial (WEB-IT trial), which had impressive results with less than 1% complication rate.
The WEB device has recently been TGA-approved in Australia, and has been used at some hospitals in Perth, Melbourne and Auckland. This device was approved for use at Royal Prince Alfred Hospital (RPAH) in December 2017.
On 17th January 2018, Dr Wong successfully treated the first patient in NSW using the WEB device at RPAH with excellent results. Long-term follow-up is still pending, but this novel treatment may prove to be a major advancement for endovascular treatment of broad-based aneurysms.