• Jason A Chen, Shervin Mirshahi, Yasser Jeelani, Joshua D Bernstock, Christopher Stapleton, and Nirav J Patel.
• Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2022 Sep 1; 165: 188-197.e1.

BackgroundThe Woven EndoBridge (WEB) device is designed for intrasaccular flow disruption for embolization of intracranial aneurysms. In limited experience so far, the rate of rupture after adequate occlusion by embolization has been low.MethodsA 58-year-old man initially had an incidental, unruptured 10.4-mm anterior communicating artery aneurysm treated with WEB embolization. Although his 6 months follow-up angiogram showed adequate occlusion of the aneurysm, he presented to our facility with aneurysmal recurrence caused by WEB compaction and rupture. This condition was treated with surgical clipping of the aneurysm. The literature was systematically reviewed for cases of delayed rupture after WEB embolization. Statistical analyses included studies with at least 20 patients and follow-up of 3 months.ResultsWe identified 36 studies, which were primarily retrospective observational studies. The rate of complete occlusion ranged from 33% to 89%, and the rate of re-treatment ranged from 1.5% to 27%. Across 4 studies, the rate of recanalization ranged from 8.7% to 13%. Two cases of delayed rupture were reported; an additional 4 cases were found in case reports and case series. In only 1 previous case, the aneurysm was reported as previously untreated.ConclusionsEarly retrospective data have begun to define the history of WEB-treated aneurysms. Rupture of a previously unruptured, WEB-treated aneurysm with adequate initial occlusion is rare. We describe such a case with techniques for management, showing that aneurysm recurrence and delayed rupture are possible despite good interim angiographic results. This report raises questions about follow-up for WEB-treated aneurysms.Copyright © 2022 Elsevier Inc. All rights reserved.

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