Endosaccular flow disruption devices, also simply known as flow disruptors, are used for the treatment of saccular, wide-neck, and usually bifurcation intracranial aneurysms. Their primary function is to stop blood from flowing into the aneurysm, allowing time for the aneurysm to heal. They are usually tightly packed nitinol-based material in different shapes.
Currently (as of 2020) there are four types of flow disruptors:
- Woven EndoBridge (WEB) Aneurysm Embolization System
- LUNA™ Aneurysm Embolization System
- Medina Embolic Device (MED)
- Contour Neurovascular System™
Antiplatelet regimen differs between institutions ranging from mono or dual antiplatelet regimens prior to and after the procedures (depending on concomitant or prior stenting).
The most common complication is thromboembolism. Delayed ipsilateral parenchymal hemorrhage, a very serious but rare complication, was also reported.
Among them, WEB is the most widely known and studied device. Large European multicenter trials (WEBCAST and WEBCAST 2) illustrated a very high success rate (complete occlusion or neck remnant at one-year follow-up) in 80% with no device-related mortality and only 1.8-2% morbidity.
Follow up imaging
Serial imaging may assess the recurrence of the aneurysm which can infrequently occur due to device migration or device compaction, possibly requiring re-treatment.
Time-of-flight MRA is a useful screening modality to assess WEB-treated aneurysms. DSA remains the gold standard for follow-up.
The WEB Occlusion Scale (WOS) can be employed to assess the adequacy of treatment.
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