Woven Endobridge as a first-line strategy for posterior communicating artery aneurysms: enhanced applicability in fetal-type variants.

BACKGROUND

This study evaluated the safety and efficacy of a treatment strategy for Posterior communicating artery (PCOM) aneurysms using first-line Woven EndoBridge (WEB), supplemented by Flow diverter (FD) in selected cases.

METHODS

This retrospective study included patients who underwent endovascular treatment for PCOM aneurysms between January 2021 and March 2025. Aneurysms were categorized as fetal or non-fetal. A first-line WEB strategy was adopted when morphology was suitable. Radiological and clinical outcomes were assessed.

RESULTS

Forty-six PCOM aneurysms met the criteria: 14 fetal-type and 32 non-fetal-type. All previously untreated fetal-type aneurysms were treated with WEB (n = 9). In the non-fetal group, the initial treatments included WEB (n = 14), FD (n = 10), and coiling (n = 4). All recurrent fetal-type aneurysms were retreated with FD (n = 5), whereas non-fetal recurrences were managed with FD (n = 3) or coiling (n = 1), depending on prior treatment. At a median follow-up of 21 months, complete occlusion was achieved in 66.7% of fetal-type and 59.4% of non-fetal-type aneurysms (P = 0.739), and adequate occlusion was achieved in 75.0% and 90.6%, respectively (P = 0.321). Retreatment was required in two cases (4.3%): one in the fetal group (7.1%) and one in the non-fetal group (3.1%) (p = 0.512). No modified Rankin Scale worsening or major complications occurred. No significant differences in treatment efficacy were observed among modalities selected under the WEB first-line strategy.

CONCLUSION

A first-line WEB strategy is safe and effective for PCOM aneurysms, including fetal-type variants, with outcomes for fetal-type aneurysms comparable to non-fetal-type aneurysms.