R ARIVANANTHAM
CHENNAI, FEB 3
In a historic breakthrough for Indian neurointerventional medicine, Rela Hospital, Chennai, has successfully performed India’s first right transradial WEB embolisation — a cutting-edge, minimally invasive procedure to treat a rare and life-threatening brain aneurysm using an advanced intrasaccular implant delivered through the wrist.
The pioneering procedure saved the life of a 60-year-old woman suffering from a complex wide-neck cerebral aneurysm, a particularly high-risk condition where the bulge in the blood vessel has a broad opening and is prone to rupture. Remarkably, the intervention avoided open brain surgery, stents, and the need for long-term dual antiplatelet medication.
- Landmark neurointervention treats rare, wide-neck brain aneurysm without open surgery
- Woven EndoBridge implant deployed via wrist artery, avoiding skull opening and stents
- 60-year-old Chennai woman saved after sudden collapse and brain bleed
- Breakthrough eliminates need for dual antiplatelet therapy in ruptured aneurysm
- Milestone positions India among global leaders in advanced cerebrovascular care
At the heart of the procedure was the Woven EndoBridge (WEB) device, a specialised implant designed to be placed inside the aneurysm itself, blocking blood flow into the bulge and allowing it to clot, shrink, and become inactive. Unlike conventional techniques, the WEB device treats the aneurysm from within, preventing re-bleeding while preserving surrounding blood vessels.
In a first for the country, the medical team accessed the brain through the right radial artery in the wrist, rather than the groin. Using a guiding catheter and microcatheter, the WEB implant was carefully navigated through the bloodstream and deployed precisely at the aneurysm site.
The patient, a homemaker from Chennai, was rushed to the hospital after experiencing a sudden, severe headache followed by loss of consciousness, accompanied by dangerously high blood pressure measuring 230/140 mmHg. On arrival, she remained unconscious and in critical condition.
Emergency investigations, including a CT brain scan and cerebral digital subtraction angiography (DSA), revealed bleeding around the brain on the right side. Doctors identified a wide-neck aneurysm located at a bifurcation point, where one blood vessel splits into two — a configuration that significantly increases procedural complexity and risk. Given the imminent threat to life, the team proceeded with emergency embolisation.
The procedure was led by Dr. Muralidharan Vetrivel, Cerebrovascular Neurosurgeon and Neurointerventionist, with support from Senior Neurosurgeon Dr. Natesan Damodaran and Clinical Lead in Neuroanesthesia Dr. Ramanan Rajagopal.
Commenting on the milestone, Prof. Mohamed Rela, Chairman, Rela Hospital, said, “This is the first time in India that a WEB device has been deployed inside a ruptured cerebral aneurysm through a transradial approach, marking a significant milestone in neurointerventional care. Treating wide-neck and bifurcation aneurysms is particularly complex, as these are rare, high-risk conditions that demand precision and speed. This breakthrough allows us to manage life-threatening aneurysms without opening the skull. By accessing the brain through a small puncture in the wrist, we not only minimise surgical trauma but also spare patients the prolonged bed rest and immobilisation associated with femoral artery access.”
Hypertension remains the primary risk factor, weakening arterial walls over time. Other major contributors include smoking, excessive alcohol consumption, stimulant drug use, genetic predisposition, and family history. The condition is more common in women, especially after menopause, and typically presents after the age of 40.
Explaining the technical advantage, Dr. Muralidharan Vetrivel said, “This procedure allows us to treat a life-threatening aneurysm without opening the skull, using only a small puncture in the wrist. We used specially designed catheters suitable for radial artery access and the WEB, a single intrasaccular device specifically designed for wide-neck aneurysms. Advanced support catheters, including the RIST system from Medtronic, were used to safely access the brain vessels through the radial route.”
The patient is now recovering well and has been shifted out of the ICU. In cases of ruptured aneurysms, doctors note that it typically takes around three weeks for subarachnoid haemorrhage and associated vasospasm — sudden narrowing of blood vessels — to subside. She is expected to remain hospitalised for 14 to 21 days, with strict blood pressure control and medication optimisation.
Highlighting the broader public health context, Dr. Muralidharan Vetrivel said that in India, “The annual incidence of intracranial aneurysms ranges from 6 to 16 per 100,000 population, translating to an estimated 76,500 to 204,100 new cases each year.”
He added that prevalence varies widely — from 0.75% to 10.3% — depending on population and diagnostic methods.
Doctors emphasise that regular blood pressure monitoring, avoiding smoking and excessive alcohol, and early medical evaluation are crucial. Any person experiencing a sudden, unbearable headache — often described as the ‘worst headache of life’ — especially with neck pain or loss of consciousness, should seek immediate medical attention and undergo urgent brain imaging.
