Woven EndoBridge versus stent-assisted coil embolization of cerebral bifurcation aneurysms

Kareem El NaamaniDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Ching-Jen ChenDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Rawad AbbasDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Ahmad SweidDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Georgios S. SioutasDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Khodr BadihDepartment of Physics, University of Toronto, Ontario, Canada

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Sunidhi RameshDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Stavropoula I. TjoumakarisDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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M. Reid GoochDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Nabeel A. HerialDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Hekmat ZarzourDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Richard F. SchmidtDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Robert H. RosenwasserDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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Pascal M. JabbourDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and

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OBJECTIVE

Stent-assisted coil (SAC) embolization has been the mainstay endovascular treatment for bifurcation aneurysms. The recent introduction of the Woven EndoBridge (WEB) device has presented an alternative endovascular treatment modality for these aneurysms. Direct comparisons of outcomes between these two modalities are limited in the literature. Here, the authors compared the outcomes of bifurcation aneurysms treated with SAC and WEB devices.

METHODS

This retrospective single-center study comprised 148 bifurcation aneurysms that were treated endovascularly with SAC or WEB devices between 2011 and 2019. The primary outcome was complete occlusion of the aneurysm at 6 months on catheter angiography.

RESULTS

The SAC and WEB cohorts comprised 85 and 63 aneurysms, respectively. The baseline characteristics were well balanced after inverse probability weight (IPW) adjustment, except for smoking status. The 6-month complete occlusion rate was higher in the WEB cohort than the SAC cohort (67.4% vs 40.6%; unadjusted OR [95% CI] 3.014 [1.385–6.563], p = 0.005). However, this difference in complete occlusion rates did not remain significant after IPW adjustment and multiple imputations. The neck remnant rate was lower in the WEB cohort than the SAC cohort (20% vs 50%; OR [95% CI] 0.250 [0.107–0.584], p = 0.001), and this difference remained significant after IPW adjustment (OR [95% CI] 0.304 [0.116–0.795], p = 0.015) and multiple imputations.

CONCLUSIONS

Use of SAC and WEB demonstrated comparable 6-month complete occlusion rates for bifurcation aneurysms. WEB appeared to be associated with a lower rate of neck remnant at 6 and 12 months compared with SAC. WEB was also associated with fewer complications and decreased retreatment rates compared with SAC.

ABBREVIATIONS

AComA = anterior communicating artery; CI = confidence interval; ICA = internal carotid artery; IPW = inverse probability weight; MCA = middle cerebral artery; OR = odds ratio; SAC = stent-assisted coil; WEB = Woven EndoBridge.
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Figure from Kim et al. (pp 1601–1609).

  • 1

    Toccaceli G, Diana F, Cagnazzo F, et al. Microsurgical clipping compared with new and most advanced endovascular techniques in the treatment of unruptured middle cerebral artery aneurysms: a meta-analysis in the modern era. World Neurosurg. 2020;137:451464.e1.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Youssef PP, Dornbos Iii D, Peterson J, et al. Woven EndoBridge (WEB) device in the treatment of ruptured aneurysms. J Neurointerv Surg. 2021;13(5):443446.

  • 3

    Campos JK, Lien BV, Wang AS, Lin LM. Advances in endovascular aneurysm management: coiling and adjunctive devices. Stroke Vasc Neurol. 2020;5(1):1421.

  • 4

    Hendricks BK, Yoon JS, Yaeger K, et al. Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications. J Neurosurg. 2020;133(1):159165.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Jin SC, Kwon OK, Oh CW, et al. Simple coiling using single or multiple catheters without balloons or stents in middle cerebral artery bifurcation aneurysms. Neuroradiology. 2013;55(3):321326.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Arthur AS, Molyneux A, Coon AL, et al. The safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal WEB Intrasaccular Therapy (WEB-IT) Study. J Neurointerv Surg. 2019;11(9):924930.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Fiorella D, Molyneux A, Coon A, et al. Demographic, procedural and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT). J Neurointerv Surg. 2017;9(12):11911196.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Heidarian Miri H, Hassanzadeh J, Rajaeefard A, Mirmohammadkhani M, Ahmadi Angali K. Multiple imputation to correct for nonresponse bias: application in non-communicable disease risk factors survey. Glob J Health Sci. 2015;8(1):133142.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34(6):13981403.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Pierot L, Moret J, Turjman F, et al. WEB treatment of intracranial aneurysms: feasibility, complications, and 1-month safety results with the WEB DL and WEB SL/SLS in the French Observatory. AJNR Am J Neuroradiol. 2015;36(5):922927.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Pierot L, Costalat V, Moret J, et al. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study. J Neurosurg. 2016;124(5):12501256.

  • 12

    Pierot L, Moret J, Turjman F, et al. WEB treatment of intracranial aneurysms: clinical and anatomic results in the French Observatory. AJNR Am J Neuroradiol. 2016;37(4):655659.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Pierot L, Gubucz I, Buhk JH, et al. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol. 2017;38(6):11511155.

  • 14

    Pierot L, Moret J, Barreau X, et al. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series. J Neurointerv Surg. 2018;10(6):553559.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    van Rooij SBT, van Rooij WJ, Peluso JP, et al. WEB treatment of ruptured intracranial aneurysms: a single-center cohort of 100 patients. AJNR Am J Neuroradiol. 2017;38(12):22822287.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Asnafi S, Rouchaud A, Pierot L, Brinjikji W, Murad MH, Kallmes DF. Efficacy and safety of the Woven EndoBridge (WEB) device for the treatment of intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2016;37(12):22872292.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Mahaney KB, Chalouhi N, Viljoen S, et al. Risk of hemorrhagic complication associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy. J Neurosurg. 2013;119(4):937942.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Tumialán LM, Zhang YJ, Cawley CM, Dion JE, Tong FC, Barrow DL. Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report. J Neurosurg. 2008;108(6):11221129.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Kabbasch C, Goertz L, Siebert E, et al. WEB embolization versus stent-assisted coiling: comparison of complication rates and angiographic outcomes. J Neurointerv Surg. 2019;11(8):812816.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Kabbasch C, Goertz L, Siebert E, et al. Treatment strategies for recurrent and residual aneurysms after Woven Endobridge implantation. J Neurointerv Surg. 2019;11(4):390395.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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