Document Type
Article
Publication Date
3-22-2025
Abstract
While the Woven EndoBridge (WEB) device has transformed the treatment of wide-neck intracranial aneurysms, incomplete occlusion remains a significant challenge requiring better understanding of contributing factors. A retrospective analysis was conducted on multicenter data from patients who underwent WEB device treatment for intracranial aneurysms between January 2011 and December 2022. Using machine learning models, Cox regression, and time-stratified analyses, we evaluated factors associated with persistent incomplete occlusion, defined as non-improving Raymond-Roy Occlusion Classification grade 2 or 3 at final follow-up. Among 813 patients (607 with < 24 months follow-up, 206 with ≥ 24 months), machine learning analysis identified aneurysm height, Acom location, neck diameter, and pretreatment mRS as predictors of persistent incomplete occlusion. On Cox regression. larger aneurysm neck diameter (HR 1.13, 95% CI 1.01-1.27, p = 0.027) and height (HR 1.14, 95% CI 1.02-1.26, p = 0.017), and radial access (HR 2.68, 95% CI 1.76-4.07, p < 0.001) increased, while posterior circulation location (HR 0.56, 95% CI 0.37-0.84, p = 0.005) decreased the risk of persistent incomplete occlusion. Time-stratified analysis revealed that in short-term follow-up (< 24 months), larger aneurysm neck diameter (OR 1.28, 95% CI 1.08-1.52, p = 0.004) increased the risk of incomplete occlusion. In long-term follow-up (≥ 24 months), smoking (OR 2.69, 95% CI 1.04-7.00, p = 0.04), higher pre-treatment mRS (OR 1.78, 95% CI 1.15-2.76, p = 0.009), and immediate flow stagnation (OR 0.33, 95% CI 0.11-0.96, p = 0.04) increased, while older age (OR 0.94, 95% CI 0.90-0.98, p = 0.002) and WEB-DL (OR 0.06, p < 0.001) and SLS devices (OR 0.02, p = 0.003) decreased the risk of persistent incomplete occlusion. Aneurysm characteristics and device type significantly influence long-term WEB treatment outcomes.
Recommended Citation
Essibayi, Muhammed Amir; Jabal, Mohamed Sobhi; Jamil, Hasan; Salim, Hamza Adel; Musmar, Basel; Adeeb, Nimer; Dibas, Mahmoud; Cancelliere, Nicole M.; Bengzon, Jose Danilo; Algin, Oktay; Ghozy, Sherief; Lay, Sovann V.; Guenego, Adrien; Renieri, Leonardo; Carnevale, Joseph; Saliou, Guillaume; Mastorakos, Panagiotis; Naamani, Kareem El; Shotar, Eimad; Möhlenbruch, Markus; Kral, Michael; Chung, Charlotte; Salem, Mohamed M.; Lylyk, Ivan; Foreman, Paul M.; Shaikh, Hamza; Župančić, Vedran; Hafeez, Muhammad U.; Catapano, Joshua; Waqas, Muhammad; Besler, Muhammed Said; Gunes, Yasin Celal; Rabinov, James D.; Maingard, Julian; Schirmer, Clemens M.; Piano, Mariangela; Kühn, Anna L.; Michelozzi, Caterina; Starke, Robert M.; Hassan, Ameer; Ogilvie, Mark; Nguyen, Anh; Jones, Jesse; Brinjikji, Waleed; Nawka, Marie T.; Psychogios, Marios; Ulfert, Christian; Pukenas, Bryan; Burkhardt, Jan-Karl; Huynh, Thien; Martinez-Gutierrez, Juan Carlos; Sheth, Sunil A.; Slawski, Diana; Tawk, Rabih; Pulli, Benjamin; Lubicz, Boris; Panni, Pietro; Puri, Ajit S.; Pero, Guglielmo; Raz, Eytan; Griessenauer, Christoph J.; Asadi, Hamed; Siddiqui, Adnan; Levy, Elad I.; Khatri, Deepak; Haranhalli, Neil; Ducruet, Andrew F.; Albuquerque, Felipe C.; Regenhardt, Robert W.; Stapleton, Christopher J.; Kan, Peter; Kalousek, Vladimir; Lylyk, Pedro; Boddu, Srikanth; Knopman, Jared; Tjoumakaris, Stavropoula I.; Cuellar-Saenz, Hugo H.; Jabbour, Pascal; Clarençon, Frédéric; Limbucci, Nicola; Pereira, Vitor Mendes; Patel, Aman B.; Altschul, David J.; Dmytriw, Adam A.; and WorldWideWEB Consortium Collaborators, "Prediction of Persistent Incomplete Occlusion of Intracranial Aneurysms Treated With Woven Endobridge Device" (2025). Department of Neurosurgery Faculty Papers. Paper 256.
https://jdc.jefferson.edu/neurosurgeryfp/256
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
40119209
Language
English
Comments
This article is the author's final published version in Neurosurgical Review, Volume 48, Issue 1, March 2025, Article number 314.
The published version is available at https://doi.org/10.1007/s10143-025-03439-8. Copyright @ The Author(s).