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Prediction of persistent incomplete occlusion of intracranial aneurysms treated with woven EndoBridge device

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
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UMass Chan Affiliations
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Journal Article
Publication Date
2025-03-22
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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.

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Essibayi MA, Jabal MS, Jamil H, Salim HA, Musmar B, Adeeb N, Dibas M, Cancelliere NM, Bengzon JD, Algin O, Ghozy S, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, Naamani KE, Shotar E, Möhlenbruch M, Kral M, Chung C, Salem MM, Lylyk I, Foreman PM, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Besler MS, Gunes YC, Rabinov JD, Maingard J, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Starke RM, Hassan A, Ogilvie M, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Sheth SA, Slawski D, Tawk R, Pulli B, Lubicz B, Panni P, Puri AS, Pero G, Raz E, Griessenauer CJ, Asadi H, Siddiqui A, Levy EI, Khatri D, Haranhalli N, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Tjoumakaris SI, Cuellar-Saenz HH, Jabbour PM, Clarençon F, Limbucci N, Pereira VM, Patel AB, Altschul DJ, Dmytriw AA; WorldWideWEB Consortium Collaborators. Prediction of persistent incomplete occlusion of intracranial aneurysms treated with woven EndoBridge device. Neurosurg Rev. 2025 Mar 22;48(1):314. doi: 10.1007/s10143-025-03439-8. PMID: 40119209; PMCID: PMC11928387.

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DOI
10.1007/s10143-025-03439-8
PubMed ID
40119209
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Open Access: This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.