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 ... show 10 more
Authors
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 M
Clarençon, Frédéric
Limbucci, Nicola
Pereira, Vitor Mendes
Patel, Aman B
Altschul, David J
Dmytriw, Adam A
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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.