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

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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Publication Details

Journal
Neurosurgical Review
Published
2025-03-22
DOI
https://doi.org/10.1007/s10143-025-03439-8
Citations
5
Primary Topic
Intracranial Aneurysms: Treatment and Complications
Type
article
Field-Weighted Citation Impact
6.95
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article

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

Alex Brehm, Joshua S. Catapano, Mohammad Ali Aziz‐Sultan, Eytan Raz et al.
5 citations
Neurosurgical Review
Intracranial Aneurysms: Treatment and Complications
6.95
article

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

Alex Brehm, Joshua S. Catapano, Mohammad Ali Aziz‐Sultan, Eytan Raz, Thien J Huynh, Assala Aslan, Ajit S Puri, Hamza A. Shaikh, Steven Hajdu, Oktay Algın, Justin E. Vranic, Marwa A. Mohammed, Rachel McLellan, Benjamin Pulli, Vedran Župančić, Muhammad Ubaid Hafeez, Markus Alfred Möhlenbruch, Neil Haranhalli, Guillaume Saliou, Mohamed Sobhi Jabal, Mark Ogilvie, Christoph J. Griessenauer, Hamza Adel Salim, Sovann V. Lay, Elad I. Levy, Guglielmo Pero, Charlotte Y. Chung, Pietro Panni, James D. Rabinov, Johan Bengzon, Stavropoula I. Tjoumakaris, Nimer Adeeb, Deepak Khatri, David Altschul, Christopher J. Stapleton, Rabih G. Tawk, Sunil G. Sheth, Shervin Mirshahi, Paul M. Foreman, Adnan H. Siddiqui, Mehmet Özgür Özateş, Muhammed Amir Essibayi, Boris Lubicz, Srikanth Boddu, Yasin Celal Güneş, Jesse George Atherton Jones, Stéphanie Elens, Mahmoud Dibas, Clemens Maria Schirmer, Iván Lylyk, Nicole M Cancelliere, Anna Luisa Kühn, Adam Andrew Dmytriw, Mohamed M Salem, Mohamed K. Ibrahim, Jay A. Vachhani, Kévin Premat, Sherief Ghozy, Vincent M. Tutino, Bruno Bartolini, Leonardo Renieri, Waleed Brinjikji, Peter Kan, Anh Nguyên, Diana Slawski, Christian Ulfert, Yasuaki Inoue, Nicola Limbucci, Joseph A. Carnevale, Caterina Michelozzi, Marie Teresa Nawka, Robert William Regenhardt, Pascal M. Jabbour, Frédéric Clarençon, Vladimir Kalousek, Felipe C. Albuquerque, Panagiotis Mastorakos, Francesco Puccinelli, Peter Bernhard Sporns, Gıyas Ayberk, Erez Nossek, Julian Maingard, Michael Kral, Martin Cuellar Torriente, Ameer E Hassan, Ali Al Balushi, Vítor Mendes Pereira, Omer Doron, Sri Hari Sundararajan, Hamed Asadi, Jared Knopman, Adrien Guenego, Jan‐Karl Burkhardt, Mariangela Piano, Basel Musmar, Muhammed Said Beşler, Eimad Shotar, Aman B. Patel, Monika Killer-Oberfalzer, Muhammad Waqas, Robert M. Starke, Pedro Lylyk, Julian Spears, Andrew F. Ducruet, Christian Swaid, Juan Carlos Martinez-Gutierrez, Hugo H. Cuellar-Saenz, Hikmet Jamil, Bryan Pukenas, Kareem El Naamani, Marios Psychogios
article en
5 citations

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.

Neurosurgical ReviewVol. 48(1)
Geisinger Medical Center (US), St. Michael's Hospital (CA), Albert Einstein College of Medicine (US), Barrow Neurological Institute (US), Montefiore Medical Center (US), NewYork–Presbyterian Hospital (US), Harvard University (US), Johns Hopkins University (US), University of Miami (US), Orlando Health (US), Ankara University (TR), Universität Hamburg (DE), University of Toronto (CA), Cornell University (US), Heidelberg University (DE), Louisiana State University in Shreveport (US), Thomas Jefferson University Hospital (US), New York Hospital Queens (US), Erasmus Hospital (BE), University Hospital Heidelberg (DE), Centre Hospitalier Universitaire Vaudois (CH), WinnMed (US), University Hospital of Basel (CH), Johns Hopkins Bayview Medical Center (US), Centre Hospitalier Universitaire de Toulouse (FR), University of Alabama at Birmingham (US), Sorbonne Université (FR), NYU Langone Health (US), Massachusetts General Hospital (US), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Presbyterian Hospital (US), Christian Doppler Klinik (AT), Baylor School (US), University Medical Center Hamburg-Eppendorf (DE), Pitié-Salpêtrière Hospital (FR), Mayo Clinic in Arizona (US), Valley Baptist Medical Center (US), IRCCS Ospedale San Raffaele (IT), Mayo Clinic in Florida (US), Neurological Surgery (US), Memorial Hospital (US), Austin Health (AU), Kırıkkale University (TR), Kahramanmaraş Sütçü İmam University (TR), University at Buffalo, State University of New York (US), University of Pennsylvania (US), The University of Texas Health Science Center at Houston (US), Stanford University (US)
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