Risk Factors of Procedural Complications Related to Woven EndoBridge (WEB) Embolization of Intracranial Aneurysms
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The Woven EndoBridge (WEB) device has been proven to be a safe and efficient endovascular treatment option for wide-necked bifurcation aneurysms. The study aimed to evaluate the incidence and risk factors of procedural complications related to WEB embolization of ruptured and unruptured intracranial aneurysms.
This was a multicenter, observational study of consecutive patients with ruptured and unruptured aneurysms who were treated with the WEB at three German tertiary care centers between May 2011 and February 2018. Patient characteristics, anatomical details and procedural aspects were retrospectively collected and the impact on procedure-related complications was evaluated.
Among 120 patients (mean age 58.5 ± 11.9 years) with 120 aneurysms (mean size: 8.5 ± 4.5 mm), WEB implantation was successful in 112 patients (93.3%). The rates for overall and symptomatic complications were 11.7% and 5.0%, respectively. At 6‑month follow-up device-related morbidity was 1.2% among unruptured aneurysms and 2.6% among ruptured aneurysms. In the univariate analysis, a lower aspect ratio (p = 0.04) and an increased width-to-height ratio (p = 0.03) were significant risk factors for procedural complications.
The results of this study confirmed the WEB to be a safe treatment option, which is associated with low complication rates and minimal morbidity. Complications tended to occur more often in aneurysms with an unfavorable ratio between aneurysm height and aneurysm/neck width.
KeywordsAneurysm Complication Subarachnoid hemorrhage WEB Woven Endobridge
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Compliance with ethical guidelines
Conflict of interest
L. Goertz, E. Siebert, M. Herzberg, H. Neuschmelting, J. Borggrefe, Ö.A. Onur declare that they have no competing interests. T. Liebig serves as proctor for MicroVention Inc./Sequent Medical (Aliso Viejo, CA, USA). F. Dorn and C. Kabbasch serve as consultants for Acandis GmbH (Pforzheim, Germany).
All procedures reported in this article were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. According to institutional guidelines, no ethics committee approval was required for this retrospective observational study. The manuscript does not contain any details that might disclose the identity of the patients.
- 3.Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, Tjoumakaris S, Gonzalez LF, Dumont AS, Rosenwasser R, Randazzo CG. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke. 2013;44:1348–53.CrossRefGoogle Scholar
- 9.Goertz L, Kasuya H, Hamisch C, Kabbasch C, von Spreckelsen N, Ludyga D, Timmer M, Stavrinou P, Goldbrunner R, Brinker G, Krischek B. Impact of aneurysm shape on morbidity after clipping of unruptured intracranial aneurysms. Acta Neurochir (Wien). 2018;160:2169-76.Google Scholar
- 10.Kabbasch C, Goertz L, Siebert E, Herzberg M, Borggrefe J, Dorn F, Liebig T. Factors that determine aneurysm occlusion after embolization with the Woven EndoBridge (WEB). J Neurointerv Surg. 2018 Oct 24. doi: 10.1136/neurintsurg-2018-014361. [Epub ahead of print]Google Scholar
- 11.Kabbasch C, Goertz L, Siebert E, Herzberg M, Hamisch C, Mpotsaris A, Dorn F, Liebig T. Treatment strategies for recurrent and residual aneurysms after Woven Endobridge implantation. J Neurointerv Surg. 2018 Aug 28. doi: 10.1136/neurintsurg-2018-014230. [Epub ahead of print]Google Scholar
- 16.Liebig T, Kabbasch C, Strasilla C, Berlis A, Weber W, Pierot L, Patankar T, Barreau X, Dervin J, Kuršumović A, Rath S, Lubicz B, Klisch J. Intrasaccular flow disruption in acutely ruptured aneurysms: a multicenter retrospective review of the use of the WEB. AJNR Am J Neuroradiol. 2015;36:1721–7.CrossRefGoogle Scholar
- 18.Papagiannaki C, Spelle L, Januel AC, Benaissa A, Gauvrit JY, Costalat V, Desal H, Turjman F, Velasco S, Barreau X, Courtheoux P, Cognard C, Herbreteau D, Moret J, Pierot L. WEB intrasaccular flow disruptor—prospective, multicenter experience in 83 patients with 85 aneurysms. AJNR Am J Neuroradiol. 2014;35:2106–11.CrossRefGoogle Scholar
- 19.Pierot L, Costalat V, Moret J, Szikora I, Klisch J, Herbreteau D, Holtmannspötter M, Weber W, Januel AC, Liebig T, Sychra V, Strasilla C, Cognard C, Bonafé A, Molyneux A, Byrne JV, Spelle L. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study. J Neurosurg. 2016;124:1250–6.CrossRefGoogle Scholar
- 20.Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, Spelle L, Berkefeld J, Januel AC, Molyneux A, Byrne JV, Fiehler J, Szikora I, Barreau X. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol. 2017;38:1151-5.Google Scholar
- 21.Pierot L, Moret J, Barreau X, Szikora I, Herbreteau D, Turjman F, Holtmannspotter M, Januel AC, Costalat V, Fiehler J, Klisch J, Gauvrit JY, Weber W, Desal H, Velasco S, Liebig T, Stockx L, Berkefeld J, Molyneux A, Byrne J, Spelle L. Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter series. J Neurointerv Surg. 2018;10:553–9.CrossRefGoogle Scholar
- 22.Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Soize S, Molyneux A, Spelle L. 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;36:922–7.CrossRefGoogle Scholar