Comparative effectiveness of stent-assisted coiling and Woven EndoBridge embolization for the treatment of unruptured wide-neck bifurcation intracranial aneurysms

Abstract

OBJECTIVE Woven EndoBridge (WEB) intrasaccular flow disruptors and stent-assisted coiling (SAC) are viable endovascular treatment options for wide-neck bifurcation intracranial aneurysms (WNBAs). Data directly comparing these two treatment options are limited. The authors aimed to compare radiographic occlusion rates and complication profiles between patients who received WEB and those who received SAC for WNBAs. METHODS Retrospective review of a prospectively maintained cerebrovascular procedural database was performed at a single academic medical center between 2017 and 2021. Patients were included if they underwent WEB embolization or SAC of an unruptured WNBA. SAC patients were propensity matched to WEB-embolized patients on the basis of aneurysm morphology. Complete and adequate (complete occlusion or residual neck remnant) occlusion rates at last angiographic follow-up, as well as periprocedural complications, were compared between the two groups. A cost comparison was performed for a typical 5-mm WNBA treated with WEB versus SAC by using manufacturer-suggested retail prices. RESULTS Thirty-five WEB and 70 SAC patients were included. Aneurysm width, neck size, and dome-to-neck ratio were comparable between groups. Follow-up duration was significantly longer in the SAC group (median [interquartile range] 545 [202–834] days vs 228 [177–494] days, p < 0.001, Mann-Whitney U-test). Complete (66% of WEB patients vs 69% of SAC patients) and adequate (94% WEB vs 91% SAC) occlusion rates were similar between groups at the last available angiographic follow-up (p = 0.744, chi-square test). Complete occlusion rates were comparable on Cox regression analysis after correction for follow-up duration (hazard ratio 1.5, 95% CI 0.8–3.1). Average time to residual aneurysm or neck formation was not statistically different between treatment groups (613 days for SAC patients vs 347 days for WEB patients, p = 0.225, log-rank test). Periprocedural complications trended higher in the SAC group (0% WEB vs 9% SAC, p = 0.175, Fisher exact test), although this finding was not significant. The equipment costs for a typical SAC case were estimated at $18,950, whereas the costs for a typical WEB device case were estimated at $18,630. CONCLUSIONS Midterm complete and adequate occlusion rates were similar between patients treated with WEB and those treated with SAC. Given these comparable outcomes, there may be equipoise in treatment options for WNBAs.

Safety and effectiveness of stent-assisted coiling with adjunctive techniques in ruptured acute aneurysms: a propensity score–matched cohort study

“…15 Kashkoush et al conducted a study involving 10 participants, which showed that both SAC and the Woven En-doBridge had extremely high rates of complete occlusion at last follow-up (94% for Woven EndoBridge vs 91% for SAC), with no statistically significant difference between the two modalities (p = 0.744). 5 Salem et al conducted a study involving 10 participants, which revealed that both the Pipeline Embolization Device (PED, Medtronic) group and the SAC group had similar complete occlusion rates at their last imaging follow-up evaluations (78.2% vs 78.1%). 16 A study by Piotin et al involving 7 participants found that the recurrence rate of the stent group was lower than that of the non-stent group (19.4% vs 33.5%), with a significant statistical difference between the two (p = 0.001).…”

“…accepted for treating unruptured wide-necked aneurysms due to its good safety and efficacy. 5,6 However, its use for treating ruptured aneurysms is controversial due to the significantly higher incidence rates of complications and mortality compared with its use for unruptured aneurysms. [7][8][9] Stent placement during surgery increases the complexity of the intervention and the risks of complications, prompting the use of antiplatelet drugs as a preventive measure.…”

Woven EndoBridge Device for Unruptured Wide-Neck Bifurcation Aneurysm: A Multicenter 5-Year Follow-up

“…13 Several studies comparing WEB and SAC in mixed populations have shown similar rates of AO between the treatments but with a higher rate of periprocedural complications in SAC (0% for WEB vs 9% for SAC). [24][25][26] However, a meta-analysis by Zhao et al 27 reported variable and suboptimal long-term complete or nearcomplete occlusion rates after SAC for wide-neck aneurysms (71.9%; 95% CI, 52.6%-91.1%). By contrast, our study demonstrated a consistently high rate of AO in both short-and longterm FUPs (90.0%-92.8%), with a 0% periprocedural complication rate related to aneurysms.…”

Woven Endo Bridge shape modification contributes to decrease in adequate occlusion rate after Woven Endo Bridge implantation for wide-neck bifurcation intracranial aneurysms

“…Endovascular treatment of wide-neck bifurcation intracranial aneurysms (WNBAs) is a challenging procedure due to the high recurrence rate. 1 Although stent-assisted coil embolization or flow diverter placement have been reported to reduce the recurrence rate, complete occlusion (CO) rates are 67.2% for stent-assisted coil embolization, 2 and 61.5%-73.2% for flow diverter placement, 3,4 which are not satisfactory compared with clipping. 5 Recently, the Woven Endo Bridge (WEB; MicroVention, Tustin, CA, USA) was developed based on a novel treatment concept called the flow disruptor.…”