Predictors of clinical and angiographic outcomes after woven EndoBridge treatment for intracranial aneurysms: an asian multicenter cohort study

Purpose: The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for the treatment of wide-neck intracranial bifurcation aneurysms. The purpose of this study was to evaluate various factors associated with clinical and angiographic outcomes following WEB treatment. Methods: This multicenter, retrospective study analyzed 405 patients with 412 aneurysms treated with the WEB device across 22 neurovascular centers. Clinical and radiologic data were reviewed to identify factors influencing patients’ clinical outcome and target aneurysmal occlusion at short-term (within 6 months) and long-term (beyond 1 year) follow-up. Occlusion status of target aneurysms was analyzed in relation to the various clinical and morphological factors. Outcomes were also compared based on institutional treatment volume. Results: Centers with higher WEB treatment volumes (more than 30 cases) demonstrated lower thromboembolic events with sequelae (0.8% vs. 5.9%, p = 0.003). The rate of aneurysmal adequate occlusion, defined by Raymond-Roy occlusion class 1 and 2, increased from 70.2% at short-term (mean, 133 ± 42 days) to 83.2% at long-term (mean, 499 ± 134 days) follow-up (p = 0.003). Aneurysm diameter was inversely correlated with complete occlusion, with a 6-mm cutoff identified. Wide-neck aneurysms exhibited lower occlusion rates at short-term period, but this effect was not observed at later periods. Aneurysms at the basilar apex and internal carotid artery terminus demonstrated higher rates of complete occlusion (p = 0.046). Smoking acted as an inhibitor of long-term occlusion of target aneurysms. Conclusion: Institutional experience appeared to play a role in reducing procedure-related thromboembolic complications. Aneurysmal diameter, neck width, location and patients’ smoking status influenced angiographic outcomes.