Citations 2
Abstract 290: Treatment Strategies for Residual and Recurrent Aneurysms After Woven EndoBridge Therapy: A Multicenter Propensity‐Matched Analysis
Gudino, Andres, Reddi, Preethi , Sridhar, V., Haranhalli, Neil , Karandish, Alireza , Aghaebrahim, Amin, Sauvageau, Eric , Crowley, W F, Dabus, Guilherme , Paul, A.R. , Puri, A, Rinaldo, Lorenzo , Brinjikji, Waleed , Goren, Oded , Siddiqui, Adnan, Jaikumar, Vinay , Essibayi, Muhammed Amir , Gutierrez‐Aguirre, Salvador F. , Hendrix, Philipp , Ransom, Ryan C. , Gudino, Andres , Ringer, Andrew J. , Kühn, Anna Luisa , Field, N., Ríos-Zermeño, Jorge , Amllay, Abdelaziz , Monteiro, Andre , Khatri, Deepak , Toledo, Otavio F. De , Crowley, W., Dabus, Guilherme C. , Matouk, Charles , Tawk, Rabih G. , Paul, A. R., Mocco, J , Majidi, Shahram , Samaniego, Edgar A , Lanzino, Giuseppe , Hanel, Ricardó A. , Altschul, David , Levy, Elad I.
Stroke: Vascular and Interventional Neurology | December 2, 2025 | Volume: 5 | Issue: S1 | Pages: No page available
Introduction Post‐market and multicenter studies report low complete occlusion rates (41‐49%) and higher retreatment rates (13%) following WEB deployment, compared to 3.8% with microsurgical clipping. While retreatment after WEB has been shown to be technically feasible, data on final angiographic outcomes remain limited. We performed a retrospective analysis of prospective databases from 14 cerebrovascular centers in the US to compare the safety and efficacy of retreatment versus continued observation for residual and recurrent aneurysms after initial WEB deployment. Materials/Methods Multinomial logistic regression was used to identify baseline characteristics of untreated and residual/recurrent aneurysms that may act as confounders, which then underwent propensity scored matching (PSM). Results Among 211 patients (125 observed, 86 retreated), retreatment was more common in initially ruptured aneurysms (p<0.001), which showed higher recurrence (p=0.036) and sac‐dominant residuals (p=0.004). These were primarily due to WEB compression on follow‐up (p=0.001), rather than incomplete occlusion with an appropriately sized device (p<0.001). Retreatment was associated with significantly higher rates of complete angiographic occlusion at last follow‐up compared to observation alone (p<0.001), a finding that remained consistent across subgroups defined by initial unruptured status, residual type, and recurrence patterns (all p<0.05). Clipping demonstrated higher, though statistically insignificant, rates of complete occlusion; flow diversion and stent‐assisted coil embolization yielded comparable complete occlusion rates at follow‐up. After propensity score matching, retreatment remained significantly associated with higher rates of complete angiographic occlusion (all p<0.05), with comparable outcomes observed between clipping and various endovascular approaches as above. Conclusion Retreatment improved complete occlusion rates; however, no aneurysmal hemorrhages occurred in either group. Further intervention may be unnecessary when the WEB device—whether compressed or intact (BOSS 0/1)—adequately protects the dome. In cases where WEB compression significantly exposes the aneurysm wall, stent‐assisted coiling or flow diversion can be performed safely and successfully, depending on vascular anatomy and surgeon preference. image image
Impact of smoking on recurrence rates among wide-neck intracranial aneurysms treated with Woven EndoBridge: a multicenter retrospective study
Vaishnav, Dhrumil , Adeeb, Nimer , Aslan, Assala , Cancelliere, Nicole M., McLellan, Rachel , Ghozy, Sherief, Lay, Sovann V. , Guenego, Adrien , Premat, Kévin , Möhlenbruch, Markus, Kral, Michael , Doron, Omer , Salem, Mohamed M. , Foreman, Paul M. , Vachhani, Jay A. , Shaikh, Hamza, Župančić, Vedran , Ayberk, Gıyas , Güneş, Yasin Celal , Rabinov, James D. , Ren, Yifan , Michelozzi, Caterina , Elens, Stéphanie , Starke, Robert M., Hassan, A. , Ogilvie, Mark , Nguyên, Anh , Jones, Jesse , Brinjikji, Waleed , Nawka, Marie Teresa , Psychogios, Marios, Ulfert, Christian , Diestro, Jose Danilo Bengzon , Pukenas, Bryan , Burkhardt, Jan‐Karl , Martinez-Gutierrez, Juan Carlos, Sheth, Sunil G. , Spiegel, Gary, Lubicz, Boris , Puri, Ajit S., Pero, Guglielmo , Nossek, Erez , Raz, Eytan, Griessenauer, Christoph J., Asadi, Hamed , Siddiqui, Adnan, Brook, Allan , 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., Clarençon, Frédéric, Cuellar-Saenz, Hugo H., Patel, Aman B. , Altschul, David , _, _, Spears, Julian , Sundararajan, Sri Hari , Balush, Ali Al, Inoue, Yasuaki , Mirshahi, Shervin , Harker, Pablo, Tutino, Vincent M., Brehm, Alex , Diestro, Jose Danilo B , Shotar, Eimad , Nguyen, Anh , Pero, Guglielmo , Kalousek, Vladimir , Altschul, David J , Regenhardt, Robert W , Ulfert, Christian , Lay, Sovann V , Essibayi, Muhammed Amir , Musmar, Basel , Salim, Hamza , Cancelliere, Nicole M , Algin, Oktay , Ghozy, Sherief , Renieri, Leonardo , Carnevale, Joseph Anthony , Saliou, Guillaume , Mastorakos, Panagiotis , Naamani, Kareem El , Shotar, Eimad , Möhlenbruch, Markus , Chung, Charlotte , Lylyk, Iván , Hafeez, Muhammad Ubaid , Catapano, Joshua S , Waqas, Muhammad , Schirmer, Clemens M. , Piano, Mariangela , Kühn, Anna Luisa , Hassan, Ameer E , Psychogios, Marios‐Nikos , Huynh, Thien , Martinez-Gutierrez, Juan Carlos , Sheth, Sunil A., Tawk, Rabih G. , Panni, Pietro , Puri, Ajit S , Raz, Eytan , Killer-Oberpfalzer, Monika , Griessenauer, Christoph J. , Aziz‐Sultan, Mohammad Ali , Tjoumakaris, Stavropoula , Clarençon, Frédéric , Limbucci, Nicola , Cuellar, Hugo , Jabbour, Pascal , Mendes Pereira, Vitor , Dmytriw, Adam A. , _, _, Dibas, Mahmoud , Vranic, Justin E. , Alotaibi, Naif M. , Harker, Pablo , Sporns, Peter Bernhard
Journal of Neurosurgery | January 31, 2025 | Volume: 142 | Issue: 6 | Pages: 1732-1740
OBJECTIVE Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck IAs has not been evaluated. This study aimed to investigate the outcomes of WEB devices by smoking status. METHODS A retrospective multicenter analysis was conducted on the data of patients from 36 sites worldwide treated with the WEB device for intracranial saccular aneurysms. Patients were stratified based on smoking status (current, former, and never smokers). The Student t-test and chi-square test were performed for continuous and categorical variables, respectively. Multivariable logistic regression was used to adjust for confounders. RESULTS Of 1376 patients with available smoking status, 504 were current smokers, 358 were former smokers, and 514 were never smokers. Upon adjusting for significant confounders, no association was found between smoking and recurrence outcomes (OR 1.39, 95% CI 0.69–2.80; p = 0.36), thromboembolic and hemorrhagic complications, and mortality among IAs treated with the WEB device. There was no statistically significant difference in outcomes between former and never smokers (OR 1.23, 95% CI 0.70–2.18; p = 0.46). The location of aneurysms differed between smoking groups, with former smokers having more anterior circulation aneurysms compared with current and never smokers (99.0% vs 96.9% vs 95.3%; p = 0.01). In terms of clinical symptoms, headache and dizziness were more common in the never smokers compared with current and former smokers (13.9% vs 8.9% vs 7.7%, p = 0.01). CONCLUSIONS This large-scale study suggests no significant correlation between smoking and the recurrence of IAs treated with the WEB device. Biological studies are warranted to better understand the biological impact of smoking on the growth and rupture of treated IAs.