Comparative analysis between stent-assisted coiling and Woven EndoBridge embolization for unruptured wide-necked bifurcation intracranial aneurysms: A propensity score matching study

Abstract

Background: Before the utilization of the Woven EndoBridge (WEB) for the treatment of wide-necked bifurcation intracranial aneurysms (WNBA), stent-assisted coiling (SAC) was the predominant endovascular treatment. Studies directly comparing the outcomes of these two methods are still limited. This study aimed to compare the safety and efficacy of SAC and WEB embolization for unruptured WNBAs through propensity score matching. Methods: This retrospective study included patients treated with SAC or WEB for unruptured WNBAs at a single institution between January 2014 and June 2023. Propensity score matching was conducted based on patient and aneurysm characteristics. The matched groups were compared for periprocedural events and 6-month clinical and radiological outcomes, assessed using the modified Rankin Scale and Raymond-Roy occlusion classification, respectively. Results: Among 286 patients, 74 were included in each group after propensity score matching. The WEB group exhibited significantly shorter fluoroscopy time than the SAC group (p < 0.001). Periprocedural complications primarily comprised intraoperative thromboembolic events, with nine cases (12.2 %) in the SAC group and five cases (6.8 %) in the WEB group (p = 0.388). Throughout the 6-month follow-up period, nuisance bleeding occurred significantly more frequently in patients with SAC (8 cases, 10.8 %). The 6-month complete occlusion rates were 85.9 % and 77.5 % for the SAC and WEB groups, respectively (p = 0.309), whereas adequate occlusion rates were 91.5 % and 90.1 % for the groups, respectively (p = 1.000). Conclusions: The 6-month clinical and radiological outcomes of unruptured WNBAs treated with WEB and SAC were comparable. WEB has advantages over SAC, including reduced fluoroscopy time and avoidance of dual antiplatelet therapy. Before the utilization of the Woven EndoBridge (WEB) for the treatment of wide-necked bifurcation intracranial aneurysms (WNBA), stent-assisted coiling (SAC) was the predominant endovascular treatment. Studies directly comparing the outcomes of these two methods are still limited. This study aimed to compare the safety and efficacy of SAC and WEB embolization for unruptured WNBAs through propensity score matching. This retrospective study included patients treated with SAC or WEB for unruptured WNBAs at a single institution between January 2014 and June 2023. Propensity score matching was conducted based on patient and aneurysm characteristics. The matched groups were compared for periprocedural events and 6-month clinical and radiological outcomes, assessed using the modified Rankin Scale and Raymond-Roy occlusion classification, respectively. Among 286 patients, 74 were included in each group after propensity score matching. The WEB group exhibited significantly shorter fluoroscopy time than the SAC group (p < 0.001). Periprocedural complications primarily comprised intraoperative thromboembolic events, with nine cases (12.2 %) in the SAC group and five cases (6.8 %) in the WEB group (p = 0.388). Throughout the 6-month follow-up period, nuisance bleeding occurred significantly more frequently in patients with SAC (8 cases, 10.8 %). The 6-month complete occlusion rates were 85.9 % and 77.5 % for the SAC and WEB groups, respectively (p = 0.309), whereas adequate occlusion rates were 91.5 % and 90.1 % for the groups, respectively (p = 1.000). The 6-month clinical and radiological outcomes of unruptured WNBAs treated with WEB and SAC were comparable. WEB has advantages over SAC, including reduced fluoroscopy time and avoidance of dual antiplatelet therapy.