Optimal device-to-aneurysm ratio and one-year radiological outcomes of volume-based woven endobridge selection

Abstract

BackgroundThe woven EndoBridge (WEB) device has been introduced for the treatment of wide-neck bifurcation aneurysms; however, device selection remains a major challenge inWEB treatment. This study aimed to demonstrate the effectiveness of WEB selection using volumetric analysis and its 1-year radiological outcomes.MethodsWe retrospectively analysed patients with unruptured wide-neck bifurcation aneurysms who underwent WEB treatment between August 2021 and January 2023. Aneurysm volume was measured semi-automatically using a three-dimensional volume-rendering programme. Radiological outcomes were analysed using the WEB Occlusion Scale (WOS) at 1-year catheter angiography follow-up. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the prognostic performance of the device-to-aneurysm volume (DAV) ratio for predicting complete occlusion. Univariate and multivariate analyses were performed to assess the predictive factors for complete occlusion.ResultsFifty-seven unruptured intracranial aneurysms, in 56 patients were treated with the WEB device. The device was changed in 14 patients (24.6%) following the + 1/-1 rule, and volume-based recommendations were appropriate for all patients. At the 1-year follow-up, complete occlusion (WOS A and B) was confirmed in 35 patients (61.4%), and adequate occlusion (WOS A, B, and C) was confirmed in 87.7% (50 of 57 patients). The ROC curve analysis showed a significant relationship for 1-year complete occlusion (area under the curve: 0.74, 95% confidence interval [CI]: 0.59-0.88) with an optimal cut-off of 0.92. The DAV ratio was the only significant predictive factor for 1-year complete occlusion in the univariate (odds ratio [OR]: 7.0, 95% CI: 2.20-24.7, p = 0.001) and multivariate (OR: 20.39, 95% CI: 3.56-111.73, p = 0.0007) analyses.ConclusionsVolume-based WEB selection was appropriate for initial device selection and 1-year radiological outcomes. The selection of a WEB device with a volume exceeding 92% of that of the targeted aneurysm could be considered for 1-year radiological outcomes.