WovenEndoBridge embolization versus stent-assisted coiling for the treatment of unruptured wide-neck bifurcation intracranial aneurysms: a retrospective study

Iván C. Baracaldo-Santamaría, Department of Neurointerventional Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
Luis A. Rodríguez-Hernández, Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Secretaría de Salud, Mexico City, Mexico
Charles A. Huamaní, Department of Neurointerventional Surgery. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Secretaría de Salud, Mexico City, Mexico
Pablo Martínez, Department of Neurointerventional Surgery. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Secretaría de Salud, Mexico City, Mexico
Marco A. Munuzuri-Camacho, Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Secretaría de Salud, Mexico City, Mexico
Ivan A. Rodríguez-Hernández, Department of Medicine and Nutrition, Universidad de Guanajuato, Leon, Guanajuato, Mexico
Jorge L. Balderrama-Bañares, Department of Neurointerventional Surgery. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Secretaría de Salud, Mexico City, Mexico
Yolanda Aburto-Murrieta, Department of Neurointerventional Surgery. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Secretaría de Salud, Mexico City, Mexico
Héctor A. Montenegro-Rosales, Department of Neuroimaging, Hospital Médica Sur, Mexico City, Mexico

Introduction: Currently, endovascular coil embolization is the first line of treatment for intracranial aneurysms. Over the last decade, several new endovascular devices and techniques have been developed for wide neck aneuryms located at the bifurcation of cerebral arteries, with varying degrees of success. Objective: To compare the occlusion rates of unruptured wide-neck bifurcation intracranial aneurysms using WovenEndoBridge (WEB) device embolization versus stent-assisted coiling (SAC). Materials and methods: We performed a retrospective, longitudinal study that included adult patients treated at the National Institute of Neurology and Neurosurgery in Mexico City, between 2020 and 2022. Patients had been previously diagnosed with an unruptured saccular wide-neck bifurcation aneurysm and were assigned to either WEB embolization or SAC. Occlusion rate was assessed using imaging studies performed 90 days after the procedure was completed. Results: A total of 14 patients were included in the study. Six patients were treated with the WEB device, and eight patients were treated using SAC. No statistically significant differences were observed between the demographic characteristics of the groups. Median aspect/ratio was 1.45 (1.25-1.82) for the WEB group and 1.67 (1.166-2.11) for the SAC group, and bottleneck factor ratios were 1.35 (1.042.42) and 1.26 (1.17-1.77), respectively. Complete occlusion was observed in 6/6 patients for the WEB group and 6/8 patients for the SAC group (p = 0.308). No statistically significant differences were observed in the complication rates, 3-month modified Rankin score, and hospital length of stay between the groups. Conclusion: The WEB device is a novel treatment that carries the same safety and efficacy profile as SAC. However, more experience with the device is required to fully understand the capabilities of the WEB.

Keywords: Intracranial aneurysms. Endovascular treatment. Stent-assisted coiling. WovenEndobridge device. Wide-neck.