Research & Innovation
Publications
Factors influencing immediate post-angiographic occlusion outcomes in intracranial aneurysms treated with the woven endobridge device
PMU Authors
Michael Kral, Clemens M. Schirmer, Christoph J. Griessenauer, Monika Killer-Oberpfalzer
All Authors
Muhammed Amir Essibayi, Mohamed Sobhi Jabal, Hasan Jamil, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Mahmoud Dibas, Nicole M. Cancelliere, Jose Danilo Bengzon Diestro, Oktay Algin, Sherief Ghozy, Sovann V. Lay, Adrien Guenego, Leonardo Renieri, Joseph Carnevale, Guillaume Saliou, Panagiotis Mastorakos, Kareem El Naamani, Arbaz A. Momin, Eimad Shotar, Markus Mohlenbruch, Michael Kral, Charlotte Chung, Mohamed M. Salem, Ivan Lylyk, Paul M. Foreman, Hamza Shaikh, Vedran Zupancic, Muhammad U. Hafeez, Joshua Catapano, Muhammad Waqas, Muhammed Said Besler, Yasin Celal Gunes, James D. Rabinov, Julian Maingard, Clemens M. Schirmer, Mariangela Piano, Anna L. Kuhn, Caterina Michelozzi, Robert M. Starke, Ameer Hassan, Mark Ogilvie, Anh Nguyen, Jesse Jones, Waleed Brinjikji, Marie T. Nawka, Marios Psychogios, Christian Ulfert, Bryan Pukenas, Christoph J. Griessenauer, , Monika Killer-Oberpfalzer
Journal association
NEUROSURGICAL REVIEW
Abstract
The Woven EndoBridge (WEB) device treats wide-necked bifurcation aneurysms, but occlusion rates vary. This study aims to identify factors associated with immediate WEB device occlusion. Data from patients treated with WEB devices across 36 sites were analyzed. Machine learning algorithms and ordinal regression models were developed to predict immediate incomplete occlusion for ruptured and unruptured aneurysms. The study included 1565 patients, with 436 ruptured and 1129 unruptured aneurysms. Immediate complete occlusion was achieved in 38.3% of ruptured and 32.8% of unruptured aneurysms. For ruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.69. Key predictors of incomplete occlusion included pretreatment mRS, aneurysm diameter, and MCA location. Ordinal regression revealed that smoking history (OR: 1.95, p < 0.001), neck diameter (Odds Ratio [OR]: 1.50, p < 0.001), and presence of a branch from the aneurysm (OR: 2.06, p = 0.016) were associated with incomplete, while bifurcation aneurysms (OR: 0.55, p = 0.017) were associated with complete immediate occlusion. For unruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.68. Significant predictors of immediate incomplete occlusion included aneurysm neck width, MCA location, and presence of daughter sac. Ordinal regression revealed that smoking history (OR: 1.29, p = 0.032), neck diameter (OR: 1.24, p < 0.001), and presence of a daughter sac (OR: 1.53, p = 0.005) were associated with incomplete, while bifurcation aneurysms (OR: 0.71, p = 0.02) and posterior circulation location (OR: 0.68, p = 0.01) were associated with complete immediate occlusion. Careful evaluation of patient demographics and specific aneurysm characteristics may help improve the outcomes of intracranial aneurysms treated with WEB device.
Keywords
BRAIN, ANEURYSMS, Woven EndoBridge, Immediate occlusion