Smaller WEB devices show lower retreatment rates than larger devices: results from the WorldWideWEB study.
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Dugar Franja, Salim Hamza Adel, Musmar Basel, Adeeb Nimer, Dibas Mahmoud, Simonato Davide, Li Yan-Lin, Essibayi Muhammed Amir, Algin Oktay, Ghozy Sherief, Lay Sovann V, Guenego Adrien, Renieri Leonardo, Carnevale Joseph, Saliou Guillaume, Mastorakos Panagiotis, Shotar Eimad, Möhlenbruch Markus, Kral Michael, Chung Charlotte, Salem Mohamed M, Lylyk Ivan, Foreman Paul M, Shaikh Hamza, Župančić Vedran, Hafeez Muhammad U, Catapano Joshua, Waqas Muhammad, Gurcay Ahmet Gurhan, Ayberk Giyas, Arslan Muhammet, Rabinov James D, Ergun Onur, Maingard Julian, Schirmer Clemens M, Piano Mariangela, Kühn Anna L, Michelozzi Caterina, Starke Robert M, Hassan Ameer, Ogilvie Mark, Jones Jesse, Brinjikji Waleed, Psychogios Marios, Nawka Marie T, Fiehler Jens, Nguyen-Kim Thi Dan Linh, Pukenas Bryan, Burkhardt Jan-Karl, Huynh Thien, Martinez-Gutierrez Juan Carlos, Sheth Sunil A, Slawski Diana, Tawk Rabih G, Pulli Benjamin, Lubicz Boris, Panni Pietro, Puri Ajit S, Pero Guglielmo, Raz Eytan, Griessenauer Christoph J, Asadi Hamed, Siddiqui Adnan, Levy Elad I, Haranhalli Neil, Altschul David, Ducruet Andrew F, Regenhardt Robert W, Stapleton Christopher J, Kan Peter, Kalousek Vladimir, Lylyk Pedro, Boddu Srikanth, Knopman Jared, Tjoumakaris Stavropoula I, Cuellar-Saenz Hugo H, Jabbour Pascal M, Clarençon Frédéric, Limbucci Nicola, Fuschi Maurizio, Patel Aman B, Almohammad Mohammad, Kemmling Andre, Dmytriw Adam A, Sporns Peter B, WorldWideWEB Investigators
Аннотация
MATERIALS AND METHODS: The WorldWideWEB consortium is a retrospective, multicenter collaboration across 30 international institutions including adults with intracranial aneurysms treated with WEB. Patients were stratified into small (≤ 4.5 mm) and large (> 4.5 mm) groups; a subanalysis compared small with very large (> 7.5 mm) devices. Primary outcome was retreatment rate. Secondary outcomes included modified Rankin Scale (mRS), angiographic outcomes periprocedurally and last follow-up (FU), and safety events (intracranial hemorrhage (ICH) and thromboembolic complications (TECs)).
RESULTS: Among 1473 patients, 229 (15.5%) received small WEBs. Baseline characteristics were similar. Small WEBs showed lower retreatment (4.3% vs 8.8%, p = 0.04) and higher complete occlusion (periprocedurally: 57.1% vs 36.6%, p < 0.01; FU: 76.2% vs 58.5%, p < 0.01). Median mRS was comparable (1 [1-2] vs 1 [1-2], p = 0.88), as was safety (ICH 2.6% vs 0.9%, p = 0.10; TECs 3.1% vs 3.9%, p = 0.69). Very large WEBs had higher retreatment (16.1%, p < 0.001) and lower complete occlusion (periprocedurally: 32.2%, p < 0.001; FU: 50.5%, p < 0.001), with comparable safety (ICH 0.9%, p = 0.27; TECs 4.5%, p = 0.51).
CONCLUSION: Small WEBs demonstrated lower retreatment, superior anatomic and comparable clinical outcomes compared with large devices, with similar safety profiles.
KEY POINTS: Question Do small Woven EndoBridge devices have comparable efficacy and safety to larger devices for intracranial aneurysm treatment despite technical deployment challenges? Findings Small Woven EndoBridge devices (≤ 4.5 mm) achieved lower retreatment rates and superior angiographic occlusion compared with larger devices, with similar safety and functional outcomes. Clinical relevance These findings support the use of small Woven EndoBridge devices for appropriately sized aneurysms, providing reassurance that deployment challenges do not translate into worse clinical outcomes, while superior anatomic outcomes may encourage their broader adoption in clinical practice.