Higher risk of recurrence in partially thrombosed cerebral aneurysms post-WEB (Woven EndoBridge) device treatment: insights from the WorldWideWEB Consortium registry.
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Saliou Guillaume, Salim Hamza Adel, Musmar Basel, Adeeb Nimer, Aslan Assala, Swaid Christian, Cuellar Miguel, Dibas Mahmoud, Cancelliere Nicole M, Diestro Jose Danilo Bengzon, Algin Oktay, Ghozy Sherief, Lay Sovann V, Guenego Adrien, Renieri Leonardo, Carnevale Joseph Anthony, Mastorakos Panagiotis, ElNaamani Kareem, Shotar Eimad, Möhlenbruch Markus A, Kral Michael, Chung Charlotte, Salem Mohamed M, Lylyk Ivan, Foreman Paul M, Shaikh Hamza, Župančić Vedran, Hafeez Muhammad Ubaid, Catapano Joshua S, Waqas Muhammad, Arslan Muhammet, Ergun Onur, Rabinov James D, Ren Yifan, Schirmer Clemens M, Piano Mariangela, Kuhn Anna Luisa, Michelozzi Caterina, Starke Robert M, Hassan Ameer E, Ogilvie Mark, Nguyen Anh, Jones Jesse, Brinjikji Waleed, Nawka Marie Teresa, Psychogios Marios-Nikos, Ulfert Christian, Pukenas Bryan, Burkhardt Jan Karl, Huynh Thien J, Martinez-Gutierrez Juan Carlos, Essibayi Muhammed Amir, Sheth Sunil A, Slawski Diana, Tawk Rabih, Pulli Benjamin, Lubicz Boris, Panni Pietro, Puri Ajit S, Pero Guglielmo, Raz Eytan, Griessenauer Christoph J, Asadi Hamed, Siddiqui Adnan H, Levy Elad I, Haranhalli Neil, Altschul David, Ducruet Andrew F, Albuquerque Felipe C, Regenhardt Robert W, Stapleton Christopher J, Kan Peter, Kalousek Vladimir, Lylyk Pedro, Boddu Srikanth Reddy, Knopman Jared, Tjoumakaris Stavropoula I, Cuellar Hugo, Jabbour Pascal, Clarençon Frédéric, Limbucci Nicola, Pereira Vitor M, Patel Aman B, Dmytriw Adam A, Hajdu Steven D
Аннотация
OBJECTIVE: To assess whether partially thrombosed aneurysms are at higher risk of recurrence or retreatment following WEB embolization compared with non-thrombosed aneurysms.
METHODS: We evaluated data from 22 academic institutions, focusing on previously untreated cerebral aneurysms treated with the WEB device. Logistic regression was utilized to analyze factors predicting long-term aneurysm obliteration and retreatment necessity.
RESULTS: Among 1303 patients, 26 presented with a partially thrombosed aneurysm. In the partially thrombosed group, the mean aneurysm maximal diameter was 10.7±4 mm with a neck ratio of 1.99±1.19 mm, larger than in the control group where the mean aneurysm maximal diameter was 6.81±2.37 mm with a neck ratio of 1.64±0.51 mm (P<0.001 for both maximal diameter and neck ratio). At the final follow-up, partially thrombosed aneurysms treated by the WEB device had a 38.5% retreatment rate, compared with 7.0% for non-thrombosed aneurysms (P<0.001). Among partially thrombosed aneurysms, the Raymond-Roy type IIIa/b occlusion rate was higher (38.5% vs 9.9%, P<0.001). On multivariate analysis, partially thrombosed aneurysms compared with non-thrombosed aneurysms had an increased rate of retreatment (OR 3.64, 95% CI 1.28 to 10.1).
CONCLUSION: Partially thrombosed aneurysms are associated with a poorer occlusion rate and a higher rate of retreatment following WEB embolization. For partially thrombosed aneurysms, the WEB device appears suboptimal as a first-line treatment, and therefore alternative techniques should be prioritized.