Faculty, Staff and Student Publications

Language

English

Publication Date

12-2-2025

Journal

Neurosurgical Review

DOI

10.1007/s10143-025-03928-w

PMID

41326865

PMCID

PMC12669363

PubMedCentral® Posted Date

12-2-2025

PubMedCentral® Full Text Version

Post-print

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

Humans, Intracranial Aneurysm, Female, Male, Middle Aged, Treatment Outcome, Aged, Aneurysm, Ruptured, Cerebral Angiography, Endovascular Procedures, Embolization, Therapeutic, Adult, Aneurysms, Brain, Woven EndoBridge, Immediate occlusion

Published Open-Access

yes

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