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New Devices and Techniques
Original research
WEB embolization versus stent-assisted coiling: comparison of complication rates and angiographic outcomes
  1. Christoph Kabbasch1,
  2. Lukas Goertz2,
  3. Eberhard Siebert3,
  4. Moriz Herzberg4,
  5. Jan Borggrefe1,
  6. Boris Krischek2,
  7. Pantelis Stavrinou2,
  8. Franziska Dorn4,
  9. Thomas Liebig4
  1. 1 Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
  2. 2 Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
  3. 3 Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
  4. 4 Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
  1. Correspondence to Dr Lukas Goertz, Center for Neurosurgery, University Hospital of Cologne, Cologne 50937, Germany; lukas.goertz{at}uk-koeln.de

Abstract

Background Intrasaccular flow disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms.

Objective To perform a matched case–control study comparing complications and angiographic outcome using the Woven Endobridge (WEB) device and stent-assisted coiling (SAC).

Methods Sixty-six patients treated with the WEB at three German tertiary care centers were included and matched with 66 patients treated with SAC based on aneurysm location and unruptured/ruptured aneurysm status. Parameters were retrospectively analysed and compared between the treatment groups using inverse probability of treatment weighting (IPTW) with propensity scores.

Results Procedural complication rates were 12.1% in the WEB group and 21.2% in the SAC group, which was statistically significant after IPTW adjustment (OR=2.2, 95% CI 1.08 to 4.4, p=0.03). Favourable outcome (modified Rankin scale score ≤2) was achieved by 57/66 (86.4%) in the WEB group and 57/66 (86.4%) in the SAC group (p=1.0). At mid-term follow-up, a similar number of aneurysms achieved adequate occlusion (complete occlusion or neck remnant) in the WEB group (93.9%) and in the SAC group (93.9%, p=1.0). Re-treatment was performed in 10.6% after WEB embolization and 12.1% after SAC (p=1.0).

Conclusions The WEB provides similar mid-term aneurysm occlusion rates to those of SAC, with no additional morbidity and potentially lower complication rates. Long-term outcome analysis will provide a definite conclusion on the use of WEB for intracranial aneurysms.

  • aneurysm
  • coil
  • device
  • statistics

https://doi.org/10.1136/neurintsurg-2018-014555

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    Footnotes

    • CK and LG contributed equally.

    • Contributors CK, LG, ES, MH, JB, BK, PS, and FD acquired the data. CK, LG, and TL developed the project, analyzed the data, and drafted the manuscript. All authors revised the paper critically for important intellectual content and provided final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CK and LG contributed equally as first authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CK and FD serve as consultants for Acandis GmbH (Pforzheim, Germany). TL serves as proctor for MicroVention Inc/Sequent Medical (Aliso Viejo, California, USA).

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data will be made available upon request in an anonymized manner.