Background Stent-assisted coiling (SAC) of ruptured wide-necked intracranial aneurysms (IAs) brings relevant concerns due to the potentially higher risk of hemorrhagic complications. The Woven EndoBridge (WEB) is considered an appealing alternative since long-term antiplatelet therapy is not mandatory. We aimed to compare WEB with SAC for the treatment of ruptured wide-necked IAs.
Methods This is a retrospective study of consecutive patients treated for ruptured wide-neck IAs with WEB or SAC at four high-volume neurovascular centers between 2015 and 2022. Angiographic results, clinical outcomes, and procedure-related complications were evaluated and compared using multivariable logistic regression.
Results One hundred five patients treated with WEB and 112 patients treated with SAC were included. The mean length of imaging follow-up was 17 months for the WEB group, and 42 months in the SAC group (p = 0.007). Treatment duration was shorter for WEB than for SAC (p = 0.04). SAC yielded a higher rate of complete aneurysm occlusion (64.5% vs. 60.9%, p = 0.640); however, this difference did not persist after adjusting for the selected covariates (aOR = 0.70; 95% CI 0.34 - 1.43; p = 0.328) (figure 1). SAC had a higher risk of procedure-related complications (23.2% vs. 9.5%, p = 0.009); however, this difference did not persist after adjusting for the selected covariates (aOR = 0.47; 95% CI 0.18 - 1.23; p = 0.123). We observed a linear relationship between the probability of a procedure-related complication and procedure time and the probability across procedure time was lower with WEB when compared with SAC (aOR = 0.40; 95% CI 0.20 - 1.13; p = 0.03).
Conclusion We found a similar safety and efficacy profile of SAC and WEB embolization of ruptured wide-necked IAs. However, treatment duration was shorter for WEB than for SAC. This result may be considered as an advantage for the WEB since our findings suggest that longer procedure times increase the probability of procedure-related complications. In addition, considering that the WEB does not require long-term antiplatelet medication, the choice of the WEB might be a viable alternative for the treatment of ruptured wide-necked IAs.
Disclosures A. Rodriguez-Calienes: None. J. Vivanco-Suarez: None. Y. Lu: None. M. Galecio-Castillo: None. M. Farooqui: None. O. Algin: None. C. Feigen: None. D. Altschul: None. B. Gross: None. S. Ortega-Gutierrez: 1; C; NIH-NINDS (R01NS127114-01). 2; C; Medtronic, Stryker.
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