Background and Objectives Woven Endobridge (WEB) is a safe and effective intrasaccular flow disruptor with over 80% adequate occlusion rates. However, complete occlusion rates remain around 50–60%. While sizing modifications and the effect of lateral compression have been shown to correlate with occlusion rates, the geometric configuration of the aneurysm long axis height as it relates to the parent artery has never been studied as a predictor of occlusion rates.

Methods This is a single center retrospective study of all cerebral aneurysms treated with WEB devices from August 2015 to December 2023 with follow-up data. We collected basic demographic, as well as follow-up data. The aneurysm entry angle was calculated by measuring the angle between the parent artery and the long axis of the aneurysm on anteroposterior as well as lateral views of 2-dimensional angiography. Independent predictors of complete aneurysm occlusion were determined using multivariate logistic regression analysis.

Results Ninety-nine patients were included in our analysis. Our cohort was 80% female, with an average age of 64, was 65% Caucasian, and comprised of 35% ruptured aneurysms. The mean size of the aneurysm was 6.3 mm in height and 5.3 mm in width with a mean neck of 3.8 mm. Our cohort included 32% basilar apex aneurysms, 28% anterior communicating artery aneurysms, 17% middle cerebral artery aneurysms and 9% internal carotid artery terminus aneurysms. In our univariate analysis, measured aneurysm entry angle and lateral compression were significant predictors of complete occlusion. However, in multivariate analysis, measured aneurysm entry angle was the only variable within our data set to predict complete occlusion (Raymond-Roy 1, WEB occlusion score A) of aneurysms treated with WEB devices. The measured aneurysm entry angle was significantly smaller in aneurysms that showed complete occlusion at follow-up (OR 1.018, p 0.03).

Conclusion Measured aneurysm entry angle is an independent predictor of complete occlusion (Raymond-Roy 1, WEB occlusion score A) in cerebral aneurysms treated with the WEB device.

Disclosures N. Khattar: None. A. Alhourani: 2; C; Epimender. S. Himel: None. C. Osorno-Cruz: None. J. Sims: None. C. Nickele: None. V. Inoa: None. N. Goyal: None. S. Morris: None. N. Khan: None. D. Hoit: None. A. Arthur: 1; C; Balt, Medtronic, Microvention, Penumbra, Siemens. 2; C; Arsenal, Balt, J&J, Medtronic, Neuros, Penumbra, Perfuze, Scientia, Siemens, Stryker. 4; C; Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Perfuze, Revbio, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI. L. Elijovich: 1; C; MIVI, Siemens. 2; C; VizAI, Scientia, Microvention, Balt, Cerenovus.