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Comparing treatment outcomes of various intracranial bifurcation aneurysms locations using the Woven EndoBridge (WEB) device
  1. Nimer Adeeb1,
  2. Mahmoud Dibas2,
  3. Jose Danilo Bengzon Diestro3,
  4. Kevin Phan2,
  5. Hugo H Cuellar-Saenz1,
  6. Ahmad Sweid4,
  7. Sovann V Lay5,
  8. Adrien Guenego5,
  9. Assala Aslan1,
  10. Leonardo Renieri6,
  11. Sri Hari Sundararajan7,
  12. Guillaume Saliou8,
  13. Markus Möhlenbruch9,
  14. Robert W Regenhardt10,
  15. Justin E Vranic10,
  16. Ivan Lylyk11,
  17. Paul M Foreman12,
  18. Jay A Vachhani12,
  19. Vedran Župančić13,
  20. Muhammad U Hafeez14,
  21. Caleb Rutledge15,
  22. Muhammad Waqas16,
  23. Vincent M Tutino16,
  24. James D Rabinov10,
  25. Yifan Ren17,
  26. Clemens M Schirmer18,
  27. Mariangela Piano19,
  28. Anna L Kuhn20,
  29. Caterina Michelozzi21,
  30. Stephanie Elens22,
  31. Robert M Starke23,
  32. Ameer Hassan24,
  33. Arsalaan Salehani25,
  34. Alex Brehm26,
  35. MajdEddin MohammedAli1,
  36. Jesse Jones25,
  37. Marios Psychogios26,
  38. Julian Spears3,
  39. Boris Lubicz22,
  40. Pietro Panni21,
  41. Ajit S Puri20,
  42. Guglielmo Pero19,
  43. Christoph J Griessenauer18,27,
  44. Hamed Asadi17,
  45. Adnan Siddiqui16,
  46. Andrew Ducruet15,
  47. Felipe C Albuquerque15,
  48. Rose Du2,
  49. Peter Kan14,
  50. Vladimir Kalousek13,
  51. Pedro Lylyk11,
  52. Christopher J Stapleton10,
  53. Srikanth Boddu7,
  54. Jared Knopman7,
  55. Mohammad A Aziz-Sultan2,
  56. Nicola Limbucci6,
  57. Pascal Jabbour4,
  58. Christophe Cognard5,
  59. Aman B Patel10,
  60. Adam A Dmytriw2,10
  1. 1Departments of Neurosurgery and Neurointerventional Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
  2. 2Neuroradiology and Neurosurgical Services, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  3. 3Department of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  5. 5Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
  6. 6Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
  7. 7Neurosurgery and Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
  8. 8Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
  9. 9Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
  10. 10Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
  11. 11Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
  12. 12Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
  13. 13Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
  14. 14Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX
  15. 15Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  16. 16Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  17. 17Neurointervention Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
  18. 18Departments of Neurosurgery and Radiology, Geisinger Hospital, Danville, Virginia, USA
  19. 19Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
  20. 20Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  21. 21Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
  22. 22Department of Interventional Neuroradiology, Erasmus Hospital, Bruxelles, Bruxelles, Belgium
  23. 23Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  24. 24Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
  25. 25Department of Neurosurgery, UAB Hospital, Birmingham, Alabama, USA
  26. 26Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
  27. 27Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
  1. Correspondence to Dr Nimer Adeeb, Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA; nimer_adeeb{at}


Background The Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in bifurcation aneurysms overall, but its usefulness in the individual bifurcation locations has been evaluated separately only in few case series, which were limited by small sample sizes.

Objective To compare angiographic and clinical outcomes after treatment of bifurcation aneurysms at various locations, including anterior communicating artery (AComA), anterior cerebral artery (ACA) bifurcation distal to AComA, basilar tip, internal carotid artery (ICA) bifurcation, and middle cerebral artery (MCA) bifurcation aneurysms using the WEB device.

Methods A retrospective cohort analysis was conducted at 22 academic institutions worldwide to compare treatment outcomes of patients with intracranial bifurcation aneurysms using the WEB device. Data include patient and aneurysm characteristics, procedural details, angiographic and functional outcomes, and complications.

Results A total of 572 aneurysms were included. MCA (36%), AComA (35.7%), and basilar tip (18.9%) aneurysms were most common. The rate of adequate aneurysm occlusion was significantly higher for basilar tip (91.6%) and ICA bifurcation (96.7%) aneurysms and lower for ACA bifurcation (71.4%) and AComA (80.6%) aneurysms (p=0.04).

Conclusion To our knowledge, this is the most extensive study to date that compares the treatment of different intracranial bifurcation aneurysms using the WEB device. Basilar tip and ICA bifurcation aneurysms showed significantly higher rates of aneurysm occlusion than other locations.

  • Aneurysm

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors have contributed to study through conception of the idea, data collection, draft, and/or review of final version as follows: Conception, draft writing, data collection, final version revision: NA, MD, JDBD, KP, AAD. Data collection, supervision, final version revision: HHC-S, AS, SVL, AG, AA, LR, SHS, GS, MAM, RWR, JEV, IL, PF, JAV, VZ, MUF, CR, MW, VMT, JDR, YR, CMS, MP, ALK, CM, SE, RMS, AEH, AHS, AB, MajM, JJ, MP, JS, BL, PP, ASP, GP, CJG, HA, AS, AFD, FCA, RD, PK, VK, PL, CJS, SB, JK, MAA-S, NL, PJ, CC, ABP.

  • 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 The following authors serve on the editorial board of JNIS, JDBD, AG, AFD, FCA, and PK.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.