Tag: Woven Endobridge

Posted on

Long-Term Outcomes of Surgical Clipping of Woven EndoBridge-Eligible Middle Cerebral Artery Bifurcation Aneurysms

Operative Neurosurgery 30:18–25, 2026

This clinical study evaluates long-term outcomes of microsurgical clipping for middle cerebral artery (MCA) wide-neck bifurcation aneurysms that meet radiographic criteria for treatment with the Woven EndoBridge (WEB) device. Using a retrospective review of a prospectively maintained registry, the authors compare functional outcomes, complication rates, recurrence, and retreatment against published WEB and clipping cohorts.

Results show high surgical efficacy: 99% treatment success, 94.1% of unruptured cases achieving final mRS ≤2, a 4.9% morbidity rate, and 0% mortality, with lower retreatment and higher complete occlusion rates than reported WEB series. The authors conclude microsurgical clipping remains a reliable option for MCA WNBAs and recommend location-specific subgroup analyses in future WEB studies.

Microsurgical Clipping Outcomes: Surgical clipping of WEB-eligible middle cerebral artery (MCA) wide-necked bifurcation aneurysms (WNBAs) achieved a 99% treatment success rate, 4.9% morbidity, 0% mortality, and 94.1% good functional outcomes (mRS ≤2) in unruptured cases, with low recurrence and retreatment rates.

Comparison to WEB Device: Clipping resulted in higher complete occlusion rates, lower retreatment rates, and lower thromboembolic complication rates compared to endovascular treatment with the Woven EndoBridge (WEB) device for MCA WNBAs.

Functional Outcomes: Both ruptured and unruptured aneurysms treated surgically showed excellent or improved functional status at follow-up, with 91.8% of unruptured and 94.1% of ruptured cases experiencing stable or improved mRS scores.

Complication Profile: Thromboembolic complications occurred in 5.9% of unruptured cases, with permanent neurological deficits in 4.9% and no surgical mortality; intraoperative rupture was rare (2.0%).

Limitations of WEB Evidence: Most WEB studies pooled multiple aneurysm locations, making it difficult to assess location-specific efficacy; at the MCA, WEB showed higher retreatment and thromboembolic rates than clipping, and lower rates of complete occlusion.

Treatment Selection: MCA aneurysms are often suitable for surgical clipping due to their accessible location and favorable anatomy, especially at experienced centers, supporting a “clip-first” approach for many MCA WNBAs.

Study Limitations: Findings are based on a retrospective, single-center cohort at a high-volume academic institution, limiting generalizability and direct comparison to randomized or multicenter WEB trials.

Clinical Recommendation: Both clipping and WEB are effective for MCA WNBAs, but surgical clipping may offer superior durability and occlusion; treatment choice should be individualized through shared decision-making, not solely based on minimally invasive appeal.

Posted on

Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study

J Neurosurg 140:1071–1079, 2024

The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device.

METHODS The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use.

RESULTS The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p =0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use.

CONCLUSIONS This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.

Posted on

Transradial versus transfemoral access for embolization of intracranial aneurysms with the Woven EndoBridge device: a propensity score–matched study

J Neurosurg 137:1064–1071, 2022

Transradial access (TRA) is commonly utilized in neurointerventional procedures. This study compared the technical and clinical outcomes of the use of TRA versus those of transfemoral access (TFA) for intracranial aneurysm embolization with the Woven EndoBridge (WEB) device.

METHODS This is a secondary analysis of the Worldwide WEB Consortium, which comprises multicenter data related to adult patients with intracranial aneurysms who were managed with the WEB device. These aneurysms were categorized into two groups: those who were treated with TRA or TFA. Patient and aneurysm characteristics and technical and clinical outcomes were compared between groups. Propensity score matching (PSM) was used to match groups according to the following baseline characteristics: age, sex, subarachnoid hemorrhage, aneurysm location, bifurcation aneurysm, aneurysm with incorporated branch, neck width, aspect ratio, dome width, and elapsed time since the last follow-up imaging evaluation.

RESULTS This study included 682 intracranial aneurysms (median [interquartile range] age 61.3 [53.0–68.0] years), of which 561 were treated with TFA and 121 with TRA. PSM resulted in 65 matched pairs. After PSM, both groups had similar characteristics, angiographic and functional outcomes, and rates of retreatment, thromboembolic and hemorrhagic complications, and death. TFA was associated with longer procedure length (median 96.5 minutes vs 72.0 minutes, p = 0.006) and fluoroscopy time (28.2 minutes vs 24.8 minutes, p = 0.037) as compared with TRA. On the other hand, deployment issues were more common in those treated with TRA, but none resulted in permanent complications.

CONCLUSIONS TRA has comparable outcomes, with shorter procedure and fluoroscopy time, to TFA for aneurysm embolization with the WEB device.

Posted on

Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms

Neurosurgery 88:779–784, 2021

Intrasaccular flow-disruption represents a new paradigmin endovascular treatment of wide-necked bifurcation aneurysms.

OBJECTIVE: To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment.

METHODS: A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion.

RESULTS: The technical success rates were 83% forWEB and 100% for clipping. Procedure related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P<.01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01).

CONCLUSION: Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient’s preferences.

Proudly powered by WordPress